"Relational disorders and their implications in the psychopathology of couple relationships"

Relational disorders and their implications in thepsychopathology of couple relationships

Ogni volta che parlo di te, tu fai parte o non parte di me Ogni volta che piango per te, tu fai parte o non parte di noi

Ogni volta che parli di me, faccio parte o non parte di te Ogni volta che piangi per me, faccio parte o non parte di noi

Antonello Venditti

The purpose of this article is to explore the tangledcomplexity of post-modern affective relationships. It takesits inspiration from aspects of Anthropology,Sociology andEvolutionary Psychology. My phenomenological background led me to mesh all of theaforementioned aspects into a relatively new current ofthought known as “New Phenomenology” (1.Alea 2013) in whichassociating multidimensional processes with a detailedanalysis of each process provides us with a view which isprobably more surgical and scientific. These aspects, notalways present in my “home”, Gestalt Psychotherapy, offer thepossibility to move away from didactical stereotypes, alwaysin concordance with ourselves but a bit apart from the restof the scientific and clinical world.

It is not easy for me to abandon the comfort area so as toconfront my ideas with those of my beloved past supervisorfor so many fruitful years, Joseph Zinker, because I continueto be stubbornly in love with notion of “Dental Agression” (2Perls F), or with those of my inspiring and admiredcolleagues and directors, Margherita Spagnuolo and GiovanniSalonia, who have allowed me the honor of being a trainer andwith whom I have discussed my ideas and modest contributions.

When we refer to couple relationships in the explosivepostmodern world we live in, it becomes necessary to re-signify the concept of “Dental Aggression,” intuited soextraordinarily by Perls as the driving force for theexistence of our species.

What we needed as hominids to survive differs very littlefrom the needs of our contemporary species, which we couldrename “homo especulatis”, an irony used to describe how wetake advantage of evolution for our own benefit.

These biological needs and drives led us as hominids males toseek reproducing females capable of surviving the labour ofbirth and females to seek males not only capable ofreproduction but able of providing the greatest possiblesupply of proteins, a challenge that will be repeated andreinterpreted during the following centuries and up to thepresent day.

This was also a practical attitude which would graduallybecome the preferred patrimony of human evolution, adaptingitself slowly to consciousness and through consciousness tothe evolutionary dimension which necessarily results from thevaluation of the experience.

The reinterpretation of these initial phenomenalrelationships was only possible due to the growth of ourbrain, growing slowly and progressively without pause untilthe present. The increase in the encephalic mass (3.WWW.portalciencia…) is related to the increased number ofproteins, the same proteins provided by the male reproducer,the proteins which likewise converted him into an appropriatecandidate. This quite ordinary peculiarity gave rise to anunprecedented evolutionary leap in the world’s biologicalhistory.

The increase in the consumption of proteins and its resultingcircumstantial advantage will drive female reproducers to not

want to surrender the possibility of producing stronger andhealthier off-spring.

This is the time when we go from the reproductive needs ofsurvival to our needs of social integration and acceptance,which we say we need.

This quantitative leap in evolution will give way also tosocial competition and the desire to dominate, by whichcomplete species of hominids will be swept away by those whofirst discover this novelty.

These new “needs” will play a brutally important role in ourchoice of partners, and those initial and ancestral choicesdetermine the preferences of the present, which we shall call“what we like of the other and/or what the other offers us toimprove our competitive opportunities in society.”

The good or bad use of this selective opportunity will be thekey for the quality of our relationships and, in turn, thequality of our relationships will be the creator of ourpossible sexuality (4 Rabinovich D 1988).

The relationships between the sexes, referred to assexuality, in all of its emotional connotations willconstitute the presenting cards for our relationships. Initself, this sexuality will always be represented through ourway of seeking what we want or need. This libidinal drivemanages our intention for contact, understanding thisphenomenological gestaltic term as sexuality in action,binding sexuality and intention for contact in an indivisiblemanner. The distinguishing sign of our primary necessities continuesto be present in many of our behavior patterns when we choosethe other sex and at the same time the lack of comprehensionof these very necessities is the cause of countless conflictsin our relationships.

As we mentioned above, the pattern of choice of the malehominid was limited to a female capable of survivingchildbirth, while the pattern of choice of the female waslimited to a male who could provide the greatest amount offood for the off-spring.

More food means more proteins. Without these vital proteins,the hominid brain would not have grown, but without socialactivity it would not have been possible to obtain moreproteins and share them voluntarily with the family group ona continuous and regular basis.

For this reason only the sophisticated framework ofrelationships made it possible to resolve the primaryconflicts of survival, conflicts which have inevitablycontinued up to the present with the contribution of languagebut with the same ancient vital pulsations. Thus, it becomeseasy to understand that these ancestral needs were slowly butcontinually converted from reproductive to relationalphenomenon (5. La Rosa S 2013).

The initially gestural language, which activates the premotorzone of the brain, called Broca’s area (6.Gallese V2007),will be the true predictor and prime neurochemical mover ofthe intention for contact.

This process of hundreds of centuries which continues up tothe present was shaped as a result of successive languageexperiences, gestural at first, later verbal, and along withthat culture which was derived from it, leaving the originalprimary selective pattern almost intact. (7. La Rosa S 2013)

Today the choices of females who will not die duringchildbirth are perfectly valid, who we re-signify today assexually more desirable and appropriate, and the same is trueof the males capable of providing a greater quantity of“proteins,” whom we re-signify as socially more competitivefor producing progeny in the world. Little has changed fromthe initial crude mechanism of choice and we are very little

aware of this when faced to “not understanding” that theancient mechanisms of selection are unfit except for minuteaspects of modern life.

It is not surprising therefore that according to the WorldHealth Organization, 64% of couples in developed societiesseparate before completing the first ten years of theirrelationships, and the percentage continues to increase.

It was not easy for our specie to survive up to these days,it did so aggressively with everything at hand. It was notonly necessary to struggle to survive, but likewise it wasnecessary to adapt to the continual changes in theenvironment and individuals of like sort.

For this task the species found it necessary to utilize allavailable vital drive, yet today the continuity of thespecies is not at stake, at least in purely evolutionaryterms. What is at stake is the continuity of ourrelationships that started as part of the evolutionaryadaptation and today appear to be unsustainable in the longterm

We are curiously victims of our own evolutionary pattern andof the utilization of what we have learned concerning thechoice of partners.

We were and continue to be talented in deforming a keyinstrument for survival into one in which ethics andaesthetics are not aligned and act together in the frontierof contact. We moved brutally from survival to theutilization of the other and of the personal image.

New relational needs demand a renovated comprehension ofindividual needs and possible “solutions” of problems incouple relations. To sum up, as hominid males we saw in thecouple a practical solution that allowed us to better takecare of a small rather than an unlimited progeny. It waseasier to take care of just one female than fight for all of

them. It appears that monogamy was a product of thispractical idea.

In this process the females could achieve a new social valuein confrontation with their equals thanks to a progeny thatsurvived and with the male as guardian of lineage. It is notmy intention in this article to reduce personal and affectiverelationships to the anthropological aspects of evolution,because the evolution of any species demands tangledconvergences to arrive at long lasting behavioral patterns.Despite that, this is the fundamental origin that upholdsmodern relationships. At least superficially, it is useful tocontinue the evolutionary path as a guide capable oforienting our present and ancestral conflicts.

How many historical needs gravitate in the psychopathologicalconflicts which characterize modern relationships?

The answer is quite obvious, it is very difficult to explainto a diabetic patient that carbohydrates can kill him when heignores that he suffers from diabetes and is desperate to eatsweets…

Thus, lacking awareness and the data that would allow us toseriously understand the consequences of our choices, weestablish the framework for our couple and familyrelationships in today’s world and many factors contribute tothe relational maladjustments we witness in our practice and,as was to be expected, were not foreseen at the beginning ofthe relationship.

The challenge, aside from understanding the alarmingstatistics that seem so natural in today’s world, is tounderstand what solutions exist for these malfunctions, ifindeed there are solutions.

Today’s extraordinary advances in clinical practicecontinually collide with new dilemmas which our diagnosticmanuals have not taken into consideration. Not only are new

difficulties added, but we must deal with those that wefailed to consider in the past. This notion leads us asGestalt therapists to think not just in terms of an intra-psychic phenomenon that the unconscious is the body, and thisunconscious body protests when the satisfaction of primarydesires is not fully responded to.

Faced with the lack of fulfillment and the scrawny happinessresulting from this kind of utilitarian relationship, overtime psychosomatic maladies are expressed first individually,then in the couple and lastly in the offspring. Themanifestation is a corporal expression which in the form ofpsychosomatic symptoms does not allow any member of thefamily relationship to escape from the misunderstanding andrelational tension that results from the lack of nurturingcontact. (8. La Rosa S 2013). It is here that Jorge LuisBorge’s words become a reality. Children are born from greatconsciousness of their parents or from total lack ofconsciousness. Our hominid ancestors were motivated by brutal and at thesame time genuine necessities. In the course of present daychoice speculations we sacrifice the honesty of our choicesand our bodies are not prepared to tolerate that, so ourbodies end up becoming sick and that at least allows us tointuit the lack of satisfaction with our choices. We, humanbeings act as if our sexuality did not gravitate in our life,yet that sexuality will be functionally responsible for thesuccess or failure of our affective relationships.

The brain as rector of our choices

From the bio-evolutionary point of view, the path that hastaken us up to the present has been modifying the morphologyof our brains, and this too, plays a decisive role in ourprimary sexual or affective choices. In fact, the evolutionof our brain and the development of our intelligence havebeen decidedly parallel with the evolution of ourrelationships.

The multiple functions of our brain and our limited butimportant comprehension of the interaction with sexual andaffective behavioral patterns allows us to glimpse to whatextent the brains of the genders evolved in response to ourneeds and creative possibilities of adaptation. If we take into consideration the brain of the modern womanweighs approximately 150 grams less than that of men, or thatthe corpus callosum in women is 30 % greater than in men andthat the proportion of “grey” activity is equal in bothsexes, we can understand that the gender differences not onlyrespond to different needs but also to a way of dealing withand resolving these needs with patterns which areanthropologically different. The evolution of intelligenceitself is aligned to these needs. If it is clear that the proportion of active grey cells isproportionally the same in the male and female brain, thiswould explain that our differences do not respond to patternsassociated with consciousness and knowledge but rather tocomplex neurochemical and adaptive mechanisms.

Fortunately, these differences allow us to see the worlddifferently and this fact appears to be the key for socialrelationships. For those of us who live in the present timesit is difficult to conclude what a successful relationship isall about. What is there beyond attraction and copulation, orin other words how can a relationship be maintained forreasons that permit the continuation of the bond in abalanced and modernly affectionate environment?

This has a neurochemical explanation. Indeed, we share withour ancestors a brain hormone which facilitates the intentionto approach an individual of the opposite sex. This hormoneappears to be responsible for promoting our intention toestablish contact, to create the necessary arousal to achieveour objective. This makes us imagine contact with the otheras inexorable and irreplaceable. It will make us desire this

person, now not only motivated by the reproductive drive ofthe hominids but by the new needs implicit in modernsexuality. A curious aspect of this hormone which drives us so decidedlyto the opposite sex, is that it begins its decline as soon assuccessful contact is established. The hormone is called“phenylethylamine”, and its activity cycle does not usuallylast more than ninety days.

In modern human beings as well as in the hominids, thishormone appears to be recognized by the sense of smell,although we, humans have ten times fewer nerve endings tocapture smells than dogs. Smell appears to be the mostdecisive factor in the choice of a couple in genital terms.The excitation at the frontier of contact is at the same timethe activation of the hormonal process that makes it possiblefor one to notice the other.

Paradoxically, this hormone, an aromatic amine, is odorlessand its composition is extraordinarily simple (C”8” H´11´N).This alkaloid, as is true of all alkaloids, deforms our visionand immediate reality, thus boosting the intention toestablish contact with the desired person.

If contact is satisfactory, it will be possible to get accessto a more complex relationship, stabilizing the levels ofoxitocin (C”43”H´66´N´12O ´12´S´2´) and dopamine (C”8”H´11´NO´2´). If the relationship is not satisfactory, it will bephenylethylamine that will trigger the generally pathologicalmechanisms that reinforce previous symptoms in accordance toour previous experience.

We can escape or manipulate the relationship as a form ofcreative adaptation, or accept it naturally and thus givespace to the evolution of an emotional and probably morerealistic relationship. These maladjustments in ourrelationships depend on how well we have learned to toleratefrustration, based on integrated emotions of growth. This

will not occur spontaneously if we have not felt body-organism-environment integrated during the first years of ourlives.

The first years of life are decisive for learning tointegrate experiences and tolerate frustration to the extentthat the family environment allows that to happen.

Faced with the certainty of dissatisfaction or the absence offulfillment, the possibility to manipulate the affectivechoice presents itself, a manipulation that operates as acreative adaptation, which not only threatens the plenitudeof present and future contacts but will also strengthen OCDmechanisms (phobias, obsessions and compulsions). (10.Salonia G2010). In everyday language we could say thatunsatisfactory experiences are not likely to add to thepackage of learning and personal growth, unless tolerance tofrustration forms part of our learning and familyinheritance.

The more tension in the relationship the more dramaticallywill the levels of cortisone (C”21”H´30Ó´5¨) rise in theblood (11. La Rosa 2008). For this reason we have learnedsince our origins to disguise or deny our frustrations and toexaggerate our qualities in the belief that this willdiminish our risk of failure in our intentions to establishcontact (12. La Rosa 2011).

Paradoxically, the levels of phenylethylamine do not declineif the objective is not achieved, to the contrary, othersymptoms begin to appear such as “object fixation and morbidjealousy”, displaced compulsions or the search for substitutesatisfactions and increased fear in the face of a repetitionof the frustrating experiences so well described by the OCDdisorders literature.

The continued presence of the hormone in the blood generatesa mechanism of object fixation and morbid jealousy reactionsdirected towards the elimination of phenylethylamine in the

organism, activating kidney function driven by adrenaline (C“9” H”13” NO”3”). As a result, and thanks to the undesiredpresence of adrenaline, our self acquires a hypertrophicaspect, in which what becomes manifest is associated toterror rather than satisfaction.

In phenomenological terms we could say that the frustration of full contact and the memory of that traumatic scene in ourminds in turn have a neurochemical register. The repetition of frustrations will materialize this phenomenon, deviating the excitement that motivates contact to a persistent paralysis that can be identified as a form of contact phobia.

Returning to the positive aspects of phenylthylamine (C”8”H´11´N´), it is responsible for the feeling of excitement andlove that has given rise to millions of human relationships.This is without a doubt the biochemical matrix for excitementand the growth of the frontier of contact in love relations.

As a result, the first obstacle to love is the desire toescape following the first period subsequent to falling inlove. Free of phenylthylamine (C”8”H´11´N) and free of thedesire to copulate and conquer, we are confronted with thefirst dilemma in relationships. It is here that creativeadaptation will play an essential and partly positive role inthe survival of the relationship, no longer sustained byphantasy concerning the other but by how the other really is.This creative adaptation will have diverse countenances andin turn has a neurochemical explanation.

To the extent that the conditions for a “successful”relationship are met in terms of our needs and desire, thebrain brings about a displacement of the purely affectiveattention so as to create spaces for more ample commoninterest.

New bases for the relationship will be established andsustained by oxitocin (C”43”H´66¨N¨12O´12S´2), more amplethan the mere genital satisfaction, creating what we call

love. This hormone establishes very clear conditions for itspresence; our needs and desires must be satisfied, not justone of them but both, on a fairly sustainable level overtime.

The objectives and desires which the brain via neurochemicaloxitocin considers satisfactory in terms of plenitude leaveno room for error. As time goes by with respect to therelationship with the desired person, the motive for unionbecomes clearer. The brain itself is not emotional, butrather emotion arises from the sum of previous experienceswhich, related to the present, give way to the “novelty” ofthe feeling. In the approach and attraction towards theother, during which we go from the intention to establishcontact to the contact itself in all of its phases, thedebate appears in our consciousness between fear and desire,an indecorous struggle between establishing contact orremaining paralyzed. We will have to opt for love, for speculative love or for therenunciation of the love relationship.

Love itself, if we were to have the right to create a more orless acceptable definition, would be the choice of the otherfrom a position of independence, even without need. To thecontrary of what society has created over the past thousandsof years, independence is the best ally of postmodern love,something upheld by the statistics. Independent andautonomous individuals are more desired and valued. On thecontrary, the more accommodating relationships occupy a lessappreciated and less erotic place.

Speculation would appear to be the solution needed to resolvethis alienated struggle between desire and fear in whichaspects associated with what the relationship offers aresatisfied, not the relationship in and by itself. We couldthink of the speculation in the choice as a sacrifice weagreed upon, in which what is left out is the plenitude ofthe relationship, a sort of agreement maintained by society

pushing us to seek in the other the substitutes for ourfulfillment. This speculation, which by no means escapes our awareness,would appear to establish the basis to obtain what we desire,but viewing the other as separate from us.

We could say that speculation inevitably leads us to acontact that is inexorably insufficient and anemic,transforming us “hysterogenically” (13. La Rosa 2011) inrelatively unloving beings, substituting love for the otherby the intrinsic love for the environment the otherfacilitates. The equilibrium of our desires is consistentwith our needs and will be in constant conflict, a conflictonly unknown to those who in the relationship “co-created”the adequate terrain for the satisfaction of both from aplace of independence, those that intuitively accept that theplenitude of the relationship is possible by the self at theservice of the contact with the other. The greatest of all ofthe gifts that human evolution offer us is the entrusting ofour self which exposes itself to risk in the search forplenitude in order to give in to the co-created relationship.

Some clinical observations

The first challenge which the physiotherapist confronts whenworking with couples is that of integrating the socialaspects that make up the phenomenological field which containthem. This involves neither overlooking nor forgetting themoment which the couple is going through and the surroundingreality.

The knowledge of the therapist, always more limited thatdesired, is a compass not always oriented towards a desiredgoal. So the therapist will be obliged to get involved in theprocess (14. Sichera A 2002), to be a chosen and sustainedvoluntary part, and if possible respond satisfactorily to themotive for consultation, which at the same time is anopportunity to offer the most ample possible vision on the

multiple adaptations of the self to each situational field(15. Wheeler G 2000) and to accept the impermeability of ourown individual self as therapists as the natural limit of anacceptable understanding of the intention that motivated theconsultation of the couple. Not only may the patients open upto the novelty, but our clinical spirit as well.

The second challenge is that of rejecting any form ofalliance with the consulting couple. Convergence is not a badword in and by itself but it becomes dangerouslycontaminating when it is associated with an alliance.Alliances, even in the context of clinical practice, willbecome a cause of obstruction of any attempt at interventionto clear up or support.

It commonly occurs in clinical practice with couples thattherapists come face to face with descriptions of how desiresand deeds are assessed independently of the partner. Theydescribe themselves as a couple, however leaving the otheraside in positive and/or negative aspects and it is herewhere a third challenge appears for the therapist: to sustainthe intentionality of the relationship beyond any and allcontent (16. Spagnuolo Lobb 2011) and also to avoidcompensating the negative aspects with those the patientsdescribe as positive.

Our emotional system is not compensated by substitutions. Itis not possible for us to believe that we like what we do notlike, nor to think that what we do not like of the other canbe substituted with something which the other does orproduces relatively well.The tyranny of our emotional and hormonal system requiresthat the relationship itself generate completeness, a form ofpossible plenitude and complementation, but exquisitelyautonomous from the very beginning of the relationship,although we are social beings and all or most modernpsychology schools so assert (17. Spagnuolo Lobb 2011).

The intention to establish contact is sustained by primaryneeds, which means that socialization is a consequence ofsaid needs. In other words, it is convenient for us tosocialize to assure the continuation of the world. Clinicalpractice with couples is a constant test of ethics for thetherapist for our patients do not realize that autonomy inthe relationship is the best antidote for the lack offrankness and spontaneity. This puts the therapist underconstant and silent confrontation with himself. The couplejoins the game and in the test raise questions and criticizethe clinical ability of the therapist. Paradoxically thecouple, when not seeking a dividing line between themselvesand confluence with the therapist, come together to protectthemselves. They do so to avoid and delay the awareness thatreflects the difficulties they are experiencing in therelationship.

We could say that at least in the beginning they will seek analliance with the therapist in order to express their own andtheir partner´s negative feelings. Either they will defendthemselves in the face of evidence that the relationshipmight be in danger of breakage or accept responsibility forthe malaise of the other or of the children—should they havechildren.

I always believed and I continue to do so that autonomy isthe key for any healthy relationship. But in clinicalpractice we must determine what levels of autonomy arepossible; without judging and avoiding arguments. Theconsulting patients will not always begin talking aboutquestions involving autonomy. They arrive at the consultingoffice in order to be supported, with the fear of discoveringthat what is taking place in the relationship may have nosolution and at times with symptoms which are not onlyemotional but also physical. Symptoms which frighten them andfor which they see no solution.Unfortunately, we don’t know the how in absolute terms. Anypossible clinical solution will once again be up to thecouple to bring to the setting in terms of their intention

for contact, thus reproducing in the setting the dynamicswhich are usually communicated.The therapist will be but a means to stress and point out thevalue of the intentionality of the relationship itself, wherethe stress will be not be put on bringing about the implicitas explicit (18. Spagnuolo Lobb 2011).

The possible specific interventions, about which I will speaklater on, are not that many in quantity, they are rather away of revisiting with the couple the steps in theintentionality of the contact towards possible autonomy.

Success, failure and insensibility at the contactfrontier

The first clarification which we must make is that durationis not synonymous with success. The statistics of the WorldHealth Organization are only statistics, they do not takeinto consideration that each experience leads to the growthor blocking of our relationship ability.In the world in whichwe live, that which does not evolve stagnates or disappears.The plenitude achieved in the relationship and thepossibility to find a nourishing contact that may result inthe enrichment of our self, constitute success by themselves.Not absolute success but enriching success, and allnourishing contact facilitates our growth (19. Salonia G2010). It is evident that at the present time the evaluation of eachexperience plays a decisive role in our choices. And thememory of these experiences helps us out at moments ofblockage or disorientation. To evaluate each experienceimplies as a minimum a certain level of autonomy and personalgrowth, an intentional sensibilization of the frontier ofcontact in which the “other” is seen as unique andirreplaceable, simply because of complementing with what ismost intimate in ourselves. It is the dimension in whichindividualism is dissolved and a repeatable “we” is co-created in future or past relationships.

In a word, the choice and support for a relationship is adance between figure and background. A figure which standsout with respect to the context. The process of formingfigure-background, always dynamic, which gives way to theemergence of the dominant figure sustained by a backgroundfilled with needs. (20.Robine JM1999).

My position when we talk about the affective relationships oftoday’s couples is that apparently our self manages to bringabout the emergence of that which the “other” shows as moreattractive or simply amplifies it. A selection of convenientaspects which make of the “other” an acceptable figure. Itwould seem that the evolution of our brain complies withpredetermined objectives during predetermined cycles,exposing the real or imaginary needs to the risks ofsearching for plenitude. This does not happen by chance, nordoes it take place without a certain degree of activeresponsibility in the selection, it has to do with abackground which has not been overlooked but rather noticed,which gives meaning to the choice of the other. It is herethat the concept of who we are and our circumstance becomesmore clear. We, as an “organism” relatively unsatisfied andseeking fulfillment, and the circumstance as an“environmental field” which we call upon to assist the lackof satisfaction, converting the field itself into a morevaluable element than the figure of the other. In a criticalsense and if it were possible, a choice outside therelationship itself.

The utilitarianism or speculation which I referred to abovewith so much emphasis is, in my opinion, an attack againstthe process of full contact, in which the figure becomesunstable and only serves as container but is not contained bythe field-environment, while the field-environment which theother offers us acquires the same relevance as the figure,emerging as the most important point of attention. A true keyfor the lack of satisfaction of post-modern contacts in whichthe field substitutes the plenitude of the we as integrated

figures. This mechanism, which is not a novelty in society,achieves greater relevance in post-modernity because it hastransformed itself into usage and habit of present times.(21,La Rosa 2011).

A second and necessary clarification which we must make isthat post-modernity is characterized by lack of sensibilityat the contact frontier (22.Spagnuolo Lobb 2011). This lackof sensibility has risen to such a degree as to make today’ssociety believe that sexuality does not leave marks on ouremotional memory or experience and that it does not gravitatein our life style and choices, almost an underestimation ofthe most intimate human experience, a sort of banalizationwhich ends up being taken lightly.

The intimate experience about which I speak when I insist inusing the word plenitude is that of two bodies whichrecognize the need for a symmetrical intentionality.

In order not to be, nor to pretend to be naive, we shouldalso respect an axiom of Gestalt unfortunately oftenforgotten. “I know that you know that I know…”, which evolvesas the relationship goes forward with “I feel that you feelthat I feel.” (23. Spagnuolo Lobb 2011).This inexorable principle of relational responsibility isalso inevitable, it is impossible to escape from thesubjective perception of the other or of the gravitation thatthat perception will have upon us. The verbalization of thisdynamic, understood as a Gestaltat to be dealt with as awhole will give the couple the key and the invitation to growtogether, an intentional sensibilization of the contactfrontier. This elemental principle is the field of clinicalexploration that will orient the therapist with respect tothe reality of the consulting couple and will also orient thecouple to become aware of the genuine feeling the other.For couples the verbalization of these axioms represents theopportunity to manifest common difficulties and theirpossible solution, it is the initial and permanent path forgrowing towards possible plenitude.

The suffering that results from the lack of relationalplenitude is too evident to be banalized. Sexuality and theintentionality of contact, which are part and motor of anyrelationship, are demanding attributes which impose clearconditions to be satisfactory. These conditions change ashistory evolves. They change to give way to aphenomenological field that is always in dynamic movement.What does not change with the lapse of time is the intimatecertainty of satisfaction or frustration.

So what are the minimum conditions for a relatively fullrelationship to be possible? What are the conditions thatwill make it fulfilling in the intimate sense?I will attempt to respond on the basis of the many couples Ihave seen in therapy and I will attempt to be faithful to thelimited number of common issues mentioned by most of thecouples. These aspects, which today I recognize as necessary,come from individual communications as well as from more thanone hundred couples that I interviewed and responded withintimate honesty. In fact, this summary conclusion is not aninvestigation but just the result of notes I have takenbetween 1990 and today.

The possible and the ideal in constant conflict withrelational superposition

As we said above, all nourishing contact not only relates to the self and therefore to our relational capability, but since it is nourishing it is a success in and by itself (24 Salonia G 2010), although when we think about a relationship we look beyond the immediate. This looking beyond the present, an inexorable but not very often positive human condition, obliges us to think about the satisfaction of a continued and repeatable contact. A continual present in ideal terms and a frustration that can be overcome in possible terms. Thus we could say that the intentionality of a relatively symmetric contact will be responsible for a sexual identification capable of going beyond genitality and

subsequently for the collective or individual ability to indistinctly resolve the conflicts in the relationship or in the surroundings.

As it can be seen, the requirements are not many but they arecomplicated to put into practice, and even more difficult toaccept when they are not complied with or when they are notpossible, based on rough statistics.

Therefore we begin to understand the intentionality ofcontact as something symmetric, something that occurs in the“momentary” dissolution of individualism. It is a mechanismin which the desires themselves are at stake with respect tothe desires of the other, and exactly where they should beput at stake, in the frontier of contact.

An understanding of this theoretical banality is not the endof this idea, but it serves to understand the differencebetween fusion and autonomy. We are not thinking of twoindividuals who fuse together in a common desire, rather werefer to two autonomies that encounter in their own and inthe common intentionality, without losing sight of the otheras different and novel. A symmetric intentionality in forceand clarity which presumes knowledge and letting the otherknow our objective. Although it is easier to say this than todo it, fortunately it always occurs intuitively andspontaneously.

Spontaneity is not always accompanied by the “becomingaware”, therefore a manifestation of asymmetricintentionality comes about when in the couple the differentobjectives overlap or there is lack of coincidence in time.This frustration relatively easy to overcome is and willalways be a call to attention concerning the difficulty, anopportunity to go beyond the blockade of the frustrationitself or to open a Gestalt which, if repeated and sustained,would have obvious consequences.

As we know, the interruptions of contact tend to becomestratified (24. Salonia 2003), something which we haveexplained above from the neurochemical point of view.

What does the idea of sexual identification mean to me interms of the couples I have been able to listen to inconsultations if we take sexuality as the letter ofpresentation of our self, as our “dental” way to open ourpath in the world, as the way to carry out our existence asbearers of our desires and with the contemporary capacity tocreatively adapt ourselves to fulfill or not to fulfillthem?. What does it mean if we understand that theconstitution of our sexuality is the sum of complete orinterrupted experiences, frustrated or satisfactory that havebeen accumulated in the baggage of our active or latentmemory?

Sexual identification with our “other” in the relationship isbut something we perceive as simultaneously complementary andantagonistic, attractive and arcane. Sexual identity iscomplementariness which allows us to dance a dance whosemusic is heard only in the relationship itself.

We feel great attraction for those who in a different waycomplement our life with “experiences” which lead to the sameend as that of our own intentionality. This form of“involuntary admiration” is what allows us to be surprised inthe “modality” of the other. Spagnuolo Lobb calls this the“novelty.” Goodman and Perls included this as a fundamentalexpression in their seminal work for Gestalt.

It is, when we speak of couples, the value of the other thattranscends the limits of the relationship. And also the meansused to approach the other in the world from our autonomousperspective.

I brings me a certain joy to bring back the word sexualityoriginated initially in psychoanalysis to dimension theversatility of the “psyche” in relation to the world, and to

integrate this ancient expression of so much clinical valueto the relational world, finally free it of the intra-psychiccharge it had before.

Thanks to the comprehension of the sexual identification withthe “other” we understand the intentionality of symmetric orpeer-based contacts and the resolution of conflicts inherentor concomitant to the relationship in a different anautonomous way. These are the unavoidable steps in theprocess of transition in the growth of the couple.

This is the foundation for an ideal though not idealizedrelationship, possible, practical and erotic. A relationshipbased on the synergic adaptation, creating antibodies againstidealization, dependency and the lack of emotional honesty; atask that sometimes is spontaneous, however it is a task.

Relational maladjustments as a result of therepeated interruption of contact

Not everything that shines is gold when we witness andparticipate in the maladjustments of the relationship andalone witness the self-imposed adaptive orphanage.

For some reason a dynamic appears as part of the lack ofadaptation for which “the I is more important than the we”.The usually desperate mechanisms displayed as a way to dealwith these differences are the result of cultural repetitionand of the lack of responsible realization of theconsequences of one’s own actions. Such mechanisms are notdefenses of an intra-physic matrix but rather a relationalbut useless search for complementariness which isdissatisfactory or even more dissatisfactory than theinterruption of contact itself.

In the face of the failure of encounters it is more frequentto invent reasons to reassure the relationship than to findout what we really want of the other and how much of that

which we desire is possible. It is here when the field isfertile for the appearance of lovers, new children, trips of“reconciliation,” moving homes and others, situations andsolutions which superficially could appear to be positive forthe relationship but which acquire a second spurious value.

At this point the possibility of a joint, symmetric andcreatively adjusted intentionality tied to the needs of thecouple moves away. In its place new compromises and/ or newfears appear. These new adaptations will be superimposed onthe previous adaptations which proved insufficient and failedto be satisfactory.

In the words of Jorge Luis Borges, “what brings us togetheris not love but terror, that is why I love you so much.” Orthe inspired words of Antonello Venditti which I cite at thebeginning of this article, may explain any and all of theaffective frustrations of humanity. Here the lack ofsatisfaction of an interrupted contact can be seen: afrustrated intentionality in which words of love are but thememory of “what no longer is and could not be.”

These words the poets chose with such precision do not referto a concrete conflict; they do not tell what happened. Theyonly manifest the impotence and the pain of the loveexperience that did not arrive at the desired end. Tounderstand that any process of interrupted contacts carrieswith it the lack of satisfaction that will impact the qualityof the relationship. But the genesis of this deteriorationoriginates in a non-reciprocal intentionality, rarelyexpressed clearly and out loud.

Certain confluent tendency to sustain “harmony” awaits thearrival of consciousness, or the end of the negation orphysical and emotional symptoms, to explode in lack ofharmony. The lack of harmony in the complaint in which the“other” should know, almost guess where and how the wound ofpersonal dissatisfaction was opened and how to heal it.

In addition to this the couples are not alone in thesituational and relational field. Different stimulus caninduce them to think that any dissatisfaction can besubstituted by new and different relationships, new ordifferent activities which enter the “field” to sidetrackattention from the conflict, no longer the conflict with the“other” but likewise with the intentionality of thefrustrated contact.

Then, that which gave meaning to the relational horizonappears to water down, so that once the process ofrestitution is completely faded, the process of inclusion ofthe other becomes even more difficult, perhaps a process ofinclusion that was speculative or genuinely the motor ofapproach. Once again individualism gains space and it is herethat the figure of the therapist becomes visible. At least ina few cases.

Criteria for specific intervention and somecommentaries

I recall the many and extraordinary criteria for interventionwhich I have followed with great attention for so many years.The ideas and articles of Joseph Zinker and Sonia Navis, themodel of family intervention of Valeria Conte and GiovanniSalonia and the latest publication of Margherita SpagnuoloLobb.

I cannot help remembering and recalling the wise andempirical words of the Argentine Gestaltist Marta Slemenson,who said that couples break up for the very motives that theybegan with. These words, the result of more than 40 years ofclinical practice with couples, are likewise the result of agenerous observation free of judgementalism. Thedissatisfaction with the contact functions as a continualdemand for satisfaction, lasting longer than the relationshipitself. In these simple words Marta pointed out the obscure

aspects of the choice of the other, obscure not for beingmacabre but for being “veiled” and not verbalized. Thesewords take me back to disquieting questions that always entermy mind when I work with couples. The many years of clinicalwork do not prevent me from also feeling the disturbing fearthat couples manifest in therapy and the disquieting fear ofhow much is at stake.

So as not to repeat once again concepts which have alreadybeen expressed, I am going to concentrate on the threeaspects referred to above related to ideal and possiblerelationships.

Clinical interventions will deal with three fundamentalaspects:

1) Developing a clear idea concerning the intentionality ofcontact that each member of the couple explains, silences orfeels. (“How much of the possible difficulties to be putforward in the contact frontier is a decision of the coupleitself and not of the therapist”).

2) Understanding if there exists and if it is possible toreevaluate the sexual identification with the other.

3) Finally, and as much as possible the couple’sverbalization of the resolution of difficulties inherent tothe couple itself or to the external factors which affect itindistinctly, individually and together.

Indeed, not all couples which function as such consciouslydevelop this relational modality, these positive andspontaneous aspects are experienced more intuitively thanreflexively. And not all couples that resist the lapse oftime focus attention or intention on all this. In the name ofvaried and valued excuses, more are the couples thatsacrifice plenitude than those that enjoy it. It isfundamental for us as clinicians to accept the limits, since

our fundamental role is that of limiting damages, even if wealso waive the ideal plenitude.

I am going to transcribe some phrases from my patients whichdescribe this idea crudely and often with hope.

“Everything is clear with her, we will continue until wecannot go on. Then we will both take our own path, certainlywithout violence.”

“I could not continue married to her in the face of theevidence of her lack of sensibility, not even the sickness ofone of our children was sufficient for her to look beyondherself.”

“He is getting old, with age he will become more dependent onme and less violent. I will still have to put up with someblows.”

“When I make love to her, when I look at her from a distance,interacting at work or with people on the street, when I seehow she dresses and undresses, I know that she is the woman Ialways wanted.”

“We are really fortunate, we love each other, we desire eachother, we admire each other and we respect each other. Wealways want to be together. And it has been that way for manyyears. I don’t know how many couples could say the samething.”

“As a man I don’t feel desired, I feel that she does what sheconsiders to be politically correct to assure that I continuethere where I am.”

“I don’t know what she wants of me, she has no interest inour daughter, nor in the children of her first marriage. Sheclaims a love that she does not manifest in her actions. Itwill be very difficult to separate and be able to continue in

contact with the girl. Sometimes I think that the only thingabout me that interests her is my body.”

General conclusions The aspects which make a relationship possible in asatisfactory way are not a synonym of inaccessibility nor arethey of unobtainable complexity. Human beings wish to beloved, acknowledged and supported, thousands of years ofevolution to pursue just that.

The neurochemical or relational reading that we do and whichwill continually be enriched and more profound is in the lastinstance just a reading. We are witnesses and players in howneeds and desires keep on changing, faster and faster overthe past few decades, to such an extent that some societieshave modified their laws to adapt to the changes. That is thecase of the English family law which gives family status to acouple that does not share the same house but maintainsintimate relations and have children. “Living apart together”(25. La Rosa 2011). The model for couple and family will inthe near future and without a doubt be different from what weknow today.

I believe that the insensibility of the contact frontiercharacteristic of post-modernity will not be eternal. I havearrived at this conclusion based on a psychobiologicalprinciple that asserts that which is extreme returns to itscontrary state. To the extent that a position becomes moreradicalized it wears out, its own energy dissipates and itseeks balance in the opposite.

One of the difficulties in working with couples was, is andwill be to recognize the intimate space of the couple as aplace of well-being and growth, value it and give it its fairand deserved importance.

A profound understanding of the neurochemical mechanisms wasfor me a way to endorse what the Gestalt theory hasmaintained for more than seventy years. In the face of thisevidence I can only feel moved. The guiding principle ofGestalt Psychotherapy continues to be aligned to the profoundhuman need to see ourselves in the eyes of the other, to hearourselves in the voice of the other and know that we arerepresented by the relationships we have been able toconstruct.

Faithful to the idea of combating the ghost of hypocrisy, wecan consider ourselves coherent with the theory, seeing asproof of that the sons of the body or the soul that weeducate and send out to the world to live by the possibilityof plenitude. We assume responsibility for probable mistakesand doubt not in putting our efforts to restore all that canbe restored.

Sergio Guido La Rosa Santiago de Chile 2014

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