Couples Voice Therapy

Following Robert Firestone's (see www.glendon.org) depth-cognitive-affective-behavioral approach, I use partners' pain as a catalyst to acknowledge their defenses, to confront the negative thought process that regulates the defenses, and to increase their tolerance for love. The goal of couples counselling is to resolve relationship problems and to learn to tolerate love.

In describing how I work with couples, I will begin by summarizing Robert Firestone's theory of the defenses and negative thought process that limit our ability to tolerate love. Then, I will illustrate this theory and the process of change using the clinical case of a couple with poor communication. Finally, I will describe the typical outcomes of couples counselling.

Theory of Defenses and the Negative Voice

As mentioned earlier, Firestone theorizes that to some extent all children form psychological defenses that originally help children survive emotional deprivation but which later underlie relationship problems in adult life.

According to Firestone, the primary defense is the fantasy bond. This is an imagined connection the infant or child forms with the primary care giver in the first years of life. When the young child is feeling alone, frightened, or emotionally deprived, the child imagines that the care giver is present, attending to its needs. This fantasy bond functions as a defense against separation anxiety,
interpersonal pain, and existential dread. It is highly effective as a defense because a human being's capacity for imagination provides partial gratification of needs and reduces tension. Without the fantasy bond, Firestone contends that the young child would be overwhelmed with anxiety and fears of annihilation.

Once children are hurt and form the primary defense, the fantasy bond, they progressively give up reaching out to their caregivers for nurture and love, and develop a defense called inwardness. Inwardness refers to a retreat into oneself, in which children learn to parent or feed themselves, to take care of their own feelings and emotional needs. Initially, children do this by thumb sucking. Later children learn other ways to gratify themselves: a favourite blanket or stuffy, masturbation, fantasy, solitary play, excessive eating, reading, TV and computer play.

As children become inward, learning to feed and gratify themselves internally, they develop a pseudo independent attitude, an illusion of self-sufficiency. The core attitude is "I can take care of myself." The defense of inwardness protects children against the pain of reaching out for love-food that may not be forthcoming, but leaves children emotionally impoverished and alone.

Inward children have a negative conception of themselves as bad, flawed, and deficient. This negative conception is also a defense against anxiety. It is only possible for small, dependent children to maintain the fantasy bond, the illusion that their parents are more loving and attentive than they really are, by seeing themselves in a negative light. When parents are at their worst behavior, children say to themselves, "Mommy and daddy are right to be angry. I'm the problem. I'm just a bad kid".

Children incorporate this negative view of themselves in the form of a negative thought process. By the time children are four or five, they have an identifiable negative thought process about themselves. A child will think, "I'm not smart. I'm not good enough. I suck." This negative thought process is internalized when parents are at their worst behavior, and express harsh, critical attitudes toward their children.

To recap, Firestone theorizes that when children are hurt, to some extent they pull away from a close attachment to their primary caregivers. In place of a close attachment, they form the fantasy bond, an imagined connection to their caregivers. This defense allays anxiety and provides an illusion of security. The child then goes into an inward state, characterized by self-feeding behavior and a pseudo independent attitude. In order to maintain the fantasy bond, the child develops a negative conception of self, characterized by a negative thought process, "I'm bad etc.".

What bearing do childhood defenses have on relationship problems in adulthood? Firestone contends that it is these same defenses which help children to survive pain that create problems in adult attachments.

When adults first meet and begin to court, they tend to relax their defenses, to risk being more open about themselves, to give and receive love freely. This is an exciting time, when people feel more alive, loving, and expansive. As time passes, adults tend to become more defended again. The fear of rejection or abandonment, as well as the sadness often evoked by positive emotions, creates anxiety. People experience that to remain open and loving is too painful and frightening, and they retreat from feeling close to a less open, more inward state.

Pulling back into a more defended, inward state reduces the fear of being hurt again, but it increases fears of insecurity and aloneness. The basic dilemma is that to some extent we are afraid of closeness, of being hurt again. At the same time, we are afraid of being alone. To solve this dilemma, we fall back on the defense that worked for us in childhood. We form a new fantasy bond, this time with our partner. At the same time that we pull back emotionally, we create an illusion of closeness that provides a feeling of security. The fantasy bond provides the illusion of closeness without the risks of close attachment.

Once partners form a new fantasy bond, they become more inward, and resume feeding themselves rather than reaching out for love-food. How adults feed themselves is similar to children, but more sophisticated. Adults feed themselves through vanity, eating disorders,
addiction to alcohol and other drugs, compulsive masturbation, and an impersonal, repetitive style of sexual relating. They also feed themselves through so-called positive habits and routines, such as excessive work, shopping, exercise, reading, TV, and computer activity.

Partners tend to have a hard time recognizing the fantasy bond between them. When it is suggested that their relationship is characterized by a fantasy bond, an illusion of closeness, rather than a close emotional attachment, people often say, "We are close. We do things together. We agree on issues and rarely fight. We exchange cards on important occasions and mark our wedding anniversary. We kiss on greeting, and have sex. What do you mean we aren't close?"

Closer examination of how the couple actually relates usually results in their recognizing that they aren't as close as they think they are, that they have difficulty tolerating love. They come to recognize that they go through the rituals and routines of being close, without real closeness. They come to recognize that they feel more alive and invested in life outside of the marriage than in the
marriage. They come to recognize that with each other, they feel shut down, maintaining little eye contact or communication, whereas outside of the marriage they feel lively and interesting. They come to recognize that each withholds giving and receiving positive responses and engages in his/her own ways of self-feeding, of gratifying themselves internally.

Adults, then, repeat the defenses that helped them survive emotionally in childhood. Because of this, there exists to some extent in all adults an inner conflict between gratifying themselves internally through fantasy, physical substances, and inward habit patterns, and reaching out for real gratification or love-food in close relationships. By adulthood, people have reached a psychological equilibrium with respect to this core conflict. In other words, they have come to feel comfortable with a certain balance between internal self- gratification and seeking gratification interpersonally. This equilibrium generally favors internal self-gratification. The more severe the childhood deprivation, the more the psychological equilibrium will favour internal gratification over seeking real satisfaction in the external world. Positive, loving experiences tip this psychological equilibrium, resulting in people pulling back to re-establish the equilibrium. This is the source of resistance to closer attachments. This is why it is difficult to tolerate love.

According to Firestone, our defenses are regulated by a negative thought process, called the negative inner voice or 'voice'. As mentioned earlier, the voice is internalized at a young age. The voice refers to a well-integrated pattern of hostile thoughts and attitudes that generates negative emotional states and self-destructive behavior, and causes people to reject positive experiences. The voice has a dual focus: it is critical and hostile toward the self, predisposing alienation from the self. It is also hostile and critical toward others, predisposing mistrust and alienation from others. The voice may be construed along a continuum of self- destructive thoughts, ranging from thoughts that are mildly critical of the self ("You should have worked harder"), to thoughts that are
punitive toward the self ("You're worthless"), to thoughts of self-annihilation ("You're not fit to live. Just get rid of yourself").

Firestone postulates that the voice and the defenses constitute an anti self-system, a destructive part of the personality, an enemy within. In his view, we have a divided self: on the one hand, the anti self-system; on the other hand, the healthy self-system. The anti self-system comprises our defenses and the voice which regulates the defenses. The healthy self-system comprises our rational thinking, wants, desires, goals, and values. Although people are conflicted internally between these two systems, the more they operate from the healthy self system, the more they are able to tolerate love.

The voice regulates the defenses, maintaining the psychological equilibrium in relationships. Let's examine a clinical case in order to more fully understand the role of the defenses and the negative inner voice in relationship problems and resistance to love.