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Can Psychodynamic and Behavioural Couples Therapy Co-Exist,  Or Must We Choose?

Jenny Sanbrook
Accredited Mental Health Social Worker Certified Gottman Therapist

s a therapist seeing individuals and couples I balance theory and techniques based on a clients needs and presentation, trying not to rigidly adhere to one or the other.  I often find models are described as being at odds with each other requiring a therapist to “choose” which camp they are in.   When working with couples, I primarily use Gottman Method of Couples Therapy however, was recently asked if psychodynamic couples work is a different approach entirely.  I have come to the view that not only can there be overlap but there can be benefit to clients in intentionally blending ideas from different models. This can assist therapy to prgoress and provide options  when clients and therapists feel stuck.

To set the scene on this, Kaslow (1981) highlights there are over 50 models of working with couples/families and over 400 different models of psychotherapy in general (See Figure 1).  Likewise, there are a number of useful couple therapy models with a research base that all have their merits (See Figure 2). Ref: Weeks and Fife, (2014).

Figure 1- Family Therapy Models/Schools (Kaslow (1981)

Therapeutic approach  Theoretical FeaturesKey Figures
Dynamic/analyticDeep exploration, projective identification, defenses and personality, attachment Freud, Jung, Bowlby, Winnicott.
BowenianFamily of OriginMurray Bowen
Relational- contextualFairness in relationships, “give and take”Ivan Boszormenyi-Nagy
ExperientialRole play, props, art, music, chair workFritz and Laura Perls, Gestalt
StructuralBoundaries, hierarchy, rulesMinuchin
Communication-InteractionCommunication and interactional patternsSatir, systems theories 
Strategic / SystemicParadoxical InterventionsHaley, Milan associates

Figure 2 – Couple Therapy Models with a research base.

Therapeutic approach  Theoretical FeaturesKey Figures
Behavioural Marital Therapy  Focus on modifying  behaviour and problem solvingDonald Baucom
Insight Oriented Couples TherapyInterpretation of maladaptive patterns from a developmental perspective.  Douglas Synder and Robert Wills
Acceptance Based Couples TherapyAccept your partner as s/he is as opposed to focus on change.Neil Jacobsen and Andrew Christensen
Emotionally Focussed Couples TherapyEmphasis on attachment and bonding.Susan Johnson
Gottman Method Couples TherapyShared meaning, conflict management and friendship.John and Julie Gottman 

Furthermore, based on a review of over 200 psychotherapy outcome studies by Michael Lambert in 1999 the model and techniques used by the therapist accounted for only 15% of the outcome and the therapeutic relationship accounted for 30%.  Extra-therapeutic factors accounted for 40% of these and included severity of disturbance including physical symptoms, motivation, capacity to relate, ego strength, psychological mindedness, and the ability to identify a focal problem.  Other factors included social support, self help literature, significant others such as teachers, clergy and friends who often use hope instilling techniques. (See Figure 3).  Thus the model whether it be a behavioural or a  dynamic approach will also have its success in client and social factors as well (Weeks and Fife 2014).

With that in mind I have chosen two models that are often considered to be at odds with one another –  Psychodynamic Couples Therapy (PCT) and Gottman Method Couples (GMCT) and outlined some differences but also similarities between them and suggest they can be built on together to be helpful to clients.  I am also referring to the work of Maureen Sawyer (2004) who outlines some of these in her chapter on this topic.

Psychodynamic Couples Therapy and Gottman Method Couples Therapy – Differences and 

Firstly some differences, PCT is  primarily triadic -the couple talk to the therapist, the focus is on being with the couple rather than doing while paying attention to countertransference feelings, fantasies – internal world of self and other. Interpretations are made by the therapist in a tentative manner.  In GMCT the therapy is dyadic with the focus on therapist as less central. The couple talk to each other during the session and the therapist is more of a coach, guiding the couples and providing specific interventions for  the couple to use in the session. The therapist will also be quite directive at times but direct the couple back to each other as soon as possible -this is also called “stepping in and stepping out again”.

In PCT, the assessment process is less structured, the couple tell their story in no particular way, focus is more on creating a safe space.  GMCT has a structured assessment process, individual and joint sessions, questionnaires and a feedback session which is  completed over 4 sessions before therapeutic techniques are introduced.

In PCT the focus is on holding and containing, in GMCT the therapist does not do the soothing rather the couple learn to soothe themselves.  In PCT there is a greater focus on defensive projective identification which is used to manage unbearable feelings and thoughts.  In GMCT there is a focus on viewing couple issues as often based in small moments in the here and now eg language, bids for connection, repairs and the amount of positive interaction even within conflict.

It is thought that in PCT change happens from the inside out, empowering a client through intrapsychic growth via the therapeutic relationship.  In GMCT change occurs more from the outside in, by empowering the couple to enhance the couple friendship, shared meaning and manage conflict effectively through resources eg the Sound Relationship House theory and associated library of interventions.  The idea is that small changes can have a ripple effect.

In terms of similarities, both models have a focus on repairs.  This is particularly relevant in relation to how couples manage conflict situations.  This can be best illustrated with reference to Tronick’s (1975) Still Face Experiment with 3 month old babies, which demonstrated the impact of a lack of attunement (and unresponsiveness) either through maternal depression or lack of emotion coaching capacity.  In these cases, it was the mothers ability to repair the misattunement that was crucial. Thus “rather than emphasising synchrony, mother interaction is a process characterised by matching and mismatching – with reparation of mismatches key to healthy attachment development” (Tronick and Beeghly 2011).  Furthemore, Tronick points out that if a mothers face remains unresponsive as in the Still Face Experiment the child reacts with weariness, and eventual withdrawal demonstrating the reciprocity in regulation of emotion.  In fact it was discovered that a mother was often mis-attuned to baby (70% of the time) but it was the quality of the repair that mattered.  

Gottman has taken this research to demonstrate that likewise with couples – the  strength of the friendship meant the couples were more likely to reach out and make interactive repair eg “I was distracted earlier, let’s make a time to talk that through tonight”. In GMCT making and receiving  repair attempts is emphasized, as chronically unsuccessful repair attempts create a diminished sense of agency and resistance.  Similarly in PCT, there is a focus on relational dynamics around repair and bonding along with repairs and bonding with the therapist.  

A second similarity is in the area of the Internal Working Model (IWM) According to Winnicott 1965 (he also uses the term Internal Representational World) – how the infant is held and contained sets up a template and expectations for the adult relationship.  As such, a person can end up seeing oneself as “all good or all bad” – ie “I’m not seen, important, prioritised” or “I am loved, worthy, able to be soothed”.  Both GMCT and PCT models  begin by attending to the here and now as the relational patterns in the here and now are a reflection of the Internal Working model.  There is a focus on self soothing and soothing the partners in GMCT for this reason.  The IWM is formed from the meaning each individual assigns to his or her history of affect regulating experiences which influences how a person approaches relationships.  So if a person is used to being soothed when distressed, the person will seek comfort from their partner.  Both models are informed by these ideas and assume that individuals form secure or insecure attachment styles as a result.  Linked to this is the focus both models have on affect regulation – a persons ability to recover from states of hyper / hypoarousal.  PCT and GMCT are informed by the idea that infants have less capacity and can become dysregulated intensely and quickly – thus the caretakers role in this is central.  Likewise these patterns if not learnt early in life need to be brought into the present and strengthened in couples work by teaching self soothing and soothing of each other.  

Fourthly the idea of projective identification  has overlaps with both models.  This is a process whereby a person manages unbearable feelings by entering the object with the whole or part of the self – and to communicate and illicit empathy. Eg I’m anxious therefore  I see anxiety in you.

Used defensively it is used to get rid of unwanted parts of the self or to control the other. In GMCT, the language of the Four Horsemen is used to describe Criticism, Defensiveness, Stonewalling and Contempt.   Criticism and Defensiveness play out as a statement that implies there is something globally wrong in a partners personality eg “why can’t you just listen for once” (you’re a hopeless listener)… – putting a “soccer ball” of criticism into partner’s body, implying the partner is defective.  They will then use Defensiveness (“you think listening means agreeing”) – which is the  beginning of the attack/defend cycle.  The “you always / you never” idea is similar to concept of splitting in PCT, putting the “soccer ball” of unwanted feelings onto the other.  In GMCT the “ stop action method” of interrupting the couple during the session is used and the alternative/antidote  eg “The Softened Start up”  is taught (“I feel ignored, about the way we organise the tasks at home, and I need us to come up with a joint plan”).   In PCT, the therapist aims to make the processes and thoughts more available to the client  and increase their ability to share via holding containment observation and interpretation.  The language of  “Un-contained / Non- metabolising” is used to describe this behaviour of projection.  

This also plays out in terms of how resistance is viewed.  In PCT resistance is viewed as  a way to ward of unbearable feelings and thoughts – ie defence mechanisms.  The therapist creates space where thinking, feeling, understanding replace defences.  In GMCT this is also thought to occur with a strong and validating therapeutic relationship and providing specific techniques (See Dan Wile, 2021) to help a person express thoughts/feelings they have been unable to and to explore “dreams/meanings” beneath a conflict. There are other similarities and points of difference that can be discussed however these are just a few main areas for consideration.

Summary 

In summary, an overlap of different models can enhance benefits of therapy or assist when clients and therapists feel stuck.  Alternative approaches can bring a breath of fresh air to the room and open up new avenues for growth especially when a clients natural  defenses have lowered. Thus both Psychodynamic Couples Therapy and Gottman Method Couples Therapy, while having some distinct differences, share the goal of developing a more positive inner representational model, regulating affect and promoting flexibility, allowing techniques to be applied from both schools of thought to the benefit of the couple.

References 

Gurman A and Jacobson N (2002) The Clinical Handbook of Couple Therapy.  Guilford Press, New York.

Weeks, G and Fife S (2014) Couples in Treatment: Techniques and Approaches for Effective Practice. Routledge NY.

Maureen Sawyer, Bridging Psychodynamic Couples Therapy and Gottman Method Couples Therapy.  In The Marriage Clinic Casebook.  

Tronick et al. (1978) The Infants response to entrapment between contradictory message in face to face interaction.  In Journal of the American  Academy of Child Psychiatry. Vol 17 Issue 1 pp 1-13.

Tronick E, and Beeghley , M (2011) Infants’ Meaning-Making and the Development of Mental Health Problems American Psychologist.  Feb-Mar 66(2) 107-119.

Wile, Dan (2021) Solving the Moment – A Collaborative Couple Therapy Manual. USA

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