In this article, the author discusses common ways in which couple consultation and therapy are practiced by psychoanalysts and the limitations of each. The author argues for an approach to the assessment and treatment of patients who present with a disturbed relationship that addresses the vicissitudes of unconscious collusion and develops this principle as a fundamental criterion for making the recommendation of couple therapy over psychoanalysis or psychoanalytic psychotherapy. The author then elaborates an understanding of a variety of obstacles, those emotionally determined and those determined by analytic ideals, which limit the analyst's freedom to assess the most appropriate modality and to conduct couple therapy within the psychoanalytic model described.Little has been written about the clinical criteria for recommending psychoanalysis or intensive psychoanalytic psychotherapy versus couple treatment. 1 It has been estimated that 50% to 60% of patients presenting for psychological treatment do so for a disturbance in intimate relationships or other significant relationships (Sager, 1976). Even when the presenting complaint is one of an affective problem or other symptom disorder, it is quite common for the clinician to find a circumscribed relationship difficulty which is either a major catalyst or component in the symptom complex, or which has coalesced into a mutually reinforcing pathogenic interaction with the partner-a collusion. In these cases this interaction continues to fuel the symptom expression. With such a large percentage of patients presenting in this manner, it is surprising that so few psychoanalysts are trained or at least well versed in the merits of couple therapy. Finkelstein (1988) comments on this peculiarity in an article in which he addresses the importance of object relations principles

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A young woman who came for treatment of anxiety and depression is presented in a detailed case report. She developed an erotized transference that was predominantly sadomasochistic and included her intention to torture and castrate the analyst. The author demonstrates how the analyst's behavior, including countertransference contributions, assisted in shaping the vicissitudes of sadomasochistic transference paradigms. A collusion was established between patient and analyst in a manner that enabled the analytic dyad to work productively toward an eventual resolution of the patient's conflicts. The author discusses the case's complexities pertaining to enactments, while emphasizing the importance of carefully monitoring and addressing countertransference experiences that mold and shape such a collusion.

is a creatively edited compilation of papers undertaken by two research and teaching groups-the Tavistock Centre for Couple Relationships (TCCR, now called Tavistock Relationships, or TR), located in London, and the Psychoanalytic Couple Psychotherapy Group (PCPG), located in Berkeley, California.To provide some history, approximately two decades ago a group of dedicated psychoanalytically informed clinicians in the Bay Area made contact with TR-an institute that had pioneered in developing theories and methods for the treatment of disturbed couple and group relationships, rooted in psychoanalytic thinking, especially the object relations tradition. As I understand the origins of this partnership, these California clinicians, all seasoned in the psychoanalytic tradition and wanting to learn more about the Tavistock application to couples, traveled to London to study the developments occurring there. Later the TR clinicians were invited to Berkeley to teach and supervise the Bay Area clinicians. Emerging from these repeated sojourns was a relationship between the two groups, eventuating in the founding of PCPG. Since then PCPG has continued to expand upon the Tavistock tradition, while continuing its collaboration with TR.Here I will say something about the Tavistock model and its history, especially for those less familiar with its approach in the treatment of couples. Beginning in the 1940s, Enid Balint, a London psychoanalyst, was instrumental in developing the Family Discussion Bureau, a precursor of TR. Eventually, she and her husband, Michael Balint, became 873325A PAXXX10.

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