Communication Failures: Secondary Complaints over Primary Demands in Family Psychotherapy

Abstract

This study aims to evaluate to what extent the initial family complaint of "lack of communication" may contain a relational mode characterized by anxiety and primitive defenses. This dynamic is evidenced by the unavailability of family members concerning the states of mind of each other, which hinders the recognition of otherness and difference. We conducted a research using clinical and qualitative methodology, conducting preliminary interviews with 16 families, belonging to middle, lower-middle and lower classes of the population of Rio de Janeiro, who sought treatment at the Service of Applied Psychology of a private university. We selected three out of the 16 clinical cases in order to illustrate the discussion. In the cases studied, we noticed that the precariousness of emotional exchange between family members hampers the joint search for understanding and the solution of family problems. We concluded that family psychotherapy, by recognizing individual autonomy and providing openness to emotional idiosyncrasies, promotes an efficient communication and, thus, family emotional health.

Keywords:
Communication; family; psychotherapy demand; family psychotherapy

Resumo

Este trabalho tem por objetivo avaliar em que medida a queixa inicial da família centrada na "falta de comunicação" pode enunciar um modo de funcionamento relacional marcado por ansiedades e defesas primitivas. Tal funcionamento se expressa na indisponibilidade dos membros da família em relação aos estados emocionais estabelecidos entre eles, dificultando o reconhecimento da alteridade e da diferença. Desenvolvemos uma pesquisa com metodologia clínico-qualitativa, focalizando as entrevistas preliminares com 16 famílias, pertencentes aos segmentos médios, médio-baixos e baixos da população carioca, atendidas no Serviço de Psicologia Aplicada de uma universidade privada. Selecionamos três dos 16 casos clínicos para ilustrar a discussão. Observamos, nos casos estudados, que a precariedade da troca emocional entre os membros da família dificulta a busca conjunta por entendimento e solução para problemas familiares. Concluímos que a psicoterapia de família, buscando reconhecimento da autonomia individual e a abertura para as idiossincrasias emocionais, se mostra fundamental para que a comunicação seja eficaz, promovendo saúde emocional familiar.

Palavras-chave:
Comunicação; família; demanda de psicoterapia; psicoterapia familiar

Resumen

Este estudio tiene como objetivo evaluar el grado en que la queja referente a las "fallas de comunicación", presentada por la familia al inicio de la psicoterapia, puede contener la manera relacional marcada por la ansiedad y defensas primitivas. Esta dinámica se expresa en la indisponibilidad de los miembros de la familia en relación a los estados emocionales entre ellos, lo que dificulta el reconocimiento de la alteridad y de la diferencia. Desarrollamos una investigación con metodología clínica-cualitativa, realizando entrevistas preliminares con 16 familias, pertenecientes a los segmentos medios, medio-bajos y bajos de la población de Rio de Janeiro, que frecuentaron el Servicio de Psicología Aplicada de una universidad privada. Seleccionamos tres de los 16 casos clínicos para ilustrar la discusión. En los casos estudiados, observamos que la precariedad del intercambio emocional entre los miembros de la familia dificulta la búsqueda conjunta por entendimiento y la solución de problemas familiares. Concluimos que la psicoterapia de familia, al reconocer la autonomía individual y dar apertura para las idiosincrasias emocionales, promueve una comunicación eficaz y, consecuentemente, la salud emocional familiar.

Palabras clave:
Comunicación; familia; demanda de psicoterapia; psicoterapia familiar

In our clinical work with families, we realized that most families pursue psychotherapy to address a complaint regarding the symptomatic behavior of one of its members or some specific difficulty. However, as we evaluate the family's intersubjective functioning, we observe that the initial complaint makes only a portion of the conflicts explicit. Thus, we believe that a careful family evaluation during the preliminary interviews of family psychotherapy must investigate beyond the obvious complaint, moving toward the unconscious motivations of the intersubjective suffering. This suffering is the core of the shared family demand; it belongs to interpsychic space, which comprises primary demands that are often incomprehensible to the entire group (Machado, Féres-Carneiro, & Magalhães, 2011).

Therefore, we have postulated that the psychotherapist's initial work aims to move the family from a symptomatic complaint to an incipient enunciation of fantasies, affections and conscious and unconscious relational patterns. Such work allows the family to perceive each member's role in the suffering rather than distancing themselves or viewing themselves as victims. This work enables the transformation from a familiar passive position with repetitive routines to a more active and creative attitude toward the relationships among family members.

The preliminary interview period allows the psychotherapist to understand what type of unconscious demands the family makes and the family's desire to transform (Rocha, 2011). This is a "craft" work; its realization comes from the recognition and understanding of intense emotional experiences that are articulated as defense mechanisms and certain family relationship patterns.

In the framework of these considerations, the goal of this work is to assess the extent to which the initial family complaint of "lack of communication" can express a relational functioning mode marked by anxiety and primitive defenses. This work was drawn from the clinical psychoanalytic and systemic approaches with families proposed by different authors (Féres-Carneiro, 1996; Flaskas & Pocock, 2009; Lemaire, 1982; Nicolló, 1988).

Preliminar. In terviews with Families

The beginning of psychotherapy, whether individual or familial, is an important moment that requires careful listening and sensitive handling by the psychotherapist. This initial period is specific and different from the treatment and is composed of preliminary interviews that are part of a clinical method (Bleger, 1980/2001). The investigation must be broad, prioritizing an understanding of the subject or the family, understanding the request for help and what is behind the apparent complaint, and seeking a diagnosis and an indication for psychotherapy (Machado, Féres-Carneiro, & Magalhaes, 2008, 2011).

It is fundamental that the family understands the importance of joint treatment. Therefore, the construction of a family demand is essential so that each member comes to the first interview with goals and motivations of his or her own. Often, these differences contribute to the presentation of a puzzling collective speech, and the psychotherapist's role is to help the family establish a shared demand (Eiguer, 1985).

When we face a new family, we are in a field of questioning and, above all, of uncertainties, which call our theoretical-clinical knowledge into question. Rait (2010) states that the first interview with the family or couple has characteristics similar to those of a blind date and involve anxiety, unfamiliarity and estrangement.

The preliminary interviews with families involve a dive in the complexity of the family system that can drown us if we are unable to think in terms of latent reasons for the joint suffering. This process involves making what is obscure in the "here and now" emerge through the exchange of thought associations, and it favors a transformation among all family members from acting out to symbolization and implication in relation to their complaints (Machado et al., 2011).

The Enunciation of Latent Thoughts and the Logic Underlying Communication

Unconscious discovery has been a major aspect of psychoanalysis since its Viennese beginnings. It assumes the presence of two distinct records of psychic functioning: the conscious and the unconscious. In his main work regarding the interpretation of dreams, Freud (1900/1996) makes the distinction between manifest content and latent thoughts; the first is accessible to consciousness, while the second is entirely unconscious. In this sense, Freud refers to the manifest content and latent thoughts as two distinct modes of expression that comprise logical and distinct domains.

From this perspective, the manifest content is established as a distortion of latent thoughts. In this sense, Freud refers to the process by which latent thoughts are transformed into manifest content as distortion work. The opposite process, starting from the manifest content and working toward the latent thoughts, is the work of interpretation. In deed, the Freudian idea is that there are two different psychic texts, the original and its translation. Stating the presence of a translation implies the existence of a concealing language that is distinct from conscious verbalization. This highlights the fact that our work is dealing with two different modes of communication.

The word "communicate" originates from the Latin word comunicare, which means "make common" or "make known" (Cunha, 2010) and describes the transmission of certain information to the interlocutor (i.e., it is an action intended to establish contact with the other). According to Winnicott (1963/1983), "communication originates from silence" (p. 173) to the extent silent communication is assumed to occur between the self and the other through the vitality of the senses, prior to the primacy of verbal language. The Winnicottian perspective, therefore, grants narrative value to sensory, perceptual and motor elements that are not expressed through words. McDougall (1978/1983) adds that the act of communicating refers to being in a relationship through which it becomes possible to be truly in contact with the other at the most different relational levels.

With this purpose, Roussillon (2005) underscores the existence of "mime-gesture-posture communication", although discourse is, in principle, a more effective means of communication. Thus, the informational role of communication is presented as secondary in the face of primitive exchanges. Therefore, it is important to pay attention to the emotional mood with which words are spoken (i.e., we should notice both the nonverbal and verbal content, as both are fundamental to communication).

Communication within the Family

Communication was the first phenomenon studied at the beginning of the theoretical-methodological construction of the family therapy field. In 1950, Gregory Bateson was one of the pioneers who studied pathological communication in families with psychotic members. Sequences of ambivalent, chaotic and ambiguous situations in this family context, which favored the relational disruption and pathology, attracted his attention (Bateson, Jackson, Haley, & Weak-land, 1956). In this first study, we can identify the pursuit of an understanding of communication beyond words that sought to extend the understanding of how the words are spoken and thus give emphasis to the relational. It was believed that the rules of the relationship defined the interactions and the ways in which family members behaved when communicating (Zordan, Dellatorre, & Wieczorek, 2012).

Communication theory, which focuses on the pragmatic dimension, proposes one of the most important and rich conceptions for articulation with other theoretical perspectives in its first axiom. This axiom asserts that all communication is an "act" that affects relating, and that in this act, words are only a part of what is being said and that even in their absence, a message will always be sent. Thus, the first discussions about how a family's affective interaction creates qualities that are peculiar to their messages in the interactional game began (Costa, 2010).

To Elkaïm (2008), communication is a resource for (re)formulating intersubjective issues. Difficulties in communication attempts within the family can discourage its members from talking openly about fears and certain experiences out of fear of rejection. In these circumstances, there likely is a chaotic communication circuit promoting a "make known" deterrent that prevents more authentic contact within the family.

Recently, interest in investigating the role of communication in the interactional family game has grown (Floyd & Morman, 2014; Galvin, Braithwaite, & Bylund, 2016). A study conducted by Portugal and Isabel (2013) found that parents and children considered communication essential for understanding each other. The data revealed that metacommunication attempts were valued, considering that parents reported seeking to clarify the interaction with their children. Such attempts did not prevent problems with communication, such as the lack of clarity and directionality.

To discover communication strategies in the relationship between children and parents, Wagner, Carpenedo, Melo and Silveira (2005) studied 12- to 15-year-old teenagers in focal groups in which they discussed aspects that could act as facilitators or obstacles in communication with their parents. The adolescents reported that the parents' bad mood created a barrier to the dialog. Another significant finding was that teenagers avoid addressing serious issues when their parents are busy. However, it is interesting to note that they also take advantage of their parents' distraction when broaching subjects that they find unpleasant, such as getting a bad grade at school, because that way they will have little time to discuss the matter.

With this in mind, we consider that the goal of communication is to contact and establish an emotional connection with the other person. At some point in the communication effort, we come across the old question whose answer we all wish to know: What goes on in the other person's mind? In this sense, Elkaïm (2014) emphasized that to achieve clarity and effective communication within the family, its members must recognize the other; that is, they must accept the difference and the autonomy of the other family members as people other than themselves. With the aim of deepening of this reasoning, psychoanalytic theory broadly developed this theme in its discussion of primitive communication. Such communication begins with the subject's first relational experiences, which are related to the figure that plays the mothering role.

Primitive Relationships

The psychoanalytic understanding of the subject's constitution implies that the subject thinks his or her birth was preceded by family speech that anticipated his place and his condition in the world. In this sense, Aulagnier (1990) states that every subject born into a "speaking space" that will have a great influence on structuring his ego. This "speaking space" is formed by the maternal and paternal desire, the costumes and the idiosyncrasies of the internal world of the parents in relation to the baby.

Arising from this bias, the ego is an historicized psychic instance that inserts the baby into an order, a symbolic time point that is immersed in the unconscious Oedipal plot of his parents (Scatolin, 2011). According to Aulagnier (1990), the baby's ego is anticipated by the ego of the mother when she interprets it in terms of her emotional experiences. Thus, a primitive communication emerges that sustains and meets the basic needs of the baby - both at the physical and emotional level: the newborn communicates its intense experiences and its mother, in turn, experiences such intensity herself and becomes able to translate it. At this early moment of the subject's existence, his or her interaction with the external environment occurs through psychic processes, especially those of the primary order that seek meaning and psychic binding (Aulagnier, 2010).

This "speaking space" must provide the infant an understanding of his or her communications, which occur through signs, sensory perceptions and reactions to internal and external stimuli, offering meaning to what does not have a representation. According to Bion (1965/1991), the mother welcomes the baby's emotional states and returns them as processed elements that can be thought through, dreamed of, and fantasized about. From this process arises communication strength, which is established in the first exchanges of the infant with its first objects and precedes the acquisition of verbal language.

According to McDougall (1978/1983), primitive communication corresponds to a pursuit of the meaning of the act, and it is the mother, as the infant's life source, who should make herself libidinously available to be the baby's thinking apparatus. Through its sensory experiences, the baby searches for someone who can receive him or her and share what is still unspeakable, thus providing relief from pulsional pressures possible. Therefore, the newborn needs to sustain a fusional state with his mother as an archaic form of relationship because separation can be experienced as a form of abandonment or punishment. In this unsaturated mother-baby unit, the infant refuses the status of being a separate subject with his or her own emotions and independent ideas.

In this context, Aulagnier (2010) mentions that the voice of the other can be proof that the experience of this unit is false, revealing the presence of the gap between speaker and listener. However, the same voice that reveals the separation also enunciates the interpretation of signs regarding the baby's states of existence. To do this, it is essential that the other allows and wants to be the target of archaic defenses of the introjection-projection type and self-cleavage, whose effect results in the baby's narcissistic balance (McDougall, 1978/1983). It is important to emphasize that the baby gradually learns from maternal continence how to process and communicate his or her experiences. Aulagnier (2010) states that at this point, it is important to highlight the construction of a co-presence in the language in which primary significances form and serve as the basis of psychic productions.

In clinical practice with families, one can observe failures in primitive communication, which is an indication of the existence a minimally responsive relational environment and makes it difficult for children to have an early experience of true communication with the other (McDougall, 1978/1983). Thus, we can say that one of the fundamental marks left on the subject is the precariousness of establishing communication with him- or herself, which leaves the child unable to recognize his or her emotional states or those of others.

Method

With the aim of determining the extent to which initial family complaints of a "lack of communication" can indicate a relational functioning mode marked by anxieties and primitive defenses, we developed a survey based on a clinical-qualitative methodology (Turato, 2013) for preliminary interviews with families.

Participants

The sample comprised 16 families with at least one child and a maximum of six children of varying ages who sought care at the Applied Psychology Service of Pontifícia Universidade Católica do Rio de Janeiro in 2014 and 2015. The family members were distributed as follows: 14 mothers, 11 fathers, 1 stepmother and 3 stepfathers, aged between 26 and 65 years; 14 children and pre-teens between 3 and 12 years, 13 adolescent children between 13 and 17 years and 6 young adults between 19 and 25 years. The families belonged to the average, low-average and low socioeconomic segments of the Rio de Janeiro population, and their relationship statuses were distributed as follows: 6 married/in a stable union, 2 separated, 6 remarried, and 2 single parents. Only 1 of the 16 families was same-sex; in that family, the parents were male and remarried. Of the 16 families, we selected 3 for this study that illustrated the problem in question.

Procedures

Preliminary interviews (approximately six interviews with each family) were performed by interns of the Family and Couple Psychotherapy teams at the university where the study was performed. The interviews were recorded according to the clinical report model. The data were analyzed to investigate the prevalent thematic issues raised by the families during the evaluation period. The study focused on the complaints presented and the latent factors described in the reports.

The project that originated this research was approved by the Research Ethics Committee of the institution where it was developed. The nature of the Applied Psychology Service as a school clinic was initially explained to the patients, as was the confidentiality regarding patient identification. All participants signed a. In formed Consent Form allowing the use of their data in teaching, research and publication.

Presentation of Three Clinical Cases

The clinical reports of preliminary interviews were analyzed with a focus on the reported complaints, the reasons for the family's latent suffering and the main existing conflicts. The initial complaint of most of the 16 families seen was directly or indirectly linked to issues related to family communication. We realize that when families complain about relationship issues, they report difficulties in communication, such as fights, experiencing little understanding of one another and failures to recognize the other as a separate individual. Of the 16 families, we chose to present and discuss three cases that illustrated the problems related to precarious communication. This problem is linked to issues such as primitive communication and early emotional states, which are exhibited through performances in the relational field.

Case 1

Family Configuration. A 58-year-old mother, separated, living with two daughters, one 25 years old and the other 21 years old. The father is remarried and remains present in the daily lives of their daughters.

The mother and daughters sought family care because, according to them, they were having significant relational problems because of constant disagreements that trigged fights, a lack of listening and misunderstandings. They named the following as the main reasons for their fights: the loss of privacy when the older daughter took her fiancé home and the mother's interference in the lives of her daughters, who defined her as controlling and without a life of her own. "If she could, she would do everything for us", one of the daughters said. During the interviews, the mother's interference in her daughters' autonomous lives became explicit, as did the quality of the family relationship. One of the daughters described the invasive aspect of her mother by comparing her to one hand: "She wants to hold everyone's hand". The father was described as someone who is present, whose guidelines are respected and, above all, heard by daughters. According to the mother, he just talks and does not fight, which makes the daughters relate well to him.

This description shows the degree to which the mother camouflages her difficulties with having a life of her own and takes over the lives of her daughters. The mother justified her directions by her desire to meet the needs and well-being of her daughters. However, when we looked more deeply into the family dynamics, we see that these behaviors aimed to meet the mother's own primitive demands, such as anxiety caused by helplessness and abandonment. This makes it difficult, for example, for the eldest daughter to leave home to live with her boyfriend, even though the couple already has a house of their own. As a result, we see that the daughters are unavailable to listen to the mother, but at the same time, they meet early aspects of the demands and therefore are ambivalent about achieving independence.

Case 2

Family Configuration. A separated mother with an 11-year-old daughter who never met her biological father. The mother's boyfriend, who is not acting in a parental role, has lived with them for 4 years.

The mother sought help complaining that she did not know how to relate to her daughter, especially after the daughter presented antisocial behavior of stealing money and mail from the neighbors. The mother and daughter stated that they interacted very little because the mother works hard to support them financially. They were emotionally distant from each other despite an explicit relational entanglement in which they slept in the same bedroom while the mother's boyfriend slept in the living room: "We say the time available for these interactions is very, very scarce". The daughter complained about the absence of the mother, who, when she has time at home, prefers to visit friends, with whom the girl established an idealized parental transfer. Regarding the absence of biological father, the daughter said that she was used to the situation and is no longer be affected by it.

The third person (the biological father/boyfriend) is defensively rejected in this relationship. In this case, it seems that there is no learning to truly communicate with one another, as illustrated in the complaints about the lack of time the mother and daughter have together. The mother and daughter are entangled and therefore cannot establish contact because for that to occur, two minimally independent and differentiate subjects would need to be present.

Case 3

Family Configuration. A 43-year-old mother and a 46-year-old father who are married and have children from previous relationships; they also have a 6-year-old daughter together.

The mother sought psychotherapeutic help for complaints that neither she nor her husband know how to relate with their daughter. They blame the large generational difference between them and their daughter, which triggers numerous fights in several situations of routine family life. They find it difficult to see themselves as adults and actually occupy a different place in the generational chain, possibly contributing to their intolerance regarding the difference between the generations.

As the preliminary interviews advanced, the couple was able to verbalize marital conflicts, which, according to the mother, stem from the husband's preference for "first" family. The mother and daughter presented a merged relationship represented by the fact that they sleep together in the same bedroom while the father sleeps in another bedroom. The mother mentioned experiences of constant rejection linked to her family of origin because she had to take care of her seven siblings and her mother never gave her attention. She also reported that she was raised by her maternal grandmother and was left by her own mother. The rejection that she had lived was being relived in the ambiguous relationship with the daughter and in her marital relationship, as in her assumption that her husband preferred his children from his first marriage.

During the interviews, the six-year-old daughter became angry and hostile when talking about the subjects discussed in the setting. She seems to be in the place of the child that her mother could not be; thus, the relationship between the two is predominantly like a mother-baby relationship in which there is a refusal to separate. Consequently, the husband cannot take his place, and there is no recognition of his participation in the parental couple.

Discussion

In the three cases presented in this study, we observed how relationship rules define the interaction and the conduct of family members when they communicate, as stated by Zordan et al. (2012). However, it was also possible to observe how these rules are founded in very primitive experiences of linking with one another, which are characterized by separation anxiety that causes discrimination between the self and the non-self ends to be experienced as something persecutory (Aulagnier, 2010; McDougall, 1978/1983).

In the studied cases, we observed that the verbal exchanges in these families were worn out and ineffective for solving problems. The families themselves recognized and verbalized that the failure of this mode of communication was the central factor in their suffering. However, what the family presented as the complaint was secondary to the primary need to address failures in the constitution of the family's psychic apparatus. The communication mode thereby reveals failures in the constitution of a thinking apparatus, one of the primary functions of the mothering bond, by which aspects that are not represented are inscribed in the symbolic field. The aggressive verbal exchanges, especially in fights, are more like a family performance of yet-unrepresented aspects. That is, we realized that the family members made too much "noise", like the cries of a baby, thirsty for communication and meaning (McDougall, 1983/1978).

In this sense, we understand that complaints regarding fights and difficulties relating are signs of suffering in the face of the precariousness of seeking an authentic and emotional exchange with the other. Under such circumstances, fights occur as an act that communicates the desire to deeply connect and possibly change something.

These families had difficulty being in relationships, as shown in Case 2. In this case, the behavior of the daughter, robbery, was a cry for help. In this cry, there was an unconscious demand to compose a "stolen" identity insofar as her parents were missing (Scatolin, 2011). The daughter stole money and mail in an attempt to rescue affection, which is based in primitive communication. This confirms the statements by McDougall (1983/1978) that effective communication requires availability for real contact. Palazzoli (2000) highlights that the verbal exchange is often presented as a restricted resource and that communication is an act beyond words.

We studied the similarities among the cases regarding the inability to recognize the other's autonomy and the difficulty of dealing with a third person who necessarily separates and excludes the parties. In Case 3, the husband cannot occupy his place because to be two, there must be a third party that separates the bonded pair and introduces the awareness of the gap (Aulagnier, 2010). For family communication to be clear and possible, each party needs to recognize the other as a separate subject from his or herself (Elkaïm, 2014).

We identified that the adult identity of parents was not integrated, making it difficult for them to occupy a place different from that of their children in the generational chain. The childish aspects of the parents end up echoing in their relational patterns, often creating difficulties with building mature relationships. A mature relationship requires to the ability to address frustrations with the limitations of every human being and with interdependence in relationships.

Final Considerations

Among the families studied here, the childish defense mechanism seemed to predominate as a means of repelling differences. Generational differences, the asymmetry of places, and the independence of the subject are rejected, despite being inexorable elements of structure in the parent-child relationship. As a result, we observe the abandonment of the parental function and the parents' internal availability as the family's continent apparatus. It is important to highlight the need to identify primitive emotional states in addition to the verbalized content in preliminary interviews with families so that both aspects of communication are integrated over the treatment period and worked out together.

One of the difficulties of developing this clinical-qualitative study with families involved the fact that the reports were not constructed directly by the authors and instead were obtained from the relevant institutions. Therefore, they represent a written posteriori collective production, which presents restrictions in our picture of the complexity of family care, including such issues as observing non-verbal and sensory phenomena, the place of the transference and countertransference, and the family dynamics in the session. We believe that these restrictions points to the growing need for greater knowledge and methodological study of clinical cases involving families seen at institutions.

Finally, this work provided access to relevant issues related to family functioning. In this respect, we observed that secondary complaints, such as communication failures between the studied family members, point to a primary demand for real psychic contact and thought capacity in a relationship. Thus, we consider that when the family is able to understand the miscommunications, new communication modes can be created and instituted, in turn generating new ways of being in a relationship. This discussion is the starting point for new research studies.

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Publication Dates

• Publication in this collection
  Oct-Dec 2017

History

• Received
  16 June 2016
• Reviewed
  25 Aug 2016
• Accepted
  02 Sept 2016