What happens when you go to couple therapy? Susanna Abse, couple psychoanalytic psychotherapist at The Tavistock Centre for Couple Relationships invites us in to this very private world…

Posted by: on Oct 25, 2013 | No Comments


Oliver and Naomi go to couple therapy Oliver and Naomi have been married for 22 years.  They met when they were both 20, whilst they were studying at medical school.  Neither of them had been in a relationship before and whilst Naomi had had several unsatisfactory sexual encounters in her teens, Oliver had never even kissed a girl before Naomi.

Naomi, now 44 is a slender, rather sad looking woman, with big brown eyes, beautiful thick and lustrous hair and a hunched anxious manner.  She is attractive and chic, but dresses quite conservatively in neat dark clothes with dainty court shoes.  In my consulting room, as she speaks she frequently glances at Oliver while she twists and fiddles with the large diamond on her wedding finger.  Oliver in contrast, is large, loud and cocksure.  Having left medicine after a brief career, he has made a fortune in pharmaceuticals.  He is very overweight, has a florid complexion and his suits whilst clearly expensive are usually crumpled, making him look neglected and uncared for.

It was the end of the summer when Naomi first rang me to make an appointment.  I had just returned from my holiday and was doubtful I had a vacancy to see another couple.  On the phone she appealed to me, saying that she thought Oliver was very depressed and likely to do something stupid if they didn’t get some help at once.  He was threatening to kill himself or to leave home and chuck in his job and she could no longer manage to keep things together for the family. Oliver, she told me was often worried and unhappy and she was at the end of her tether.  She wept when I said that I would refer her on to a colleague as I was already ‘full’ and at length I relented and offered them an appointment for an assessment that week.

At the first appointment, they told me the reason why they needed help now.  Their marriage was in crisis; Oliver had discovered that Naomi had been in contact with an old friend from university called Robert.  He had come across a series of texts and emails between them that were flirtatious and suggestive. Whilst he seemed to believe that ‘nothing had happened’, the discovery of these emails had revived long buried feelings about an earlier event.  They told me that a year into their relationship, just after they had moved in together and got engaged, Naomi had a brief but passionate affair with one of their friends.  This friend, Gus, was a rather lost and lonely person who they befriended and offered a home.  Gus had grown close to them both, going to watch football with Oliver and playing tennis with Naomi.  When Oliver found out that Gus and Naomi had been sleeping together, things fell apart.  Naomi was terrified that she would lose Oliver and threw Gus out on the streets and after some weeks, Oliver and Naomi were reconciled.  Soon after this event, they married and had 3 children in quick succession.  Their youngest child Michael was now 11 and about to start secondary school.

In the first session, Oliver veered between arrogant posturing and tearful terror.  He threatened to throw Naomi out of their home and to tell her mother that she was a slut and a bitch.  He ranted about Robert, but then lapsed into angry musings about the affair with Gus.  At times he seemed to confuse the two situations, so that I too became lost and unsure whether Gus and Robert was the same person.  This confusion between the past situation and the present seemed at the heart of Oliver’s distress, as ancient buried feelings about the old betrayal broke through his bluff arrogance, leaving him trembling and overwhelmed like a little boy.

At the next session a few days later, they were a little calmer.  The sense that they had found someone who had agreed to help them with their problems seemed to have soothed the situation and Oliver had been able to go to work for the first time in nearly two weeks.  I had made clear that I thought these current difficulties were complex and might link to previous events, not only within the relationship but also went back further to their own childhoods and families of origin.  They listened politely to this little speech and Naomi agreed, saying that she had thought about that herself, which prompted me to ask her to tell me a little about her own family and how she had got on when she was growing up.

Naomi said her parents were divorced.  She had two older brothers and her parents had finally split up when she was 11.  Her mother and her were still close and she gave me the sense that she felt her relationship with her mother was cloying, claustrophobic and controlling.  Her mother was ‘not well’ and had not been well for many years.  Her brothers were busy and did not take much interest in his mother, leaving Naomi to do most of the caring.  Indeed, Naomi, now a GP, seemed to spend most of her time caring for others, whether it was her mother, her children, her patients and most importantly ,and it seemed quite constantly even Oliver.  Naomi also told me that her father had been something of a philanderer who had had many many affairs before Naomi’s mother had lost patience.  After the divorce, he had married a much younger woman, but this relationship had too broken down.  He was currently living with a woman from Columbia that he had met on the internet.  She was 29 to his 69 and Naomi had, up to now refused to meet her.  Naomi said that her father was very successful and very generous, so that she too was wealthy in her own right.  Despite this generosity however, Naomi from a very early age had felt her loyalties divided and had struggled to maintain a relationship with her father that didn’t seem to alienate and anger her mother.

After listening to this story, I wondered if I had a better understanding of where Naomi was coming from.  Torn between her parents, did she feel deep down she had only two choices? One to care endlessly for everyone and especially Oliver, or alternatively to get her own needs met in a way that didn’t seem legitimate, exactly as her father had done.

In this second session, Oliver also told me something of his childhood, but his story gradually unfolded over many sessions.  He was the youngest child of older parents.  Both of his parents had suffered many losses in their lives, having been forced to flee their home countries during the war.  Describing his parents, he gave me an impression of two quite depressed and distant people along with a picture of a rather lonely and sad childhood.  He told me that he had gone to boarding school at 11, following his mother’s diagnosis of breast cancer.  She died three years later and he never felt he had a chance to mourn her, as his father would brook no discussion of her illness or death.    Did I now understand more about Oliver?  The way he covered over his anxious fear of loss with arrogance and bluff became more understandable.  Had the discovery of these emails between Naomi and Robert, triggered off a whole avalanche of repressed feelings about loss and betrayal?

Over the next 14 months these themes and many more were explored between us.  Each Tuesday evening Oliver and Naomi would come to see me at 7.30pm and tell me about their week, their thoughts, their ups and downs, their sex life, their  ongoing struggles with parents, their ongoing issues with bringing up their children and their fears and hopes for the future.  Each week, I would listen and we would try and understand together what made life at times so difficult for them both.  We would explore how the ghosts of their past relationships and their childhoods would come alive in their day to day interactions.  So that simple things such as deciding whether their eldest daughter should go on a school adventure would revive ancient fears of loss for Oliver and ancient weariness for Naomi, as she reassured and soothed him until he could rest easy that the children would be safe and sound.

A key change over the period of the therapy came about when Naomi becoming more able to share and understand her own worries and concerns.  Would Oliver be able to support her?  Would she be able to get the love and care from him that she so frequently gave to others?  Gradually she allowed Oliver and me to know her better and she would talk more readily about her own worries and frustrations, rather than simply burying them.  Oliver, in turn could now be the strong one in the relationship rather than simply another ‘child’ to be cared for.  His sense of confidence and strength grew, making him less clingy and demanding.  As a bonus, their sex life seemed to improve as Oliver became both more sensitive to Naomi’s needs and more confident that he could satisfy them.

The couple ended therapy in the spring.  They felt ready and as we were coming up to the Easter holidays it seemed like a good time to them to end the work and say goodbye.  At the final session, we talked about their initial reason for their coming to therapy and both laughed saying that those things were only the tip of the iceberg – a symptom of much deeper issues.  I wondered if they could put this into words?  Would they be able to describe their journey?  Would they be able to say clearly what had really been bothering them both?  This is what they said.

Naomi- “ I think that I have always looked after people.  First of course my parents and I think I did this to try and keep them happy, to try and prevent them from splitting up.  Then with the kids and Oliver I did the same thing, made myself indispensable.  Made myself cross and exhausted too!!  That’s why I suppose I took refuge in the emails and texts, I never really felt anything for Robert, it just felt like something for me.  Something of my own, I felt really angry with Oliver, with his neediness and demands and felt that I deserved someone to care for me!”

Oliver – ‘The thing is Naomi, you never asked.   You never said you needed me to support you.  I know I was all wrapped up in myself and I know I was a pain about a lot of things, but it seemed to me that ever since we got married you didn’t really need me at all.  Not even for money, thanks to your dad!  What’s really helped me with this therapy, and let’s be honest I didn’t think I would take to it at all, is the fact that you’ve shown me that I’m needed too.  That I’m not just some wimp who you are sick of taking care of.  And you know, that makes me more sure of you, more sure you’re going to stick around”

This is a completely fictional account of a couple’s therapy, designed to give the reader some idea of what couple therapy is about and what kind of issues couples bring. Whilst the story below aims to represent accurately the process of therapy, the couple’s dynamics and the themes that couples discuss, the couple described  here bears  no resemblance to anyone whether living or dead.

Susanna Abse Couple Psychoanalytic Psychotherapist The Tavistock Centre for Couple Relationships

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