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Abse, S. (2013). Further thoughts on When a Problem Shared is a Problem … Whose Illness is it Anyway?: Questions of Technique When Working with a Borderline Couple. Cpl. Fam. Psychoanal., 3(2):178-187.

(2013). Couple and Family Psychoanalysis, 3(2):178-187

Further thoughts on When a Problem Shared is a Problem … Whose Illness is it Anyway?: Questions of Technique When Working with a Borderline Couple

Susanna Abse


No single set of thoughts or ideas is ever likely to be sufficient to the task of helping couples who present us with the greatest challenges. My 2006 paper, now reprinted in this issue, “When a problem shared is a problem … whose illness is it anyway?” explores some of the processes operating between couples who present with borderline features and addressed some of the technical challenges of the work. In that paper, I discussed traditional psychoanalytic technique with couples and questioned its efficacy. Seven years on, in conjunction with colleagues, I have had further thoughts that may be of interest. These thoughts have arisen out of the developments currently in progress at the Tavistock Centre for Couple Relationships (TCCR) where we are aiming to develop more effective interventions, specifically tailored to meet the needs of such couples.

Developments in neuroscience and attachment studies have begun to deepen our understanding of the aetiology of borderline states and this understanding is now being integrated into psychoanalytic theory by researchers and theoreticians such as Professor Peter Fonagy in the UK and Dr Allan Schore in the USA. It is pleasing to note that some of the insights of psychoanalysts, such as Winnicott and Bion, are beginning to be evidenced empirically by research into the structures of the brain, leading us closer to Freud's ambition that psychoanalytic theory would one day be verified by science, establishing at last its biological basis.

One particular aspect of this new learning is in the area of affect and affect regulation, which I believe has particular significance for the couple therapist through its close link to containment. Both psychoanalytic and attachment theorists recognise the significance of emotional regulation for the healthy development of the self. In psychoanalysis, Bion (1962) showed how the caregiver's capacity to process and manage emotional affects that contained the infant, was central to healthy development.

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