The Ways We Love: A Developmental Approach To Treating Couples (Book Review)

Author:  Sharpe, Sheila A.
Publisher: New York: Guilford Press, 2000
Reviewed By: Adeline Corrin, Summer 2002, pp. 64-66

Sheila Sharpe’s The Ways We Love: A Developmental Approach to Treating Couples is a rare find that offers a marvelous feast for the reader: a groundbreaking theory and clinical approach enriched by vivid clinical vignettes spiced with humor and candor. The main course is further enhanced by the inclusion of a cultural perspective on the development of love relationships, as expressed in popular movies, songs, stories, and television. In crystal clear prose devoid of jargon, the author seamlessly interweaves all of these elements to read like a fascinating novel.

While psychoanalytic theory has increasingly focused attention on understanding the mother-child dyad and the therapist-patient twosome, comparatively little attention has been paid to understanding that most dynamic and mysterious of all duos: the adult love relationship. Given that we deal with the difficulties of loving (and hating) in intimate partnerships everyday, I find this omission quite perplexing. We are fortunate that Sharpe’s book takes us to the heart of this neglected area of theory, charting significant new terrain in almost every chapter.

Of the many theoretical contributions the author makes, the most obvious is her extension of psychoanalytic developmental theory to include the adult love relationship as having a distinct evolution of its own. Although others have tried to fit love relationships into developmental models designed for the individual (most commonly utilizing Erickson’s, 1959, Stages of Man), Sharpe has created a model that truly captures the couple as a unique, complex system. She has spent more than 30 years creating and refining her model, continually making revisions as her clinical experience suggested new possibilities or failed to verify an aspect of an existing formulation.

Sharpe’s current conception evolved from an earlier model based on the object relations concepts of Henry Dicks (1967), integrated with the application of Mahler’s et al (1975) developmental phases to couple relationships. She gave up many aspects of this model, described in several previous papers (1981, 1990, 1997), because she recognized that: (1) one developmental line, designed for the mother-child relationship, was not sufficient to capture the complexity of couple’s development; (2) development and treatment needed to take into account a couple’s needs for connection along with separation-individuation processes, and (3) couple’s problems were often a result of their struggles with the difficulties of normal development and not always evidence of pathology. Additionally, partners responded much more positively and rapidly in treatment, when she began to see them through the lens of normal development rather than the lens of deviant development and psychopathology.

I am in agreement with her view that “a clinical focus on dysfunction interfere[s] with the creation of a safe, growth-promoting environment, and this notion is probably as true for individuals as it is for couples. (p. 4)” Sharpe’s current approach, with its emphasis on the positive, normal aspects of development and recognition of a couple’s needs for connection and separateness, provides the clinician with a conceptual framework that more effectively encourages partners’ to understand their dynamics and supports their capacities to mature.

Beginning with the two central relational themes and primary tasks of a couple-connection and separateness—Sharpe has identified the central patterns of relating associated with each theme. The three main patterns promoting connection are nurturing, merging, and idealizing. The four main patterns fostering separateness are devaluing, controlling, competing for superiority and competing in love triangles. Each of these seven universal patterns of relating originates in the individual’s early relationship development and has its own developmental line interwoven with all of the others.

While Sharpe borrows from Anna Freud’s concept of developmental lines, her conception of how the developmental phases progress does not follow the linear model of most stage theories. Rather, the patterns progress in the form of a spiral by recapitulating earlier steps throughout the life of the relationship. (This concept, she notes, derives from Piaget’s concept of vertical decalage.) Thus, early romantic phase forms of merging or idealizing both evolve into more mature forms but are also re-experienced in their original global forms throughout the life of the relationship. In this view, experiences of merging and other primitive modes of attachment are necessary to sustaining intimacy and passionate love.

With her equal attention to both connection and separateness, Sharpe brings together in a coherent formulation the significant findings from attachment theory and from separation-individuation theories. A major drawback of other conceptions of couple relationships is a singled-minded focus on one or the other relational theme. Those who view separation-individuation as the only significant developmental process make the partner’s differentiation (from each other and/or family of origin) the central focus of treatment (Bowen (1978), Framo (1976), Bader & Pearson (1988)). Likewise those who view couples through the attachment theory lens (notably Sue Johnson, 1996) tend to ignore the importance of separation-individuation themes as well as other aspects of a couple’s patterns of connecting.

For each of the seven patterns of relating, Sharpe systematically traces its normal development and considers normative and pathogenic factors that may evoke a temporary stall or long term “derailment” of a couple’s development. As an aid to the reader, the clinician, teacher, or researcher, she provides charts that summarize the development of each pattern. The phases are presented with their associated tasks (both for the couple and as a guide for the therapist) along with the points of regression and derailment that commonly occur in connection with each phase. There is also one complex chart that presents the general phases of development and each of the developmental lines in parallel, so that their interrelationships can be seen.

The theoretical and clinical beauty of these patterns is that they come from Sharpe’s direct observation of couples’ interactions, are described in behavioral terms that will evoke recognition in most therapists. If you’ve ever wondered what constitutes the ties that bind, or how, when, and why we connect, separate, or individuate, this theory tells you in very specific terms. This closeness to experience makes her model useful as an assessment tool by both novices and advanced therapists. For example, if a couple begins their first session with battles for control in the foreground, one can clearly see that control is a central concern. (Other patterns, particularly nurturing, may also be present but less immediately visible).

Continuing the assessment using Sharpe’s model, we can determine that the battling couple is stalled or stuck in a differentiation phase wherein the partners are struggling to more firmly, and loudly, establish themselves as separate individuals within the relationship. An early intervention of Sharpe’s would be to convey to the couple, the adaptive, normative aspects of their interaction. She notes that most couples plagued by fighting feel their relationship is a failure, and it’s very helpful to the creation of an accepting, empathic holding environment for couples to understand the attempted adaptive meanings of this behavior before exploring the maladaptive aspects.

The severity of this couple’s problems can range from a normative, developmental stall that requires minimal intervention, to serious entrenchment that indicates that the pattern has become defensive and the couple’s development is more permanently regressed or derailed. Usually, a certain kind of rigidified role relationship defines the interaction. For example, in the case presented, the couple’s control battles were played out with the wife acting in the role of controlling parent and the husband playing the role of an oppositional child.

In Sharpe’s view, the presence of such a collusive role relationship usually reflects the reenactment of past deficits and conflicts most often stemming from the partners’ families of origin. Treatment in these cases is likely to be long-term and difficult. For most of the patterns, Sharpe presents one case example that represents the kind of problems she considers indicative of a temporary stall in normal development. A second case example reflecting more pathological entrenchment is also presented.

The author is at her very best in writing about her treatment of difficult cases. There are many excerpts from sessions presented in dialogue form that also include her own thoughts and feelings as they occur in sessions. Of particular help is her identification of the kinds of collusive role relationships commonly associated with each pattern. For example, entrenched devaluing, blaming interactions are often reflected in the collusive role relationship of “judgmental parent-guilty child.” Nurturing collusions often take the form of “the caretaker and the needful child,” or “the caretaker and the self-sufficient child.” A common idealizing collusion is “the adoring parent and the adorable child.” These collusive role-relationships can also be viewed as projective-identification systems, and Sharpe makes a significant contribution to theory in this area by identifying commonly encountered collusive systems. Additionally, she details and illustrates the kind of countertransference reactions each collusion is likely to evoke in the therapist as treatment progresses.

Sharpe beautifully describes her experiences of being drawn into various couples’ systems, and her subsequent utilization of her experience to intervene more effectively with the couple. She is quite open about her reactions to certain couples and her mistakes. Here is an example taken from an early phase treatment session with Eva and Sid, a couple with profound nurturing deficits played out in a caretaker-needful child role relationship. This session is aptly titled: The Pancake Incident: Food for Thought. The couple is fighting about Sid’s serving Eva a giant pancake for breakfast. Sharpe lets us in on her thoughts and feelings.

“Their tattletale manner of opening a session was typical. Sid played the martyred parent trying to take care of ungrateful Eva. And she played the poor, innocent child, victimized by a domineering bully. I already felt discouraged and drained, like an exhausted mother who no longer had the energy to deal with quarreling siblings. I was worried my irritation would show” (p. 78).

Later on Sharpe intervenes to curb escalation of their bickering. Her intervention does not work. She states: “I withdrew for a while, trying to figure out why my intervention not only misfired but fanned the flames. I wondered if Eva felt I had taken Sid’s side and so needed to reemphasize his badness. I was aware of becoming increasingly disoriented and unable to think clearly as the sound of their relentless bickering drove me further into a state of numb detachment” (p. 79).

In the following excerpt, Sharpe works to understand her reactions in order to be enabled to intervene with the couple more effectively. She writes: “I tried to examine the reactions they evoked in me, of an exhausted mother desperately needed by two rivalrous siblings. Obviously, they both felt starved for some kind of care. Each viewed the other as withholding the right food, and each simultaneously viewed the other as the competitor for mother’s care. The main content of the interaction was about the pancake, about feeding and not being fed in return (Sid), or being fed the wrong thing at the wrong time (Eva).”

She then uses these insights to make a more effective intervention that enables the couple to recognize their shared unconscious needs for nurture and great shame over having these longings. Her first of several interventions begins as follows: “It seems to me this argument is about not getting what you need-not getting enough food and feeling like you’re starving . . . .I think you get into these complicated fights, so that anger can distract you from the painful disappointment of needing something and not getting it.”

This interpretation is gradually accepted by the couple and further integrated by a sharing of humor among the three of them. For the first time, both partners made jokes. The rest of the session continued with productive exploration of each partner’s painfully deprived background.

There are many additional bonuses offered by this unusually rich book. Her discussions of cultural influences are of particular interest. Considering her study of competition as it is portrayed in the movies, she demonstrates how our culture conveys the message that open competition in marriage is unacceptable and inevitably destructive, while also setting forth confusing gender-role expectations. Consequently, the suppression of competitive impulses towards one’s spouse is encouraged, leading to the flourishing of covert, destructive forms of expression.

For example, men who are ashamed to acknowledge competitive feelings about a successful wife are apt unconsciously to even the score by having an affair. Conversely, a wife whose jobs are deemed less important than her husband’s may covertly compete with the more important, powerful husband by undermining his masculinity in the bedroom through disinterest or dissatisfaction. Sharpe considers awareness of our societal attitudes towards competition and gender role to be necessary to helping couple’s with difficulties in this area. She also recommends discussion of these kinds of cultural messages with couples in therapy as a potentially useful way of bringing covert competition into awareness.

I cannot think of a professional book I could recommend more highly. Given that love-life concerns are usually central to most people coming for therapy, I consider this book to be essential reading not only for clinicians working directly with couples, but also for those who primarily do individual therapy or psychoanalysis. Patients and couples in therapy can also be given this book or selected chapters to augment the therapy process. Several of my patients and other lay readers I know have found this book to be a most interesting, helpful guide to understanding the many mysteries of their own unique love relationships.

References

Bader, E., & Pearson, P.T. (1988). In quest of the mythical mate: A developmental approach to diagnosis and treatment in couples therapy. New York: Brunner/Mazel.
Bowen, M. (1978). Family therapy in clinical practice. New York: Aronson.
Dicks, H. (1967). Marital tensions. New York: Basic Books.
Framo, J. L. (1976). Family of origin as a therapeutic resource for adults in marital and family therapy. Family Process, 15, 193-210.
Erikson, E.H. (1959). Identity and the life cycle. New York: International Universities Press.
Johnson, S. M. (1996). The practice of emotionally focused marital therapy: Creating connection. New York: Brunner/Mazel.
Mahler, M., Pine, F., & Bergman, A. (1975). The psychological birth of the human infant. New York: Basic Books.
Sharpe, S.A. (1981). The symbiotic marriage: A diagnostic profile. Bulletin of the Menninger Clinic, 45, 89-114.
Sharpe, S.A. (1990). The oppositional couple: A developmental object relations approach to diagnosis and treatment. In R.A. Nemiroff & C.A. Colarusso (Eds.), New dimensions in adult development (pp. 386-415). New York: Basic Books.
Sharpe, S.A. (1997). Countertransference and diagnosis in couples therapy. In M.F. Solomon & J.P. Siegel (Eds.), Countertransference in couples therapy (pp. 38-71). New York: Norton.

Reviewer Note

Adaline Corrin is a psychiatrist and psychoanalyst in private practice in San Diego, CA and on the faculty of UCSD Dept. of Psychiatry and San Diego Psychoanalytic Institute.

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