1st Edition
Psychoanalytic Approaches to Loss Mourning, Melancholia and Couples
Psychoanalytic Approaches to Loss: Mourning, Melancholia and Couples applies psychoanalytic ideas to the clinically complex issue of loss in couples and families and outlines a new model for the treatment of associated unresolved grief. In line with contemporary approaches to couple and family psychoanalysis, this integrated object relations and link theory model provides a clear framework and approach for assessing and treating this clinical presentation.
The book brings together contributions from internationally known and respected clinicians and authors who focus on loss, including repeated pregnancy loss, the loss of a child or parent and the loss of a relationship itself. These psychoanalytic couple therapists take the reader inside their consulting rooms, enabling observation of their approaches to the treatment of couples experiencing loss and associated unresolved grief.
Psychoanalytic Approaches to Loss: Mourning, Melancholia and Couples will make an important contribution to the literature on grief and mourning and the application of psychoanalytic thinking to couples presenting with difficulties linked to unresolved grief, following loss. It represents an essential resource to psychotherapists, counsellors, family therapists, mental health professionals and many others supporting those experiencing loss.
CONTENTS
Acknowledgements
Contributors
Preface David Scharff
Introduction Timothy Keogh
SECTION I Theoretical understandings and clinical approaches to loss
Chapter One Timothy Keogh
Psychoanalytic understanding of loss and its relevance to couples and families
Chapter Two Elizabeth Palacios
Link Theory and Object Relations Theory: An enriched approach to working with melancholic couples
Chapter Three Cynthia Gregory-Roberts & Timothy Keogh
Assessing and formulating the significance of issues of unresolved loss in couples functioning
Chapter Four Timothy Keogh & Cynthia Gregory-Roberts
A proposed theoretical framework and model for intervention
Section II Loss in couples and families: Theory and practice
Chapter Five Anna Maria Nicolò & Stefania Tambone
Family defenses against mourning
Chapter Six Judith Pickering
Intergenerational loss in couples
Chapter Seven Catriona Wrottesley
Early loss of a parent and coupling difficulties
Chapter Eight Carl Bagnini
Loss of a pregnancy and its psychic impact
Chapter Nine Monica Vorchheimer
Loss in the everyday life of couples
Epilogue
Biography
Timothy Keogh is a training and supervising analyst and full member of the Australian Psychoanalytical Society. He is Honorary Senior Lecturer, Medical School, University of Sydney, and a research fellow of the International Psychoanalytical Society.
Cynthia Gregory-Roberts is an individual, couple and family psychoanalytic psychotherapist in private practice in Sydney, Australia. She is a member of the Australian Association of Social Workers and College of Social Work and an accredited Mental Health Social Worker.
This book focuses on the impact of loss in couples and families where persistent grief leads to a chronic form of melancholic depression and sense of hopelessness, referred to diagnostically as complicated grief. Drawing on clinical and theoretical developments in couple and family psychoanalysis over the last several decades, this text, the first of its kind, provides the reader with a range of contemporary and innovative contributions concerning this clinical presentation, one hundred years after Freud’s original text Mourning and Melancholia (1917). The extensive clinical experience of the internationally known authors has allowed them to develop and illustrate an integrated object relations and link theory framework, which opens new perspectives in the understanding of complicated grief as it, manifests in couples and families. The editors propose an original approach to the assessment of this problem and a short-term intervention model for its treatment, underpinned by this framework. Their clinical approach allows a questioning of the method, the metapsychology and the epistemological pedestal of contemporary psychoanalysis and in doing so, opens up a new field of research. This new way of listening to psychic suffering, which focuses on the inter-subjectivity of the couple relationship, also highlights the potential preventive mental health value of such an approach to diagnosis and treatment. From this vertex the book also examines the effects of the intergenerational transmission of un-mourned loss, which not only affects the couple (family) as a whole, but also has consequences for the broader social and cultural contexts in which they live. Moreover, the book addresses a clinical issue of immense contemporary relevance considering the suffering and adverse implication un-mourned loss can cause in individuals, couples and families and thus our world. The book, whose authors are recognised by the IPA and the IACFP, therefore represents a significant contribution to the field of couple and family psychoanalysis.
Rosa Jaitin President, International Association of Couple and Family Psychoanalysis
Loss, grief and mourning are universal human experiences. Over the centuries, tradition, culture, religion, philosophy, direct interpersonal sensitivity, generosity and intergenerational wisdom have provided human beings help and support in facing these painful experiences. This book demonstrates, however, that when complicated grief occurs, such supports are often not enough and darkness and despair can dominate the internal psychic landscape. In these circumstances medication is often seen as the solution. The authors show how psychoanalysis can go deeper. In particular, they demonstrate how couple and family psychoanalytic interventions can help in facing and working through the immense loss of a family member and avoid the temptation of denial, disavowal, withdrawal or fixation to an impossible, omnipotent recovery, as in the myth of Orpheus and Euridices.
I highly recommend this seminal text on complicated grief, not only because it is scientifically valuable, but also because it is full of humanity. The book is both fascinating and touching, wide and deep and profoundly rooted in psychoanalytic theory and culture. It contains the best psychoanalysis can offer today about this crucial subject, thanks to the contributions of some of the most experienced and qualified clinicians from around the world, who represent cutting-edge thinking about couple and family psychoanalysis.
Stefano Bolognini, Immediate Past-President, International Psychoanalytical Association
How timely, following the publication just over 100 years ago of Freud’s seminal paper, Mourning & Melancholia, that such a rich collection of perspectives on loss are explored in relation to the important field of couple and family relationships. Timothy Keogh and Cynthia Gregory Roberts have brought together their own creative thinking on working with loss in couples and families with a collection of astute clinical papers from highly acclaimed couple and family psychoanalytic therapists from around the world. All affirm that it is the unconscious meaning of loss that determines the capacity to mourn or fall into serious depression.
The editors are, both experienced clinicians in this area, have also produced a book that interweaves Object Relations theory with the concept of the link (el vinculo) creating an enriched understanding of the impact of unmourned loss on relationships, including intergenerationally on those in the present. The other contributors to the book highlight through closely observed clinical material or film, both the shockingly tangible losses that are nonetheless avoided and the less tangible losses such as the loss of an idealised relationship, that are harder to get hold off. They show that without being addressed, these have a destructive influence on relationships. We know that loss is an intrinsic part of human experience and the failure to mourn is detrimental to mental health. What this impressive book achieves, is to show how unrecognised and unmourned loss gets deeply embedded in the couple and family psyche, how, without being addressed, this impedes creative development. This excellent book will be of enormous value to all those working with couples and families, whether couple therapists, analysts or mental health practitioners, particularly for those wishing to expand their understanding of the more deeply unconscious aspects of loss and the impact on relationships.
Mary Morgan, Tavistock Centre for Couple Relationships
