Attraction and Attachment

• •
Understanding Styles
of Relationships
This page intentionally left blank
 Attraction
and Attachment:
Understanding Styles
of Relationships

Barbara Jo Brothers
Editor
First Published 1993 by The Haworth Press, Inc.
Published 2013 by Routledge
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Attraction and Attachment: Understanding Styles o f Relationships has also been published as Jour­
nal o f Couples Therapy, Volume 4, Numbers 1/2 1993.
© 1993 by Taylor & Francis. All rights reserved. No part of this work may be reproduced or
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Reprinted 2009 by Routledge

Library of Congress Cataloging-in-Publication Data

Attraction and attachment : understanding styles of relationships /

Barbara Jo Brothers, editor.
p. cm.
“Attraction and attachment has also been published as Journal of couples therapy, volume 4,
numbers 1/2,1993”-T.p. verso.
Includes bibliographical references.
ISBN 1-56024-620-0 (alk. paper)
1. Man-woman relationships. 2. Marriages. 3. Marital psychotherapy. I. Brothers, Barbara,
1940-
HQ801.A825 1993 93-42448
306.8l-dc20 CIP

ISBN 978-1-315-80118-6 (elSBN)

 Attraction and Attachment:
Understanding Styles
of Relationships

CONTENTS

Balance and Attachment and-Sometimes-Love 1

Barbara Jo Brothers
Six Ways of Making ‘Us’ 3

Marriage and Attachment: An Exploration

of Ten Long-Term Marriages 13
Alyce Jackson
Overview of Results 14
Continuity 15
Discontinuity 17
Insight and Change 19
The Interpersonal Context for Change 22
The Role of Marriage 23
Conclusions 28

Objects of Heart’s Desire 31

Bruce J. Schell

Response to Bruce J. Schell’s Article: “Objects of Heart’s

Desire” 39
Aliya Alexana
Sexual Intimacy-Towards Equal Relationships Between Men
and Women (with Treatment Assistance of a Computer
Program) 41
Louis Sommeling
Towards a Psychology of Human Sexuality 42
Male Sexuality and Object Relation Theory 50
With a Little Help of the Computer 55

The Mating Game: What We Know and What We

Don’t Know 61
Joan Atwood
Biological Theories of Mate Selection 62
Social Psychological Theories of Mate Selection 63
Psychological Theories of Mate Selection 68
Discussion 77

An Overview of the Historical and Empirical Antecedents

in the Development of the Codependency Concept 89
Frank P. Troise
Introduction 90
Contemporary Codependency Theory 91
The “Disturbed Personality” Theory 92
The “Disturbed Personality Theory”: A Feminist
Perspective 94
The “Stress” Theory 95
Empirical Study of the Capacity for Intimacy in Wives
of Alcoholics or Codependents 98
Discussion 99

Codependency and Depression: A Correlational Study 105

Betsey Backe
Erin L. Bonck
Marie L. Riley
Methodology 112
Results 114
Discussion 117
The Acceptability of Alternative Treatment Formats
of Relationship Therapy: Ratings by Premarital
Subjects 129
Marian R. Flammang
Gregory L. Wilson
Methods 131
Results 134
Discussion 138

Change, Vulnerability, Fear, and Taking Risks-

An Interview with Virginia Satir 141
Sheldon Starr
 ABOUT THE EDITOR

Barbara Jo Brothers, MSW, BCD, a Diplomate in Clinical Social

Work, National Association of Social Workers, is in private practice in
New Orleans. She received her BA from the University of Texas and
her MSW from Tulane University, where she is currently on the facul­
ty. She was Editor of The Newsletter o f the American Academy of
Psychotherapists from 1976 to 1985, and was Associate Editor of
Voices: The Art and Science o f Psychotherapy from 1979 to 1989.
She has nearly 30 years of experience, in both the public and private
sectors, helping people to form skills that will enable them to connect
emotionally. The author of numerous articles and book chapters on
authenticity in human relating, she has advocated healthy, congruent
communication that builds intimacy as opposed to destructive, incon-
gruent communication which blocks intimacy. In addition to her
many years of direct work with couples and families, Ms. Brothers
has led numerous workshops on teaching communication in families
and has also played an integral role in the development of training pro­
grams in family therapy for mental health workers throughout the
Louisiana state mental health system. She is a board member of the
Institute for International Connections, a non-profit organization for
cross-cultural professional development focused on training and
cross-cultural exchange with psychotherapists in Russia, republics
once part of what used to be the Soviet Union, and other Eastern Euro­
pean countries.
 Balance and Attachment
and-Sometimes-Love
Barbara Jo Brothers

Love does not take you off balance.

-Virginia Satir, July 12, 1968

SUMMARY. A brief discussion of balance in family systems and

various forms of attachment between couples observed by Virginia
Satir; “ Six Ways of Making ‘Us.’ ” Illustrations are included.

As therapists, we all know there is much in this world that passes

for love and has far more to do with leftover dependency needs and
unresolved attachment issues. The person in chronic disharmony
within herself or himself is, emotionally, in no position to be in
harmony with a partner unless both partners are much more aware
of their respective inner selves than most people are inclined to be.
Thus, they seek blindly to bring their system into balance and they
make the desperate thrust for attachment, rather than the discovery
of loving connection.
As I thought about those various forms of “love impostors” and
this volume’s theme-“Attractions and Attachments”-! remem-

[Haworth co-indexing entry note]: “Balance and Attachment and-Sometimes-Love,’* Brothers,

Barbara Jo. Co-published simultaneously in the Journal of Couples Therapy (The Haworth Press, Inc.)
Vol. 4, No. 1/2,1993, pp. 1-11; and: Attraction and Attachment: Understanding Styles of Relationships
(ed: Barbara Jo Brothers) The Haworth Press, Inc., 1993, pp. 1-11. Multiple copies of this article/chap­
ter may be purchased from The Haworth Document Delivery Center [1-800-3-HAWORTH; 9:00 a.m. -
5:00 p.m. (EST)].

© 1993 by The Haworth Press, Inc. All rights reserved. 1

2 Attraction and Attachment: Understanding Styles of Relationships

bered Virginia Satir speaking about these matters in terms of bal­

ance in family systems:
All families work toward wholeness, [but] probably the bal­
ance is going to require terrible things, a terrible price . . . We
have to think of balance as what price does each part [of the
system] play in order to keep the balance . . . If one part pays
more than another part, then the thing is destructive . . . what
price do you pay in order to “keep a balance?” Some of us
have paid half of our lives for a balance so we shouldn’t
disturb anybody . . . (1982, p.73)
Balance is achieved at too big a price, for one part is against
another. Backs hurt and genitals don’t work and all kinds of
other stuff in relation to this. (1982, p. 126)
Virginia’s definition of “mental health” (a term of which she was
not particularly fond, but used here for want of a better one) was a
behavioral one: to achieve it, people would (1) give up static, styl­
ized—and, therefore, “unhealthy” responses for coping with their
self doubt, (2) learn to honor their feelings as a step in honoring
their own identity, (3) then chose, instead, authentic responses that
fit the given occasion.
In a couple of the earliest Satir workshops that I attended, Virgin­
ia presented her observations about relationships between couples,
using her now well-known method of placing volunteer role players
from the audience in sculpted body positions. “Six Ways of Making
‘Us’ was how she captioned her discussion of styles of relation­
ship among couples. As I had found the images very useful through
the years, I have included, in the next few pages, my own illustra­
tions from my notes taken at the workshops. (See Figures 1-6.) I
have not found them indexed, as such, in any of the major works
that present her model.

1. Virginia Satir. Speaker: July, 1968. Week-long seminar sponsored by

NASW Southern Regional Institute, Biloxi, Mississippi: August 1971. Month­
long seminar sponsored by the Evergreen Institute, Eveigreen, Colorado. Except
for a very brief, unlabeled, description of “the drag” and reference to “victim/
victimizer” under “Positive Pairing” in The New Peoplemaking, p. 326, these
“six ways” do not appear in the books on the Satir model.
 Barbara Jo Brothers 3

Her point was that all six of the illustrated ways inhibit indepen­
dent action and growth and mitigate against “standing on one’s own
two feet.” In all six, the balance of one depends on the other.

SIX WAYS OF MAKING ‘US’

Siamese Twins: this is the symbiotic relationship wherein it

seems that neither member of the pair can take a step without the
other; it may look like they are separate people, but they share a
common backbone. “Siamese Twins” can be performed by people

FIGURE 1. SIAMESE TWINS

4 Attraction and Attachment: Understanding Styles of Relationships

FIGURE 2. SUFFOCATION

whose stress response is super-reasonable (Satir, 1988, 1991) when

the emphasis is more on “head” than “heart.” There would be a
lack of emotional connection if they were to move apart.
Suffocation: a variation of the symbiotic relationship, but with
more intensity of feeling and less “room to breathe.” “You are my
whole world” ; mutual placation prevails.
Leaning on Each Other: a mutually dependent stance where
each person would topple if the other made an independent
move; it looks like space between them, but contact is rather
meager.
The Drag: can be seen in “old-fashioned” marriages where the
husband is head of the household and “takes care of” the woman;
can be seen in marriages where the long-suffering wife “takes care
of” the alcoholic husband.
 Barbara Jo Brothers 5

FIGURE 3. LEANING ON EACH OTHER

Victim/Victimizer: husbands “ hen-pecked” by wives and

wives battered by husbands are two ends of a continuum of this
position.
Adoration: one of the members of the couple put the other on a
pedestal; generally, there is no sex between them-they are together
for “spiritual” reasons.
It was Virginia’s ambition to free couples from the static, reflex
defensive responses to their pain by giving them access to their own
inner resources. She believed deeply in the essential value of every
human being. For her, a person was a marvel, a unique creation in
the cosmos. She wanted to give back to each family member with
whom she worked, the gift of his/her own self which would provide
the energy and motivation for that person taking active charge of
her/his own life.
0\

FIGURE 4. THE DRAG

4A
HB
 FIGURE 5. VICTIM/VICTIMIZER

5h
5F
Oo FIGURE 6. So-Called “SPIRITUAL” RELATIONSHIP
 Barbara Jo Brothers 9

. . . There are pieces we need to retrieve that will help us to

move to where we can be what I call in charge of our own life.
Another way of talking about it is to take our life in our own
hands. Another way of talking about it is to become a co-cre­
ator of our life force. (Satir and Banmen, 1983, p. 333)
Long years of working with families had shown Virginia that
those who labored to model themselves after images of how they
“ ought to” be and “ should” be were seriously diminishing their
chances of authentically being their own person. She invented
her family reconstruction and parts party vehicles as ways of
helping family members see the origins of their “ shoulds” and
“ oughts.”
Virginia’s bone deep respect for people, all people, was the real
“moving force” behind her success. She understood the great heal­
ing power that comes with mutual respect and mutual understand­
ing. Understanding this power, Virginia designed her “medita­
tions” to help bring the person into balance before she or he entered
into interaction with another. In her earlier days, she called them
“centering exercises.” The purpose of the following exercise,
which took place in her third month-long Process Community
Seminar, was to help build a context conducive to making connec­
tions between people; she considered such a context essential for
both the learning process as well as the growth process:
. . . and let the tension go out on an outgoing breath . . . And let
yourself further become aware that you are safe and secure in
your chair, and feel your body, your feet on the ground and your
bottom on the chair, your back pressing against the back, giving
you that solid support. And let yourself further become aware
that your feet, resting on the floor, are not only supported by the
floor, but by the energy that comes from the center of the
universe, coming up through your feet and legs and into your
body, being your source of groundedness . . . This energy is
forever available for people through the day, all day long, all of
the time that you live and breathe on this planet. . . It is only for
your awareness to be in touch [that is required], and you take
advantage of the energy. Energy of groundedness that comes
from the center of the earth. Let yourself become aware of the
10 Attraction and Attachment: Understanding Styles of Relationships

energy from the heavens, as it moves down through the top of

your head into your face and neck, arms and chest, meeting the
energy of groundedness . . . That energy from the heavens, the
energy of inspiration, of sensing, of imagination, the place
where all the real imaging is grounded. And as the energy of
intuition, [of] inspiration, of sensing meets the energy of
groundedness, it forms still a third energy. And the energy of
intuition, imagination and sensing is also forever there. It waits
only for you to acknowledge access to it. And as these two
energies mingle together, the third energy they create is the
energy of connectedness with another human being, the energy
that flows out through your arms and skin and eyes, facial
expression, to other persons, creating the bonding, the joy, the
possibilities of building with other people . . . I’d just like you
to become aware that you have energies like a three-legged
stool, energies from this connectedness, your intuition. . . Ener­
gies which create a balance of yourself. . . (Satir and Banmen,
1983, pp. 1 & 2)

Of course, the “seventh way” of making “us” that takes place

between two people who are able to maintain their separate bal­
ances can not be illustrated and may only be experienced; it is a
living, in-the-moment response that is appropriate to whatever is
going on in the context and within the hearts of the two people in
interaction at the given point in time.
Virginia made use of many different routes to help a given couple
or family move toward this balance of energies. The first step was
to bring into awareness in each individual in the system a sense of
her or his own worth; this would facilitate a sense of balance from
w ithin-1peace within” as she called it in the last several years of
her life (1987). Only when the separate selves within a system
could perceive themselves as centered would a constructive connec­
tion with another be possible. Mutual respect between two people
follows respect for the self within each. Two persons might then
exist-not in symbiotic bonds, not as burdens to each other, not
attacking each other, or distancing each other-but in creative con­
nection with each other. This was what Virginia meant in speaking
of “peace between.” Virginia Satir’s extended vision included the
 Barbara Jo Brothers 11

possibility that such balance, coming as a result of mutual, deep

respect, could also occur in the larger “family system,” the family
of humankind. This is what she meant when she spoke of “peace
among.”

REFERENCES
Satir, V. (Speaker). (1982, August). Lecture presented at Process Community II,
Crested Butte, Colorado.
Satir, V. & Banmen, J. (1983). Virginia Satir verbatim 1984. Transcription of
Process Community HI, 1983, Crested Butte, Colorado. (Available from Delta
Psychological Services, 11213 Canyon Crescent, N. Delta, British Columbia,
Canada, V4E2R6.)
Satir, V. (Speaker). (1987, October). [Videotape]. International Human Learning
Resources Network. October Meeting. Hacienda Vista Hermosa, Cuernavaca,
Mexico. (Available from Morris Gordon, 3705 George Mason Dr. #C35, Falls
Church, Virginia 22041).
Satir, V. (1988). The new peoplemaking. Mountain View, California: Science and
Behavior Books.
Satir, V., Banmen, J., Gerber, J., Gomori, M. (1991). The Satir model. Mountain
View, California: Science and Behavior Books.
This page intentionally left blank
 Marriage and Attachment:
An Exploration of Ten Long-Term
Marriages
Alyce Jackson

SUMMARY. Attachment behavior (Bowlby, 1969) is considered an

integral part of intimate human relating throughout the life span.
This research examined the recollections of ten happy couples in
long-term marriages as to their attachment experiences in childhood,
and their current attachment experiences in marriage. The findings
indicated that none of these happily married subjects were raised in
homes where both parents were physically and emotionally avail­
able. Yet, in adult life they had clearly succeeded in establishing ful­
filling long-term relationships. These findings suggested that attach­
ment behavior is subject to modification throughout the life cycle
and is not rigidly fixed in childhood. The data suggested that insight,
changes in the parent/subject relationship, and the marital relation­
ship were some of the primary factors which could account for the
changes in attachment behavior.

Children leam what they live. Do childhood attachments, howev­

er, serve as models for intimate relationships in adulthood? Propo­
nents of continuity argue that a person’s emotional development
during childhood serves as a template which both structures and
increasingly restricts future affective functioning. Opponents posit
that discontinuity rather than permanence characterizes intrapsych­
ic and interpersonal development. Are individuals who are success-

[Hawoith co-indexing entry note]: “Marriage and Attachment: An Exploration of Ten Long-Teim
Marriages,” Jackson, Alyce. Co-published simultaneously in the Journal of Couples Therapy (The
Haworth Press, Inc.) Vol. 4, No. 1/2, 1993, pp. 13-30; and: Attraction and Attachment: Understanding
Styles of Relationships (ed: Barbara Jo Brothers) The Haworth Press, Inc., 1993, pp. 13-30. Multiple
copies of this article/chapter may be purchased from The Haworth Document Delivery Center
[I-8OO-3-HAWORTH; 9:00 a.m. - 5:00 p.m. (EST)].

© 1993 by The Haworth Press, Inc. All rights reserved. IS

14 Attraction and Attachment: Understanding Styles of Relationships

fully married in long-term relationships the products of happy

homes whose current adult functioning is the repetition of earlier
family of origin experiences? If happily married spouses were
raised in environments which were less than optimal where and
how did they leam to form mutually satisfying attachments?

OVERVIEW OF RESULTS
The research on which this article is based explored the attach­
ment histories as well as the current attachment experiences of
currently married adults. Ten happy couples in long-term marriages
(mean = 27 years) who were nominated by clergy and mental health
professionals and screened with the Dyadic Adjustment Scale
(Spanier, 1976) were interviewed in depth using a semi-structured
inventory. Eight major themes of attachment were explored: avail­
ability, understanding, separation and reunion behavior, loss, sup­
port receiving, support giving, and autonomy.
What were the subjects’ recollections of their early attachment
experiences? How did they describe their marital relationships? The
results will be briefly summarized due to space restraints. Eighteen
subjects grew up in homes where at least one parent was physically
available. None of the subjects experienced a parental death during
childhood, nor were any of them separated from their caretakers for
an indeterminate period of time. Nine participants indicated that one
parent provided understanding and compassion during childhood. In
adulthood, however, 18 subjects had at least one relationship which
enabled them to feel understood. As children, eight subjects turned to
others when they felt emotionally distressed. Yet, in adult life, 16
subjects turned to their spouses when they felt upset, and all of them
attempted to provide support to their partners when needed. While
14 subjects described themselves as compliant children, all of the
spouses indicated that their marital relationship included reciprocal
tolerance of autonomous ideas and/or behaviors.
The data from these categories revealed some striking differ­
ences between childhood and adult life. Despite the fact that the
subjects were all happily married, none of them described an “ Oz-
zie and Harriet” type childhood home life where both parents were
physically and emotionally available. Similarly, none of the sub­
 Alyce Jackson 15

jects described both of their parents as understanding although 45%

of the sample indicated that one parent provided understanding
during childhood. In adult life, on the other hand, 15/20 subjects
reported feeling understood by their spouses. In seven couples,
there was a reciprocal relationship where each perceived the other
as a primary source of comprehension and compassion.
How does one make sense of the findings? How is it that subjects
who came from less than ideal circumstances were able to develop
satisfying family lives, and in most instances have more successful
marital relationships than those reported of their parents? If internal
working models of self and other formed during childhood guide
intimate relating throughout the life span, how does one understand
the discrepancy between the subjects’ graphically detailed child­
hood remembrances and their current experiences in adult life?
Bowlby, after all did note that “. . . whatever expectations are
developed during those years tend to persist relatively unchanged
throughout the rest of life” (1973, p. 238). This article will examine
some of the results through the lenses of two major schools of
thought: continuity and discontinuity in human development.

CONTINUITY

We may our ends by our beginnings know

Bowlby’s (1979) work supported the extension of attachment
theory from childhood to adult love and loss. Although Bowlby did
speak about the ways in which developmental pathways could be
modified, the bulk of his work focused on the personality’s tenden­
cy, through self-regulation, to maintain its current direction of de­
velopment. “. . . and on those [internal] models are based all of his
expectations, and therefore all his plans, for the rest of his life”
(1973, p. 369). He contended that “attachment behavior character­
izes human beings from the cradle to the grave” (p. 40). Similarly,
Ainsworth posited that “there are and can be other significant at­
tachments in the life span: husband to wife, wife to husband, . . .
close friend to close friend to name a few” (1972, p. 101).
Bowlby’s contention that inner working models are highly resis­
tant to change has also received significant theoretical and empirical
16 Attraction and Attachment: Understanding Styles of Relationships

support. Fairbalm and others suggested that the intertwining of an

adult’s internal representations of the self and the attachment figure
has a pervasive effect on the individual’s thinking and interpersonal
behavior (Cohen, 1974, p. 216). Chess, Thomas, Korn, Mittelman,
and Cohen’s (1983) research supports the continuity position. In their
New York longitudinal study they found that there was a significant
correlation between an assessment of marital conflict taken when the
subjects’ children were 3 years old and a measure of the children’s
adult adaptation taken when they were 18 to 22 years old.
The Berkeley Growth Study (Elder, 1979; Caspi and Elder, 1987),
another longitudinal investigation, also supported this contention.
Using initially retrospective reports from the parents of the first
children studied, the researchers found that growing up in families in
which the parental care was viewed as unaffectionate, hostile, and
controlling was associated with the development of personal instabil­
ities that were reflected in tension in the marital relationship and
extreme and arbitrary discipline shown towards their own children.
The children of these individuals (the third generation) themselves
were likely to develop problems as adults, the women being de­
scribed by their own children (the fourth generation) as ill tempered
and by their husbands as explosive in child rearing (Dunn, 1988,
p. 200). Similarly, Brooks (1981) concluded that children raised in
warm consistent environments later raised adolescents who were
socially and emotionally integrated and thus likely to replicate
their early environments when they married and had children. How
prevalent was continuity in the sample we studied?
In this study, nine of the twenty subjects described attachment
patterns in adulthood that are congruent with the ones they reported
in childhood. For example, these subjects were asked what they did
when they were emotionally upset during childhood and adulthood.
They responded that they turned to a parent or spouse.
Mr. Erikson, who has been married for 21 years, provides per­
haps the clearest example of continuity of support seeking or attach­
ment behavior. During his childhood he turned to his father for
understanding and assistance. In adulthood,

. . . I will always discuss it with my wife and get her feedback

on it. Sometimes as a sounding board, sometimes to get her
 Alyce Jackson 17

advice, opinion, recommendation for action. . . . [She has

always been] supportive of my endeavors professionally,
supportive of me as a person. Like in the way that my father
was. . . about taking my side on things.. . . I mean obviously if
I am wrong she is going to be supportive of me emotionally,
but point out to me that I might have done something or other
to screw things up. In that sense [she] has always been a very
good truthsayer to me.

Congruency or continuity, of course, indicates that those subjects

who did not turn to others during childhood continued that pattern
in adulthood. That was borne out by the results of this study. Mr.
Tourosian’s (married 34 years) observation illustrates the point.

I would keep to myself. I still do that. I have a habit of not

communicating if I feel something is wrong or a situation
arises. I generally don’t like to pass the problem off. I try to
resolve it myself, or stew over it myself, or let it resolve by
itself. I still have that habit which is not good and is probably
one of the reasons why I had a heart attack.

DISCONTINUITY

Although Bowlby wrote at length about the formation of inner

working models and their tendency to persist throughout the life
span, he never contended that once established an attachment pat­
tern was irrevocably fixed. In his last book (1988), citing recent
research, he focused more on the etiology of developmental change.
He employed the construct of developmental pathways to explicate
his view that people are continuously shaped by past experiences
and current interactions with their environments. Current experi­
ences can, thus, modify the individual’s course or pathway.
This means that it is necessary to think of each personality as
moving through life along some developmental pathway, with
the pathway followed always being determined by the interac­
tion of the personality as it has so far developed and the envi­
ronment in which it is then finding itself. (1988 p. 172)
18 Attraction and Attachment: Understanding Styles of Relationships

In the last book he authored before his death Bowlby wrote about
change throughout the life span. He indicated that it was a human
being’s inherent ability to change that laid at the heart of therapy.

Although the capacity for developmental change diminishes

with age, change continues throughout the life cycle so that
changes for better or for worse are always possible. It is this
continuing potential for change that means that at no point in
life is a person invulnerable to possible adversity and also that
at no point in life is a person impermeable to favourable influ­
ence. It is this persisting potential for change that gives oppor­
tunity for effective therapy. (1988, p. 136)

His belief that early attachment patterns can be altered is echoed

by Belsky and Nezworski (1988).

If the nature and the quality of care provided to the child is

changed and/or the child’s or adult’s [italics added] working
model of self and of relationships is modified, then according
to attachment theory we should expect that developmental
outcomes anticipated on the basis of early assessments of at­
tachment security should not necessarily emerge. Although
such contextual and/or personal changes may be difficult to
evoke, they are presumed not only to be possible but also to
have predictable outcomes. Indeed, under the right conditions,
one might anticipate change in developmental trajectories and
thus appropriately speak of “ lawful discontinuity.” (p. 14)

Bowlby cited Brown and Harris’s (1978) research to amplify his

point. Their study compared depressed women versus controls in
inner London, outer London, and the Scottish highlands. Brown and
Harris (1978) identified four variables which appeared significantly
more frequently among depressed members of the population.
Three of these variables involved current events and circumstances.
The first was a severe unfortunate event which typically involved
an important personal loss or disappointment. This event usually
occurred during the year prior to the beginning of the depression.
The second variable was die absence of a companion to whom the
subject could confide. The third variable was chronically difficult
 Alyce Jackson 19

living conditions. Only the fourth variable was a historical one. It

was a woman’s loss of her mother due to death or prolonged separa­
tion before her eleventh birthday (Bowlby, 1988, p. 174).
While it is unlikely that any of the subjects studied were familiar
with the theoretical and empirical support for discontinuity, many
of them undoubtedly would agree with its existence. Fifty five
percent of the subjects described childhood attachment behaviors
which were not congruent with their described reactions as adults.
Ten of these 11 subjects who did not remember or did not turn to
others when upset as a child, did so as adults.
It is doubtful that Bowlby would label more than half of the
sample “the exception to the rule.” What phenomenon could ex­
plain the outcome? Perhaps the sample was too small. While it is
likely that the percentage of people describing incongruent child­
hood and adult attachment behaviors might change in a larger sam­
ple, it, of course, is unclear to what degree and in what direction.

INSIGHT AND CHANGE

Those who can not remember the past are doomed to repeat it
-George Santayana

Bowlby’s (1973) contention that once formed inner working

models are intractable to change was based on his premise that they
operate outside of the individual’s awareness. He also posited that if
people became aware of their deepest beliefs about self and other
they could choose to maintain them or, if viewed as dysfunctional,
modify their beliefs and behavior. Bowlby posited that this process,
along with the therapeutic relationship, was the crux of psychother­
apy. He addressed the topic of therapeutic change.

Thus, the patient is encouraged to believe that, with support

and occasional guidance, he can discover for himself the true
nature of the models that underlie his thoughts, feelings, and
actions and that, by examining the nature of his earlier experi­
ences with his parents, or parent substitutes, he will under­
stand what has led him to build the models now active within
20 Attraction and Attachment: Understanding Styles of Relationships

him and thus be free to restructure them [Italics added]. Fortu­

nately the human psyche, like human bones, is strongly in­
clined towards self-healing. (1988 p. 152)

He also believed that people have the capability of assessing their

internal models with little professional psychological interpretation.
For Bowlby, the essence of psychotherapy was that the answer lies
within.
Bowlby cited Main, Kaplan, and Cassidy’s (1985) research to
support his contention that individuals who had free emotional and
cognitive access to their internal models could improve their mental
health. Main et al. found a strong correlation between how a mother
described her relationships with her parents during her childhood
and the pattern of attachment her child currently had with her.
“Whereas the mother of a secure infant is able to talk freely and
with feeling about her childhood, the mother of an insecure infant is
not” (Bowlby, 1988, p. 133). Adults were evaluated after being
administered the Adult Attachment Interview. Subjects who were
identified as “secure” valued attachment relationships, exhibited
readiness of recall, and lacked idealization of parents or of past
experiences. Subjects who were identified as avoidant lacked those
characteristics.
The finding that Bowlby found particularly germane was one
which he described as an exception to the “general rule.” The
researchers focused on mothers who described unhappy childhoods
but were able to raise children who appeared to be securely at­
tached. They discovered that a characteristic of these women which
differentiated them from the mothers of insecure infants was the
womens’ ability to relate balanced accounts of their childhoods.
While the women were frequently upset during the interview, they
were coherent and included both positive and negative aspects of
their childhoods and their relationships with their parents. Main did
not posit that it was necessary that the subject had “forgiven” their
parents for past transgressions. It was sufficient that the subject was
able to coherently discuss their ambivalent feelings and to some
degree recognize their parents as part of the human condition. The
researchers concluded “ that free access to, and the coherent orga­
nization of information relevant to attachment play a determining
 Alyce Jackson 21

role in the development of a secure personality in adult life”

(Bowlby, 1988, p. 135).
All of the current research subjects spoke about how their child­
hood experiences impacted on their adult lives. They showed re­
markable insight into their parents’ assets and deficiencies as role
models as well as their own strengths and weaknesses. The major
theme which emerged from this process was the subjects’ percep­
tions that their parents had done the best they could. Understanding,
accepting, and forgiving one’s parents were threads that were inter­
woven throughout the interviews.
This type of “working through” or cognitive and emotional integra­
tion of childhood material is indicative of people who have recognized
their histories and, thus, escape the condemnation to repeat them. Not
surprisingly, the subjects who had been in therapy had given the matter
a great deal of thought. As Bowlby (1988) suggested, this awareness
and integration allows for the formation of modified models and para­
digms for intimate relating with spouses and children.
Several of the discontinuous subjects reported that they used
their childhood relationships as negative models to serve as a
springboard for healthier contemporary relationships. Another dis­
continuity that emerged was changes perceptions. Mr. Oppenheimer
who has been married for 34 years stated:
My mother sort of reflected what she herself had been taught. . .
I suppose the only thing that has changed is that I have finally
come to the realization that I am not going to change her, and I
ought to stop trying. My attitude has changed considerably. She
doesn’t have that many years left so I might as well make them
as comfortable and pleasing as possible.
Six subjects spoke about the impact of their parents’ marriages
on their current marital relationship. Five of them “ learned by the
negative,” that is by either doing the opposite of what their parents
did or consciously living in a very different way. Mrs. Oppenheim­
er, for example, reflected:
I don’t think that the marriage between my mother and my
father was particularly happy to tell you the truth. It sounds
like everything was wonderful. I don’t think they had much of
22 Attraction and Attachment: Understanding Styles of Relationships

a relationship. I think they were almost like two worlds, and

they would intersect occasionally, but I don’t think they com­
municated that well between the two of them to tell you the
truth . . . I did not want to replicate that kind of situation. So I
think in some ways I learned from the negative.
Another theoretical perspective which sheds light on the continu­
ity/discontinuity issue is the interpersonal perspective.

THE INTERPERSONAL CONTEXT FOR CHANGE

Epstein (cited in Ricks, 1985) posited that representational or

inner working models change as a consequence of lawful processes.
First, change occurs in the context of emotional experience. While
Epstein acknowledged that emotionally significant events may not
result in representational modification because of situational factors
or individual differences, he posited that change is unlikely to occur
in the absence of emotion. Second, he hypothesized that if attach­
ment bonds are acquired via the internalization of early interperson­
al experiences, modification occurs in the context of three major
types of emotionally corrective interpersonal experiences:
through change within the same early relationship across time,
through repeated experience in other relationships that discon-
firm earlier acquired models, and through especially strong
emotional experience within a single relationship that similarly
disconfirms earlier postulates. Since models of self and other
are complementary, reflected appraisals from others that differ
from childhood appraisals are particularly significant. . . . the
implicit logic behind naturally occurring changes in self-esteem
is as follows: ‘I admire this person; he likes and respects me.
Then maybe I am a worthwhile person myself; after all, I re­
spect his judgement.’ (p. 227)
Several of the participants indicated that their relationships with
their parents had changed significantly over the course of the sub­
jects’ adulthoods. Those subjects whose parents are still alive spoke
in terms of their current relationships. Some of the subjects de­
 Alyce Jackson 23

scribed how their interactions with and attitudes toward their par­
ents shifted as the latter became elderly and confronted death. Mrs.
Stanford (married 11 years) spoke about her current relationship
with her mother and father.
I am really happy with [my relationship with my parents as an
adult]. Since my dad retired we are really having conversa­
tions. . . . There was that time when we didn’t talk that much
[college and young adulthood], and then I think when I Anally
decided to have kids and could share that, being pregnant, my
mom and I talked about it a lot. That was the beginning of us
getting back on course together and sharing experiences as an
adult. I really felt like we could be adults together.. . . I know
there are things they don’t like about what we do. . . . I feel
really fortunate. I take them for granted.
Several subjects reported that their relationships with their par­
ents had changed dramatically over time disconfirming to some
degree their “earlier acquired models” (Epstein cited in Ricks,
1985). In addition, all of the subjects experienced a strong emotion­
al experience within the single relationship of marriage. Two pos­
sible consequences of “ a strong emotional experience within a
single relationship” are altered self-perception and increased self­
esteem. Thus, as we shall see in the next section, the subjects’
improved relationships with their parents may in part have been due
to the impact of the subjects’ marriages on themselves and their
perceptions of others.

THE ROLE OF MARRIAGE

[The marriage] has been therapeutic, and corrective, and a

godsend. It’s more than made up for my slow start in life. God
knew just what I needed.
-Mrs. Walton

Mrs. Walton’s analysis of the role marriage has played in her life
has significant theoretical and empirical support. Mattison and
Sinclair (1979), Napier and Whitaker (1978), Kirschner and Kirsch-
24 Attraction and Attachment: Understanding Styles of Relationships

ner (1986), and others have posited that marriage offers individuals
a second chance to form an attachment relationship. They also
believe that for many individuals the marital relationship can ame­
liorate, at least in part, the effects of earlier less satisfying relation­
ships.
The Kirschners (1986) posited that in all marriages there is a
natural drive to create a healing relationship, one that not only
replicates, but also transcends transactional gestalts that the spouses
experienced in their families of origin. Mattison and Sinclair (1979)
expressed a similar concept. “Marriage holds the promise of being
able to make better what was felt to be wrong in the past and to
make partnership more satisfying than is dimly remembered from
childhood” (p. 52).
Mr. Oppenheimer and Mrs. Walton (married 28 years) indicated
that, at least in their lives, this was indeed the case.

I think if anything my childhood experiences had a positive

impact because I am aware of the fact that things perhaps did
not go as I wished they had gone, and I think in many ways I
have compensated for that. I think I compensate in my rela­
tions with my wife and certainly in my relations with my
children.
-Mr. Oppenheimer

I think some of the things that happened to me I used to

reverse . . . My husband was the complete antithesis of what I
grew up with which was what perhaps drew me to him initial­
ly . . . I never had any affirmation. My husband affirms me
more than I affirm him . . . I think he knows that I didn’t get
that as a kid so he does it a lot.
-Mrs. Walton

Mr. White, who was married 12 years, believed that his relation­
ship with his wife has had a positive effect on his physical and
psychological well being.

Whether [my wife] is a substitute for my mother or not I don’t

know. When I met my wife I was taking a prescription of Lib­
 Alyce Jackson 25

rium for a spastic colon which was totally anxiety related.. . . I’d
say the wedding was the last time I had any. I don’t feel there is
any risk of getting back in that scenario with the possible excep­
tion of losing one of my immediate family.
The Kirschners’ (1986) described how marriage, a “strong emo­
tional relationship,” fosters change. The Kirschners believe that
attachment is one of the primary needs throughout the life cycle.
They posited that spouses transfer their attachment needs from their
parents to each another in the beginning of marriage.
In a regressive burst, termed falling in love, mates idealize
their partners in a manner resembling that of a young child
with a parent. This process sets the stage for each spouse to
accept the other’s suggestions and ideas about himself or her­
self and the nature of reality, much as a child does with a
parent. The new bond replaces the old parental relationship
and thus promotes individuation from the family, one of the
first tasks of marriage. (1986, p. 4)
There is also empirical support for the belief that stable mar­
riages improve mental health and buffer the individuals involved
from at least some of the deleterious effects of stress (Dunn, 1988,
p. 198). Kotler’s (1985) research indicated that strong marital
relations were therapeutic for a partner whose early experiences of
care were less than optimal. Kotler and Omodei (1988) found that
later marital quality was strongly related to the mental health of
both partners. Similarly, Gove, Hughes, and Style (1983) posited
that “ . . . it is the quality of a marriage and not marriage per se that
links marriage to positive mental health” (p. 122). Valliant’s (1977)
longitudinal research concluded that the variable which best pre­
dicted mental health was the subject’s capacity to remain happily
married over time. Egeland, Jacobvitz and Stroufe (1988) discov­
ered that an emotionally supportive, satisfying marriage helped
women who were abused during childhood to break the cycle of
abuse when raising their own children. Rutter and Quinton (1984)
echoed their results. In Long-term follow-up of women institutiona­
lized in childhood: Factors promoting good functioning in adult life
they stated that “the findings . . . suggested that the spouses’ good
26 Attraction and Attachment: Understanding Styles of Relationships

qualities exerted a powerful ameliorating effect leading to an in­

creased likelihood of good psychosocial functioning and a de­
creased likelihood of personality disorder.” The researchers empiri­
cally proved that the positive effects could not be attributed to
assortative mating or the effect of the women on their spouses.
A majority of the studies focused on how stable or happy mar­
riages prove to be beneficial for women. Can the same be said for
men? Gove, Hughes and Style (1983) stated that while the affective
quality of the marriage is more important for females, marital status
alone is important for males. It is probably safe to assume, there­
fore, that the benefits of a supportive marital union will accrue to
men as well as women.
The Minnesota (Morris, 1980; 1981), Berkeley (Main and Gold-
wyn, 1984), and Amherst (Ricks, 1985) studies also found that
good child outcome was associated with mothers who lived in
stable marriages and had positive self-esteem despite having been
raised themselves in families where they experienced either rejec­
tion or abandonment. These women often had exceptionally strong
ties to their husband’s families which also served to ameliorate their
childhood deficits.
While all of the subjects did not explicitly talk about how their
marriages have effected their mental health, all of the subjects indi­
cated that their unions had a positive impact on their lives. When
asked to describe their spouses the subjects used adjectives such as
peaceful, understanding, healing, nurturing, and caring. True modi­
fication of one’s inner world is not a quick or easy process. Several
of the subjects indicated that they experienced difficulties during
the initial phases of their marriages. Mrs. Stanford, for example,
continues to struggle with the conflict between her current life and
her previous expectations. She began crying when describing her
husband’s attributes. When asked why she replied, “I just feel so
grateful. I feel like I ’m so lucky.. . . It just feels like I’m not really
worthy enough. Like why should I be so lucky.” For those individu­
als who are fortunate enough to grow up in optimal conditions a
happy marriage reinforces a positive view of self and other. Many
people, of course, are not so fortunate and grow up with treatment
that ranges from indifference to abuse. While the results are not
 Alyce Jackson 27

generalizable to other populations, for 11 of the current subjects,

marriage did provide a welcomed second chance.
It should be understood that insight, change in emotionally sig­
nificant relationships, and the ameliorating effects of marriage are
not mutually exclusive but, in many cases, overlap to some un­
known degree. An example of how these factors can contribute to
positive change during adult life is exemplified by the life of Her­
man Crabbe, a subject whose life was examined longitudinally in
the Grant Study (Valliant, 1977, pp. 247-248). At 19, Crabbe was
viewed as “ bizarre” and “suffered perhaps the most pathological
mother in the entire Study.” His father was crippled and often the
target of his wife’s paranoid ideation. A social investigator who
visited Crabbe’s parents wrote “It was the most pathetic interview
I’ve ever had.” The evaluation team noted that “Crabbe knew that
his mother was clinging to him, but he could not muster the ap­
propriate emotion. Instead he withdrew into the safety of his own
head and spent his time with moths not people.” He was diagnosed
as schizoid. At age 30, Crabbe was described as not seeing people
“ as they are psychologically but rather in terms of whether or not
they provide support, whether they make demands or leave you.”
After Herman’s mother died both the subject and his father en­
joyed a sudden “ burst of health” and the father/son relationship
improved. One year later Herman’s evaluation indicated that he no
longer exhibited schizoid symptoms. His “marriage prospered.” At
age 50, he was evaluated as “a little on the extroverted side.” In
Crabbe’s words he “no longer avoided closeness and familiarity
with other people.” Instead, he wrote, “I react to events with a good
deal of feeling.”
To what did Valliant (1977) attribute Crabbe’s documented pro­
gression away from schizoid fantasy toward meaningful relation­
ships with people?

First, a danger passed; he was free at last from his mother’s

psychopathology. Second, at thirty-five, Herman experienced
several hours of group psychotherapy. Third, in his early thir­
ties he made friends with his father and for the first time
acquired a second parent. Most important, he was blessed with
a marriage that was one of the most fulfilling in the Study. He
28 Attraction and Attachment: Understanding Styles of Relationships

had married young, and there was no question that in part he

married to obtain the competent mother whom he never had. It
worked. His wife did far more than college to free him from
his family. After twenty-five years of marriage, he could write
to the Study, “ I have the same wife, and am getting more
attached to her all the time.” (p. 250)

CONCLUSIONS
This study, like Kotler and Omodei’s (1988), Brooks’ (1981) and
others, offers moderate support for a continuity model to the degree
that early attachment relationships appear to have been influential
in many of the subjects’ lives. The finding that discontinuity might
better describe the majority of the subjects’ development echoes
several of the conclusions that Valiant (1977) reached in the Grant
study and those of Egeland, Jacobvitz and Stroufe (1988).
The results from these studies and others also indicated that rela­
tionships with others, specifically marital and psychotherapeutic
relationships, modified to some extent the deleterious effects of un­
fortunate childhood experiences. The marital relationship, whether
legalized or not, is for the majority of adults, one of life’s most
important and consequential experiences. Additional research could
shed more light on how, for some individuals, it is also the context
for emotionally corrective change. Future research should focus on
the circumstances in which the marriage relationship is healing.
The findings from this study should provide fiuther encourage­
ment to those members of the therapeutic community who espouse
the possibility of characterological change. They particularly sup­
port those marriage and family therapists who believe that positive
marital and family relationships ameliorate to some degree the
childhood developmental immaturities of both spouses and, there­
fore, pave the way for their children’s healthy development (Kirsch-
ner and Kirschner, 1986).
Bowlby (1988) believed that therapeutic change occurred when
the client was able to use the therapist as a secure base from which
to explore the self and his or her interactions in the world. The
present results indicate that if troubled spouses can learn from the
therapist to provide that resource for one another, the healing pro-
 Alyce Jackson 29

cess will continue long after the psychotherapy sessions have end­
ed. Each spouse’s development or personal growth will enhance the
modification of the partner’s working model.
The current findings to a large degree confirm the beliefs of
Bowlby, Valliant, and others. Tragic events and early vicissitudes
did not fully determine the subjects’ paths in life. While early inter­
personal difficulties can set the stage for later developmental prob­
lems, the subjects in this study also found that relationships were
healing.

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 Objects of Heart’s Desire
Bruce J. Schell

SUMMARY. We enter the world with an expectancy of love and a

need to love. That which we love is dictated by our histories and lim­
ited by our fears. This paper explains some of the consequences of
that for the individual and the couple.

We all love someone or something. It may be that our love is

ephemeral, arising and fading with the passage of the sun through
the sky. It may be that our love is constant, enduring like the stars
through the years. The passion of our love may be like a flickering
candle or bum with the intensity of a conflagration. Our love may
be for a person or power, an idea or beauty, pleasure or physical
well being. With some people the presence of their love is obvious.
With others its presence is indirectly noted much as the presence of
a subterranean river is revealed by the life it makes possible on the
surface.
We are all lovers for that is basic to our human nature. The
particulars of who or what we love, its intensity, and who or what
we feel loved by are shaped by our history. How does our comfort
in loving others and our knowledge of ourselves as beloved become
lost? How does distrust, anger, and fear blind us to our birthright as
lover/beloved? We shall investigate the forces that shape our love

Bruce J. Schell, PhD, is a clinical psychologist and Professor in the Depart­

ment of Family and Preventive Medicine at the University of South Carolina
School of Medicine in Columbia, SC.
[Haworth co-indexing entry note]: “Objects of Heart’s Desire,” Schell, Bruce J. Co-published
simultaneously in the Journal of Couples Therapy (The Haworth Press, Inc.) Vol. 4, No. 1/2,1993, pp.
31-38; and: Attraction and Attachment: Understanding Styles of Relationships (ed: Barbara Jo Brothers)
The Haworth Press, Inc., 1993, pp. 31-38. Multiple copies of this article/chapter may be purchased from
The Haworth Document Delivery Center [1-800-3-HAWORTH; 9:00 a.m. - 5:00 p.m. (EST)].

© 1993 by The Haworth Press, Inc. All rights reserved. 31

32 Attraction and Attachment: Understanding Styles of Relationships

through an exploration of the consequences when our need to love

and to be loved is unsatisfied and then through case examples of
couples in psychotherapy. The underlying spirit of this article is
expressed in the refrain:
from you I receive,
to you I give,
together we share,
from this we live.
At the most basic physiological level we are bom with an incred­
ible capacity to adapt to different conditions. We are designed, at
the genetic level, to survive in widely varying environments. A
principle component of this ability to adapt is the relative “plastic­
ity” of our brain function compared to other animals. Much of what
we know about the world is based on experience rather than being
“hardwired” into the brain. This plasticity allows us to adaptively
shape our responses to successfully survive dangerous environ­
ments. One of the genetically determined aspects of our brain is that
we, for our current age, overassess danger. In a time when physical
survival was dependent on remembering and responding to danger­
ous situations it was vital that once frightened we learned to avoid
that danger.
That pro-survival ability continues today to assess danger and
shape our avoidance of perceived dangerous situations, but does
this predominately in a psychological world and frequently operates
unconsciously. Threats to our need for love and to our loving nature
are processed along the same brain pathways that once protected us
from the saber-toothed tiger. The result is a strong fear reaction to
anything that threatens our love and for the conditions surrounding
that threat to be highlighted with a mental danger sign. The more
threat the developing child received to his/her need for love and to
their loving self, the more their internal psychological map is high­
lighted with danger signs and the more their life is constricted.
The infant is bom with a total expectancy of being welcomed and
loved. There is no other knowledge than that a love connection is
natural. We make precious and rarify that which is perceived as
scarce and so have changed our knowledge of the natural place of
love in our life into something rare and difficult to obtain. The
 Bruce J. Schell 33

infant is bom in a state of total need and literally does not survive in
the absence of those needs being met. Having been bom with a total
expectancy of and need for their needs to be met, there is a corre­
spondingly total vulnerability. Each failure to meet their needs has
an impact on the developing ego and the more severe the depriva­
tion, the more significant the impact on the developing sense of self.
The experience of not being received and loved creates deformation
of the loving/loved expectancy as well as of the sense of self. This is
a deformation of the expectancy and need for love not an elimina­
tion of it.
In examining the potential distortions in our lover/beloved sense
of self it is of value to think of the self that needs to be loved, the
expressions of that need, and the lover that will exactly satisfy the
need as a functional unit. Failure to satisfy any aspect of the unit
effects the other aspects. For example, if the need is to be loved, the
expression of it may be reaching out with arms or lips, and the
satisfying lover may be the mother. If the mother is not available, the
child will go to the next available person to meet the need. No matter
how loving that substitute for the mother is, there will be incomplete
satisfaction as it is a substitute for the mother, not the mother. If the
need is repeatedly unmet at the human level, the child will seek
satisfaction with non-human objects. With continued frustration,
awareness of the need and its original satisfying object are sub­
merged and satisfaction is sought with a new substituted object. Over
time, with repeated partial satisfaction the child begins to identify the
need as related to the substituted object If, for example, food was the
partial solution to the need to be loved then when the loving impulse
arises it would be experienced as a need for food. No matter how
sated with food, since the need was for love, there remains a sense of
being unfulfilled, that something is missing.
Linus and his blanket, from the Charlie Brown cartoons, provides
a good visual example of the need satisfaction expressed with a
non-human object, the blanket. Linus is always seen with the blan­
ket, which illustrates a consequence of the substitute love object not
being the original satisfying object. Incomplete satisfaction of the
need increases the attachment to the object which is expressed in a
compulsive relationship with it. So we could consider the blanket
for Linus as his solution to the absence of, for example, an available
34 Attraction and Attachment: Understanding Styles of Relationships

mothering one and/or excessive fear attached to meeting that need

with humans.
The need for love and intimacy continues as a central organizing
principle of life, but its expression grows increasingly obscure as
the failure to satisfy the need is repeated. What we have learned
about the nature of love and ourself in relationship to love is an
important determinant of our personality structure. Our strategies to
obtain love, our beliefs concerning love and concerning ourself as a
love object, and our beliefs regarding the relative scarcity or abun­
dance of love, all are reflected in our personality structure.
An evolving part of my practice is to spend some time examining
what people believe about themselves as lovers and as the object of
someone else’s love. Some have a very clear vision of themselves as
a lover, but their image of themselves as someone’s beloved is
missing except, as it is reflected in their view of themselves as a
lover. It is as if they believe that the pleasure of their beloved is as
close as they can get to being loved. Others easily see themselves as
loved in their immaturity but cannot imagine themselves loved in
their maturity. So we explore what the person has learned about the
relative abundance or scarcity of love, their strategies to obtain
love, how those strategies differ between men and women, and
what occurs when love is available.
There are a multitude of strategies to try to ensure that love or
intimacy will occur. Some common ones are to become the cute
child, the controlling one, the loving child, the angry one, the fright­
ened vulnerable child, the worried one, the hardworking, brave, and
self-sacrificial child. Each of our strategies, as lovers and beloved
are our strengths and failings in the couple relationship.
An aspect of treatment in psychotherapy involves distinguishing
between the absence of love and when so much of the love/beloved
energy is bound to nonhuman sources of satisfaction that little of
the person remains available to either love or be loved. Repeated
partial satisfaction through nonhuman objects binds a certain por­
tion of our love energy to that object. With that binding and the
others that take place, over time, under ordinary circumstances
there is progressively less available for human relationships.
In the first flush of love the importance of the nonhuman love
objects is temporarily decreased. In a sense, the range and depth of
 Bruce J. Schell 35

our possibilities as lover/beloved are revealed during this time.

With the waning of that first flush of love the person’s availability
to love and be loved may diminish. When that diminishment leads
to the couple presenting for psychotherapy, it is valuable to explore
how much of their capacity to love and be loved is bound to other
people and to nonhuman objects. There can be significant relief in
their discovering that they or their partner was not bom with a
deficiency in the ability to love, but rather it is bound to other
sources of satisfaction. We begin to examine the various objects
their love is bound to and the conditions surrounding how those
objects became a solution to their need to love and to be loved. I am
not positing that all nonhuman passionate involvements represent
displacement of unmet early needs. Signs that suggest that possibil­
ity are addictive features in relationship to the object. Tliis may
include anxiety at the possibility of not interacting with the object, a
compulsive quality to the interaction with it, and the timing of the
use of it suggesting a primary mood altering purpose.
The following case study highlights features of the binding pro­
cess and the consequences within a couple.
Harry is a 40 year old once divorced man who is married to Judy,
a 34 year old woman who had been in several very important
relationships. They had been married approximately two years
when they entered psychotherapy. They had a premarital relation­
ship of approximately one year, but had not lived together. They
each described feeling in love with and loved by the other during
their courtship and during the early months of their marriage.
They entered psychotherapy at her insistence. She had grown
concerned over the waning of her feelings of being loved and how
he seemed less emotionally available to her love. He felt their
relationship was satisfactory, even though he conceded the intensity
of their contact had diminished. He saw that as a normal conse­
quence of the marital relationship and used his previous marriage as
proof of that. His parents had divorced when he was young, and he
had been primarily raised by his mother who was an explosive
alcoholic. He described memories of his mother threatening him
with a pistol, threatening to shoot him if he misbehaved. Judy’s
history, by comparison, was much more benign with clear memo­
ries of her parents loving relationship and of feeling cared for by
36 Attraction and Attachment: Understanding Styles of Relationships

both parents. However, in elaborating on this she described her

father as busy and frequently unavailable.
In exploring with Harry where he felt safe, loved, and cared for,
the predominate area was in music. He described how in conflictful
or frightening situations he would turn to music and quickly feel
soothed and removed from those situations. He currently has an
extensive collection of CD’s, which hold a place of honor in their
home. In his life the most constant and reliable relationship was
with music. Judy observed that many of their evenings were spent
with him listening to music. When he played his guitar he would
isolate himself and become angry if she entered the room.
We love when we feel safe and with whom (what) we feel safe.
The two issues facing Harry were how to feel safe with Judy and
how to free some of the love energy bound to music and therefore
unavailable to his relationship. A frequent issue at this point is that
while the person’s actions are controlled by their fear, they are
unaware of it. In part that arises from our tendency to block aware­
ness of fear with another effect. Boredom, indifference and anger
are frequent blocking affects.
In the safety of the psychotherapy hour it is possible for the
patient to free some of the bound love energy and bring it to the
couple relationship. We first explored the meaning of music at the
cognitive and emotional level. The approach was patterned after
Pesso (1973). That approach emphasizes that we are symbol-mak­
ing and symbol-using beings and that it is possible to modify impor­
tant psychological structures through the use of a person’s symbol
system. The most effective way of doing this is to make literal and
tangible the meaning of their symbols. For this to occur there must
be a safe enough atmosphere for people to re-enter and re-experi­
ence their vulnerability and the wounding of that vulnerability.
With the creation of a safe enough atmosphere Harry was able to
invest some of the sense of safety and love that was bound to music
in consciously created symbolic figures. The symbolic figures were
people or objects that he chose to enact aspects of his internal
conflicts and aspects of his symbolic solution to these conflicts. We
might think of this as a conscious creation and utilization of a
“transitional object.” A transitional object whose function is to free
energy bound to his historical (music) solution and make it avail-
 Bruce J. Schell 37

able to his current relationship. The steps involved were those re­
quired to remain true to his internal reality and to his sense of
personal safety. The effect was for him to discover more of a sense
of possibility in the world, to feel safer, and to have an increased
capacity to love and be loved in his relationship to Judy.
We have looked at one consequence of a person’s early environ­
ment forcing a substitute solution to the love need. That solution left
Harry present but removed love from the relationship. In the next
case we shall examine, the love remains but in an essential way the
person is removed from the relationship. It is arguable that unless
you are fully present the love expressed, is at least partially false.
Durang (1985) in The Marriage o f Bette and Boo expressed it this
way;
Unless you go through all the genuine anguish that you feel,
both justified and unjustified, the feeling of love that you do
have will not have any legitimate base and will be at least
partially false. Plus, eventually you will go crazy.
In general, to love the other and to express it requires a trust that
our love will be accepted. Where there is excessive concern over its
reception we become timid in its expression and vigilant concerning
its reception. For intimacy and love to be present and experienced
between two people, two selves must be present. If one or both
people are overly focused on how they are received then there is a
tendency to lose track of the self in focusing on the other’s reaction.
This eventuates in the other becoming a judge of our love, resulting
in an exchange between a superior and an inferior.
Our primary information about the expression of love is the way
we and our intimates were treated. Helen, 38, and Luke, 39, have
been married for 20 years. They entered psychotherapy after she
read some of the adult children of alcoholic’s material. Helen came
from a home in which her father was a frequently absent alcoholic
and her mother was very controlling and deprecating of her. Luke’s
father was a religious fanatic and an absolute ruler of his wife and
children. His mother was warm, loving, submissive to his father,
and died when he was 16.
They both learned, in the name of love, to vigilantly watch the
other. She watched in the hope of pleasing and thereby earning his
38 Attraction and Attachment: Understanding Styles of Relationships

love. He watched in the hope that if he controlled enough he would

never be left. The development of their full selves in relationship to
each other had been neglected in their fearful preoccupation with
each other. As she began to focus more of her awareness on herself,
she began to grieve for her neglected self and then to rage against a
lifetime of being controlled. His focus on himself thrust him back to
his mother’s death and his continued fear of abandonment. Amidst
the sparks generated by these two growing selves an occasional
flash of love is seen. They continue in psychotherapy.
Underneath the surface storms that couples bring to psychothera­
py, there remains the powerful current of their love. If we, as psycho­
therapists, focus on handling the storm and lose awareness of the
deeper currents, we risk perpetuating their early less than optimal
solutions to their need to love and be loved. It is vital to remember
that often we are treating the parents of the next generation. If, in our
work we help them more completely live the full range of their
loving nature then the birthright of their children will be enriched.
Appraisal of the couple’s beliefs about themselves as lovers and
as beloved furthers the shift from the myopic view that their im­
mediate distress produces, to one that supports the process of be­
coming more fully human. That is, it becomes possible for them to
see their current distress in the context of their total history and of
their potential future possibilities.
In a previous article (Schell, 1992) I suggested the importance of an
appraisal of the couples spiritual life. In this article I emphasized an
appraisal of the couples’ beliefs concerning love. As psychotherapists
it is our vision of the couples’ possibilities that deeply influence the
process, content, and outcome of our work with them. What we attend
to and what we neglect help shape the immediate outcome of psycho­
therapy, and for many couples, the long term outcome of their lives.

REFERENCES

Durang, C. (1985). The marriage of Bette and Boo. New York: Dramatist Play
Service Inc.
Pesso, A. (1973). Experience in action. New York: New York University Press.
Schell, B. (1992. Elements of couple psychotherapy and awakening. Journal of
Couples Therapy, 3(1).
 Response to Bruce J. Schell’s Article:
“Objects of Heart’s Desire”
Aliya Alexana

Loving is the purpose of life. One is bom being pure love rather
than learning love; the rejection of this love creates a lifelong striv­
ing to reattain the state of loving bliss-loving for the joy and awe of
loving. B. Schell’s description of love development with its distor­
tions is excellent although I believe the infant has only love to give
and the learning process is how to have it received rather than how
to obtain it. The same distortions occur in either event. I do disagree
with his idea that one loves power, beauty, pleasure, etc.
Love is the natural human state. Beauty and ideas may touch a
person deeply to open up the innate love within. One appreciates
beauty which releases the loving energy, rather than loving beauty.
Many positive experiences and emotions may unlock one’s capacity
for love and thus begin the path of achieving the purpose of life.
The drive for power is the result of an absence of love. It is an
ego distortion with the purpose being to obtain love, not to love.
Melanie Klein (Envy and Gratitude, 1965) describes greed as the
fear that one will not obtain sufficient love, so one tries to get as
much as possible before it is withdrawn. This, as an adult ego, is so
insecure that it believes power will convince others to love it. We
are loved for being, not for achieving. The latter is a distortion of
love resulting in the oxymoron of “conditional love.” Envy, greed
and jealousy are derived from the concept of scarcity-that there will

[Haworth co-indexing entry note]: “Response to Bruce J. Schell’s Article: “Objects of Heart’s
Desire,” Alexana, Aliya. Co-published simultaneously in the Journal of Couples Therapy (The Ha­
worth Press, Inc.) Vol. 4, No. 1/2, 1993, pp. 39-40; and: Attraction and Attachment: Understanding
Styles of Relationships (ed: Barbara Jo Brothers) The Haworth Press, Inc., 1993, pp. 39-40. Multiple
copies of this article/chapter may be purchased from The Haworth Document Delivery Center
[1-800-3-HAWORTH; 9:00 a.m. - 5:00 p.m. (EST)].
© 1993 by The Haworth Press, Inc. All rights reserved. 39
40 Attraction and Attachment: Understanding Styles of Relationships

not be enough love. All other scarcities are substitutes for insuffi­
cient love.
Unfortunately a majorfactor o f the human condition is that one’s
capacity for loving is cut off from awareness and expression
through fear and the pain of life. I agree with Schell that we respond
to emotional fears with a primal reality, but emotional losses are
more confusing and stressful to a developing ego than the direct
fear of a known physical threat. All fear is the direct or indirect
anxiety of the loss of love. The fear in turn causes insecurity, doubt,
mistrust, hopelessness, pain, resentment, anguish and despair.
Transformation of the fear into pure love and acceptance is neces­
sary to begin loving. This is the purpose of the therapy process.
People seek love from others and believe in error that their appreci­
ation of being loved is actual loving. It is true that various types of
appreciation and gratitude can open the heart to experience true
loving of other.
We seek human love in an effort to tap the love energy locked
within us. In fact, most relationships become so bound with expecta­
tions that true loving is not achieved-the primal fear of loss while
risking intimacy interfering with that possibility. If the relationship
can achieve enough security, one can succeed in opening the channel
of love from within and the experience of loving another can begin.
As this loving expands, one gradually experiences divine as well as
human love. Increased divine love increases human love in turn. This
process continues until one attains again the capacity for pure loving
that was lost at birth. Allowing oneself to know such loving and love
(lover and beloved-Schell) enables a communion with man and God
that fills the soul with awe and joy-the natural state of being.
 Sexual Intimacy-
Towards Equal Relationships
Between Men and Women
(with Treatment Assistance
of a Computer Program)
Louis Sommeling

SUMMARY. By rethinking sexual basic concepts we liberate sexol­

ogy from mere biological and technical models. The sexual focus
combined with the Object Relation Theory creates a promising ther­
apeutic perspective for couples. Special attention will be given to
male processes. Some vignettes of the computer program Sexpertise
illustrate this article.

In our days the equal relationship between men and women is a

difficult one. In this article we will rethink some of the sexual
rituals between men and women, specifically such basic concepts as
arousal, desire and also some power-aspects as they can occur in a
sexual relationship.
Further down we will discuss the implicit philosophies of thera-

Louis Sommeling, PhD Psychologist, is a psychotherapist at the Groningen

University in Holland and Sexologist at the Rutgers Foundation (Dutch National
Institute for treatment of sexual problems), is Fellow of the Dutch Group Psycho­
therapy Association and the International Pesso Psychotherapy Federation. At
present he is working on a book about Male Desire.
[Haworth co-indexing entry note]: “Sexual Intimacy-Towards Equal Relationships Between Men
and Women (with Treatment Assistance of a Computer Program)/* Sommeling, Louis. Co-published
simultaneously in the Journal of Couples Therapy (The Haworth Press, Inc.) Vol. 4, No. 1/2,1993, pp.
41-59; and: Attraction and Attachment: Understanding Styles of Relationships (ed: Barbara Jo Broth­
ers) The Haworth Press, Inc., 1993, pp. 41-59. Multiple copies of this article/chapter may be purchased
from The Haworth Document Delivery Center [1-800-3-HAWORTH; 9:00 a.m. - 5:00 p.m. (EST)].

© 1993 by The Haworth Press, Inc. All rights reserved. 41

42 Attraction and Attachment: Understanding Styles of Relationships

pists, which still remain sometimes unconscious. This would influ­

ence treatment options and their effectiveness.
Rethinking a sexual focus, combined with the Object Relation
Theory, supplies a clear paradigm for better understanding of both
the female and the male partners. Special attention will be given to
the understanding of the resistance of men in therapeutic processes.
The issue of gender from the male perspective in relation to psycho­
therapy is until today not very well developed in the international
therapeutic community.1
Surprisingly, the computer can aid the treatment of sexual intima­
cy problems without necessarily disturbing the therapeutic encoun­
ter. The Sexpertise programs as developed and spoken of here, will
assist therapists as well as clients in making some expertise and
experience concrete and available. This expertise has been developed
mainly by the Rutgers Foundation, the Dutch National Institute for
treatment of current sexual problems. (In the Low Countries, initially
research was focused on problems resulting from a restrictive sexual
morality. During the 1970s attention shifted to the rapid process of
sexual liberalization and its practical consequences, such as the need
for family planning education and services. The past decade was
largely dominated by two issues: sexual abuse, including possible
sexual contacts between helpers and clients, and research on sexually
transmitted diseases. As most of these studies have been published in
the Dutch language only, they have not sufficiently added to the
international body of knowledge. This is regrettable because, particu­
larly the Netherlands is now characterized by an open and permissive
attitude regarding sexuality, which gives it quite a unique position in
the world, not just in terms of attitudes and behavior, but also in
terms of research possibilities.)

TOWARDS A PSYCHOLOGY OF HUMAN SEXUALITY

Today, modem sexologists agree that sexuality is first and fore­

most a psychological reality. Contrary to previous thoughts, our
sexual behavior is not totally guided by a biological drive, but
comes as a combination of hormones and humanly learned experi­
ence as well as its interpretation. These three factors together shape
 Louis Sommeling 43

the characteristics of human sexuality. To say it in a popular way:

sex is not only between our legs, but also between our ears!
In aiding our clients as therapists, we should help to become
explicit about sexual arousal as well as the hidden needs we human
beings are longing for. Also, some attention to the power aspects of
the sexual game may support clients in shaping their personal sexu­
al life.

Rethinking Sexual Arousal

The arousal curve o f the American researchers Masters and

Johnson (1966) has been given much publicity. It showed what
happened following effective stimulation of penis and clitoris. This
model of Masters and Johnson suggests, briefly, that partners must
pass through this whole curve at all times, in order for them to have
‘healthy’ sex. Actually the effect of this model in practice may be
called rather dubious: as if this ought to be everybody’s “ natural”
reaction, as if one ought to reach this norm in order to be classified
as ‘normal and healthy’ beings. In our daily practice however, if
you ask people to draw their arousal curve, this “standard curve”
seldomly emerges. Rather, you’ll see flat and steep lines, long take­
off runs, nice detours, etc. (Figure 1).
Helen Kaplan (1974) describes how, in its suggestive clarity, the
curve of Masters and Johnson turns out to be a simplification of
reality: there is no such thing as a continuously rising process. In
physical arousal there are two stages to be distinguished:

a. a genital-vagocongestive reaction (mainly blood supply, re­

sulting in erection, moistening of the vagina and swelling of
the labia)
b. a reflexive reaction of the flesh (primarily muscular, resulting
in contraction of the muscles and orgasm).

So, partners, experiencing sexuality, embark on a sort of a two-

stage rocket: a continuous stimulation of one stage could ignite the
other. The value of Kaplan’s findings is the insight that one stage
being ignited, does not necessarily imply that the other stage has to
be turned on too.
44 Attraction and Attachment: Understanding Styles of Relationships

FIGURE 1. The computer program Personal Sexpertise provides couples

with help in dealing with sexual intimacy. X has noted the average excite­
ment course of her/his partner. The partner gives an opinion of X’s notations.

MALE SEXUALITY arousal

a
r
0
u
s
a
I
time

Give a number to each of the following aspects:

(1 = very badly sensed; 10 = excellent; 0 = not rel.)
a. pre love making, initial arousal 16
b. arousal in the beginning of interaction 19
c. orgasm progress 14
d. arousal at termination of lovemaking 18
C O NTINUE .... TYPE A KEY F10 = STOP

Here is how this has been conveyed to clients in the Personal

Sexpertise program. In a mini-lecture on the arousal curve, (sub­
menu for men), the following text appears on the screen:

Arousal does not necessarily have to end in orgasm. If arousal

is like a walk up a mountain, then people can also stop halfway
for a ‘nice picnic on a mountain meadow.’ After this, they may
return to the valley, or go for the top anyway. So you have
more than one way of making love at your disposal. The
chosen way will probably fit much better your own wishes and
possibilities as a woman or as a man. There is more than
penis-centered top-excitement. Using sex this way, men will
widen their possibilities of arousal. As a baby, a men’s skin
was a sensual organ from top to bottom, not just his penis.
Later on in puberty boys would feel aroused by a single
glance, a manner of walking, a nice figure, a looking forward
to a meeting. This wide scale of erotic experiences often fades
away for men, and that’s too bad. It can be regained, though,
for sexuality is not only made up by physically conditioned
 Louis Sommeling 45

processes, but above all by ideas we’ve been talked into in the
years that we’ve been living.
The fact that not only the clients but also many professionals still
tend to think in terms of a merely biological model of sexuality too,
has far-reaching consequences. To name some examples: unneces­
sary medical operations are still performed (e.g., for vaginism or a
tight foreskin). Mythical prejudices are perpetuated, e.g., about
asexuality of older women and men. Also, there are many no-sense
making intake questions for clients, such as: “How many times do
you do it?” There are more important questions to be asked than,
e.g., the latter, as we will see in the next section.

Sexual Desire: What Are We Looking fo r in Sex?

Object Relation theorists state that libido is object-seeking and not

primarily pleasure-seeking. Our needs are deeply psychological and
not merely biologically rooted. Sometimes in sexual desire people
want to touch mythical depths. At other times they want to fulfill a
more basic human need, such as there are: support, nurturance,
protection and “limitation”2 (Pesso, 1992). We can, in some ways of
kissing someone else, basically seek the fulfillment of our own need
for nurturance. In caressing along our body-contours, our identity
and ego-boundaries are tenderly limited and validated. Holding one
another in the darkness of the blankets, we protect and/or find protec­
tion. There are many ‘erogenic’ zones in the body as places where
we can get-not strictly sexual-support (e.g., behind the knees, the
small of the back, the buttocks).
In an amusing story Lillian Rubin3 gives an illustration of how
this can work with mainly not so much biological, but more psycho­
logical components of our so called ‘sexual’ excitements. She inter­
viewed a man who felt very excited when he “got” a women into
orally stimulating him; he felt an extreme power over her submis-
siveness. Then Rubin interviewed his female partner: she felt her­
self aroused by the same act of fellatio: she experienced power over
the extreme vulnerability of the man!
In his investigations Fisher (1973) found at least eighty reasons
for people to want to have sex. (For a categorization and therapeutic
applications see Figure 2).
46 Attraction and Attachment: Understanding Styles of Relationships

FIGURE 2. Screen of Personal Sexpertise: support in explicating implicit

expectations of couples on desire. X has asked himself what his partner
expects from sex. The partner gives an opinion as to the correctness of X’s
rotation.

MALE SEXUALITY WHY SEX?

F1= ACKNOWLEDGMENT AND STATUS (test to discover whether or not you’re

important enough for the other to be interested)
F2= PROTECTION AND DEPENDENCY (securely hidden away, seeking or giving
protection)
F3= FEELINGS OF POWER (testing if you can influence circumstances the way you
want, taking possession of the other).
F4= LOVE, AFFECTION (wanting to feel that the other appreciates you in all aspects
and v.v.)
F5= PHYSICALLY WELLBEING (experience of lust, content, release of tension)
F6= INDEPENDENCE (keeping your reserve, being above sexual dependency,
sexualize intimate feelings)
F7= THERE IS NOT ONE THING THAT ALWAYS TAKE PREVALENCE (it changes)
F8= ANYTHING ELSE, NOT MENTIONED HERE
F9= HEDOESNTKNOW

Harry chose for you: F1

TYPE A FUNCTION KEY: F10 = STOP

What are we looking for in sex? When people come with sex
problems it is important for therapists to invite them to think about
their needs by asking such a question. But giving an answer to this
question would suggest that people have an awareness of why they
want something. Most of the time however, unconscious needs play
a role in the background.
If we ask a client ‘What is it you are looking for in sex, why do
you do it?’, the obvious answer is usually something like: ‘Because
I love it.’ If you keep on asking however, often there turns out to be
a good deal more to it. Possible hidden motivations could be: ‘to
relieve my sexual tension,’ ‘to make another person feel nice and
comfortable,’ ‘to prevent a fight at home,’ ‘otherwise I wouldn’t
live up to the standard coitus frequency of the average man and that
makes me feel sure,’ etc. People tend to sexualize their human
needs. In those cases, they may use an ‘improper’ way to express
 Louis Sommeling 47

those needs. They would have been better served, had they been
able to express this some other way.
Inviting clients to think about their sexual motivations will sup­
ply alternatives. It creates possibilities to act in a more adequate and
personal way and to better meet our needs. Especially male thera­
pists (Aghassy, 1984, 1990) can sometimes make mistakes in the
interpretation of the behavior of their clients: behavior which looks
on the surface ‘sexual’ can often also be interpreted as testing
behavior or as a need for approval, support or affection.

Power-Aspects o f Rules, Definitions and Therapy-Strategies

Belief systems, rooted in secret sex-specific ideas, sometimes

have hidden power in our world. In the section above, we eluded to
a different paradigm from the biologically oriented definitions of
sexuality as they have emerged in a male oriented society.
Now, in the next paragraphs, we will look more closely to the
influence this has had on clients and on therapists.
Sex can be seen as a game with rules (Vennix, 1981). Discussing
the rules can open couples’ eyes for the power aspects of their
sexual encounters. The definitions of the rules may seem “natural,”
but who has written them? It may be helpful in a therapeutic ap­
proach, to aid clients in re-owning their own, individually appro­
priated rules.
The computer program Personal Sexpertise helps to open cli­
ent’s eyes for gender-specifically formulated rules.
Here is an example of a male rule: ‘The penis is the organ
which offers the most pleasure, so a nicely fitting vagina is the
best thing you can have.’
If women were to formulate these rules in a similar way,
how would this same rule be reformulated in this case? [In the
computer program the user is enabled to formulate her or his
own answer to these questions.]
In this case such could be: ‘The clitoris is the organ which
offers the most pleasure, so soft fingers or a nice, able tongue
is what one should look for in a man.’
A second example of a male rule: ‘For me intercourse ends
in a lovely orgasm; if she has her pleasure too, that’s a wel-
48 Attraction and Attachment: Understanding Styles of Relationships

come bonus.’ In reverse the female rule can be: ‘As a rule I
don’t climax during intercourse. I do, if we pet to climax; if he
comes too while petting, good for him.’

Therapists should be conscious of the influence their own gen­

der-specific ideas can have on the therapeutic treatments they offer.
In the daily practice of a Dutch sexologist for example, one can
often encounter the following scene:

The couple comes in and he may say: “She never feels like i t ”
She nods “yes” and feels guilty.
He points at her and thinks: “She is the patient.”

Which paradigm will lead the therapist here in his/her interpreta­

tions? The paradigms in the strategy we offer will have far reaching
consequences for treatment!4
In the computer program Sexpertise Professional, the program
which accompanies the Personal Sexpertise, some choices and their
consequences are listed:
As a therapist, you may think:

1. “ Most likely there’s something wrong with her. For that rea­
son she’ll need a psychological or physical examination.”
2. “We’ll start a therapy to teach her to own her sexual feelings,
for that’s what she lacks.”
3. “We’ll try and teach him how to lessen his libido.”
4. “We don’t speak about sexuality at all, because our focus is
on relationship problems; relationship problems are always
“ deeper” than sexual problems.”
5. “We are going to talk about their different expectations and
belief systems regarding sex. . . ”

Option 1 and 2 are typically macho points of view: the engine

has broken down and must be repaired. She is being labeled as the
patient. Therapy based on such assumptions, is likely to fail (the
covered aggression, showing itself in the body resistance, is not
explored). Medical examinations are here performed unnecessarily.
Medical treatment is only indicated in the case of physical pain or
use of medicine. In most cases there is nothing wrong with the
 Louis Sommeling 49

body. That there should be something wrong in a psychiatric sense

with the woman is also not the first option in this common case.
Option 2: It is not clear why she doesn’t feel like having sex. The
problem ‘lack of libido’ mostly has its cause elsewhere. Maybe he
is the one who is a poor lover, who has no notion of her form of
sexuality. And she may not be aware either of the fact that she may
have her own, different from his, forms of erotic desire.
Often, in therapeutic interventions, a choice is made here for one
of the two partners. And often this choice is in favor of the man’s
view and against the woman’s. (It is assumed that she’s the one who
needs to change.) That is why such a therapeutic intervention is
bound to end in failure.
Men will usually say: when sex is okay, the relation will be okay.
In reverse women will often say: when the relation is okay, sex will
be okay. True, she may, also in this case, turn out to be the one who
has an obvious problem, e.g., she can’t have an orgasm, even while
she herself would very much like to have one. Or she may be so
tensed up that a penis cannot enter her (vaginismus) and she as well
as he, would like to change that. This need to change does not need
to be only for the relationship, but could also be really for herself. In
that case a therapy for her would be indicated. But frequently it is
the man too, who has some sort of trouble.
Comparable to vaginismus with a woman, a man can suffer
from a tight foreskin; this can also be because he is afraid of
sex, or has never learned to masturbate properly. In such a
situation, that should also be paid attention to. But not primari­
ly by the doctor: a psychotherapist can provide him with some
exercises to widen the foreskin and overcome anxiety.
Option 3: It may be an original and radically feministic option to
point towards the male partner as the one who must change. The
question is, however, will it become clear this way why she has not
been able to solve her part of their problem without therapy? In this
option the man is being labeled as die patient: the therapist sides too
much in that case with the woman. For that reason this type of
treatment is also likely to fail.
Option 4: Couples therapists in general tend to perceive sexual­
ity as a “deeper,” i.e., a communicative problem. If they do so, they
50 Attraction and Attachment: Understanding Styles of Relationships

will not talk explicitly about sexuality. Such an attitude, however,

can also be a rationalization of the therapist’s own inhibitions.
Many clients, coming to our institute after analytic or mere commu­
nication therapy, complain that, because of their experiencing their
problems as sexual, their therapist’s attitude is not compatible.
Would it not show mere respect for a therapist to enter the interven­
tion through the client’s entrance (and perhaps exit by one’s own)?5
Option 5: In my opinion the choice to talk first about the different
expectations and ideas about sex with the client is the most ap­
propriate. It could be, that the woman does not feel like having sex,
because she has no choice but sit at home all day long, while he is
out there in the world. Or there may be something else she hates.
After all this has been explored and she turns out to be interested in
doing something about sex, the problem may be defined as follows:
Perhaps sex to them is only having intercourse and it is just that
which the woman does not like (but has not dared to speak out
about it so far).
So before starting any kind of sex therapy there are other things
we have to do as therapists. First, it has to become clear that a
woman has a right to her own kind of erotic life and this can be
different from his wishes. In the same way, we may have to con­
vince the man that there is more to sex than penis-centered arousal.6
Furthermore we may have to show that sex therapy is not just a
question of labeling one partner as the patient.
Generally the difficulty is to be found between partners; so they
both have to take their responsibilities. But first of all we have to
talk about their different expectations and ideas about sex. Having
discussed these topics, the ground is prepared for training new
behavior and new forms of making love (and now the body- and
skin-focusing aspects of the Masters and Johnson exercises may be
a useful approach).

MALE SEXUALITY AND OBJECT RELATION THEORY

The sexual focus as elaborated upon and rethought in the first

section of this article, now will be integrated and completed with a
perspective which relates to the Object Relation Theory. These two
 Louis Sommeling 51

approaches put together, illuminate a paradigm which can guide our

therapeutic interventions.
My research shows that group or communication therapy for
couples mostly effects women, in the sense that they become more
assertive; men only feel a little more connected, but in general do
not experience real individual change (Sommeling, 1991). This
article will end by describing our experience with this dual thera­
peutic focus as a promising perspective especially for men to
change their behavior.

Desire and Autonomy

The bridge between the two approaches was built by Winnicot.

He formulated the relationship between healthy autonomy and adult
sexual arousal management:
Being able to enjoy being alone with another person who is
alone, is in itself an experience of health. Lack of id-tension
may produce anxiety but time-integration of the personality
enables the individual to wait for the natural return of id-ten­
sion . . . (Winnicot, 1965)
This then leads us to asking an interesting question about sexual­
ity: “Do we seek contact with another person because we are
aroused?” or “Do we long for someone and therefore make our­
selves excited?” (Schmidt, 1974). Sometimes we have to stand by,
wait and sustain, without getting anxious.
To me it came as a shock when someone asked me for the first
time, (referring to the Masters and Johnson curve): “Which part is
the interactive phase, and which part the solophase?” The initial
stage of love making is highly interactive, there is a lot of contact
with the partner and arousal can arise here by stimulating each
other. But the middle part in which intercourse and orgasm has its
place, is adequately named the so/ophase.7 Especially during this
latter phase partners will be more on their own and solo. Despite all
the romantic illusions about ‘togetherness’ we can only experience
a true orgasm, if we decide to shift our focus of attention away from
our partner and more to ourselves, from interaction to individual
experience.
52 Attraction and Attachment: Understanding Styles of Relationships

(The stereotyped ideal and norm of “having an orgasm together”

only can mean that both individuals have an orgasm at the same
time). By accepting there is always “something between,” by real­
izing our existential aloneness and individuality, we grow toward
becoming autonomous partners. The so-called “primary sexual
problems”8 then, rooted in the individual case-history, primarily are
to be found in this solophase-area. And the so called “secondary
problems” mostly have to do with a lack of sufficient interactive
skills (Everaerd, 1981). Today sexual problems with intimacy in
men are not, generally speaking, caused by a lack o f interactive
skills but are primarily rooted in their individual case-history. So in
therapy we have to focus on individuation-separation processes too
and guide men to develop true autonomy. Psychologists like Nancy
Choderow et al. have described the problematic character of male
identity (based in the dilemma of not being the mother and not
being able to find a figure of identification in a psychologically
absent father). We as men have learned that separation is more real
than intimate connection. We are individuated but have not grown
to autonomy.9 We often experience fear of symbiotic engulfment
and defend ourselves by drawing our boundaries well by withdraw­
al and by controlling the other person involved. While deeply long­
ing for connection with the other, we confuse at the same time
“contact” with “symbiosis,” by reactively wanting to claim and to
possess women. We throw a “temper tantrum” if we don’t get what
we so desperately want. Therefore also in sexual relationship true
contact is only possible after disentanglement from individual sym­
biotic illusions and after finding the “optimal distance.”

Couples Therapy and Processes o f Men

In ten years of group therapy with couples who have sexual

desire problems, at first we, the therapists, mainly saw changes in
women, but no real individual changes in men. In later years, men
also experienced larger changes (Sommeling, 1991).
What was the secret of this shifting with the increase of the
treatment effects? First of all I was having a relationship with a self
confident woman and in my own therapy process was focussing on
personal change. But also I had a good working relationship with
 Louis Sommeling 53

the female co-therapist; so we became a better identification-model

for the couples we worked with.
Secondly, we managed and developed a dual focus of therapeutic
interventions. Next to exploring the cognitions about sex as men­
tioned above, our interventions were more analytically focused on
individuation-separation aspects.
By describing Group Focal Conflicts10 according to Whitaker
and Lieberman (1964) we discovered successive phases in the
changes the men went through and in the way they were working
through their inner processes.
These phases were:

a. Stage of anxious entanglement. In the beginning of group-

therapy, couples sit next to each other and speak about them­
selves in terms of “we.”
b. Stage of aggression and accusation in terms o f 44she” and 44he.”
Men and women are no longer sitting next to each other. The
men accuse their wives of not wanting sex, and advise them to
go see a doctor or the sex therapist With this statement men take
the one-up position of “sitting in a waiting-room,” but at the
same time keeping themselves in the submissive position of let­
ting go of the solution of the problem! Here, we get a glimpse of
the profound depths of some of men’s problematic feelings to­
wards women (often rooted in negative mother projections); they
can “eat” the mother, they have “rights” because they are mar­
ried and therefore the “owners” of the female body.
c. Stage of distance, the massive 4,no” o f the women. Women
have in this stage developed solidarity with each other, have
grown assertive and self-confident. This leads to more confu­
sion in the men and they started to feel more scared. “Blam­
ing my partner” doesn’t seem to work anymore in this stage
of the group therapy for couples.
d. The final stage: transition from individuation to autonomy. Hie
therapists’ support is especially needed for men in this anxiety
causing stage. The male part of the clients begin to speak in
terms of “feeling” and in the “I-form”: “I, as a man, felt de­
pressed, isolated, abandoned and not loved.” Such a state of con­
fusion turned out to be the painful condition for the development
54 Attraction and Attachment: Understanding Styles of Relationships

of more autonomy. Now is the time for the men to slowly start
identifying with die (encouraging) male therapist and with the
other men in the room, the famous “male bond” (Tripp, 1976).
Masculine Spirituality
The difficulty which men co-experience in staying alone for
sometime without looking outside themselves for another symbiotic
confusion, is beautifully pictured in Nelson’s lecture Male Sexuality
and Masculine Spirituality (1991):
Women tend to experience their sexuality as internal, deep and
mysterious. As a male on the other hand, I am often inclined to
experience my sexuality as more instrumental. My penis is an
instrument for penetrating and exploring a mystery which is
essentially external to me. And the linearity, the hardness, the
straightness of the prized erection all are important to my
understanding of reality. Then spiritually ( . . . ) I am prone to
believe that mystery is “out there” rather than sensing the
mystery dwelling within me ( . . . . ) .
The flaccid penis is empty of the engorging blood which
brings hard excitement to the phallus. Flaccidity is letting go
of all urgency; the spiritual experience of sinking, letting go
and emptying is an experience of divine grace, as interpreted
in the Christian tradition. It means trusting God that we do not
need to do, that our being is enough. It means trusting our­
selves to the darkness.. . .
I would like to conclude here that autonomy is a condition for
real sexual intimacy. It seems that especially men have to learn to be
alone (which is something essentially different from withdrawal!).
Instead of waiting until the woman will love him, a man has to learn
the secret that only in a position of true autonomy is he able to be
attractive. In that position of autonomy a man can take at the same
time responsibility for the sexual and the communicative problems
he and his partner are having as a couple. In such a position he will
be less emotionally dependent on his partner and consequently
claim her less as well.
When one of the male sex symbols of the eighties, William Hurt,
won an Oscar, I asked some female clients what made him so
 Louis Sommeling 55

attractive to them. Here are some of their answers: “He looks at

you, really seeing you too, and at the same time he is true to
himself.”- “He is his own; he gives a lot, yet does not drown in it.”
In an interview Hurt himself said: “ I think I discovered a long time
ago, and rediscovered sometimes, that I am alone-not that I’m
lonely, but I am alone.”
Only autonomous partners are capable of having a good relation­
ship and a human sexuality which is satisfying to both. The dual
focus, as described above, of rethought sexual basic concepts and of
attention for autonomy creates a clear paradigm for men to under­
stand themselves.

WITH A LITTLE HELP OF THE COMPUTER

This article is illustrated with some computer vignettes. Thera­
pists tend to look down on computers, but clients are enthusiastic
(Schwartz, 1984). Schwartz studied the use of computers in clinical
practice and even mentions transference feelings. Binik (1988) and
Reitman (1984) describe the use of computers in self help sex-ther-
apy for some restricted sexual dysfunctions. In the Sexpertise com­
puter programs11 the expert knowledge is systematized from a
Dutch National Institute for treatment of sexual problems.
Reviewed theories on sexuality and therapy experience with
today’s sexual intimacy problems are made available to everybody
(Sommeling, 1990).
The computer program Personal Sexpertise can be used by cli­
ents (the use should be supervised by the therapist). The computer
program also can be used in some way by people who do not have
severe problems. In interactive games Personal Sexpertise helps the
user to acquire more insight into his or her own sexual as well as
communicative functioning. There are games and mini-lectures on
arousal, explorations on “rules,” and questions on sexual motiva­
tion. It is also possible to obtain feedback on stereotyped sex-spe­
cific roles, in the behavior “ macho- or femi-score.” The program
supports openness on intimate topics (e.g., Figure 1 and Figure 2).
A quiz analyzes the user’s prejudices, exclusively medical thinking,
belief in myths, etc. These games don’t have the pretention to be
validated tests, but will discuss attitudes and give feedback on
56 Attraction and Attachment: Understanding Styles of Relationships

cognition and traditional myths about sexuality (like, e.g., the fa­
mous male myths of Zilbergeld (1978). Information screens on
modem contraceptives, sex problems and literature are available as
well as simple exercises for treatment of anoigasmia, vaginismus,
erectile failure, premature ejaculation and a tight foreskin.
Especially for professionals there is a second program: Sexper­
tise Professional. This computer program offers support to thera­
pists, social workers and general practitioners in the field of intake
assessment and treatment of sexual problems. Also more “recent”
problems, like incest, sexual abuse, AIDS and problems related to
female emancipation are talked about here. Of course, a therapist
can never be replaced by a computer.
Without reducing the therapeutic encounter however, the pro­
gram may prevent the therapist from overlooking some essential
questions. Some reflections about options for treatment are added
(individual, partner, sex- or communication-therapy). Reported ef­
fects of medication on sexual dysfunctions are pointed out.
Installed on data-bank or TV-teletext, the information in these
computer programs is easily accessible, twenty-four hours a day
(Figure 3). Already available comparative examples in the field of
sexology are the Human Sexuality Computer Service in New York

FIGURE 3. Computerized information on-line (databank) or on diskette.

Screen of Sexpertise, installed in a waiting room.

GENERAL INFORMATION

F1= CONTRACEPTIVES
F2= IF SOMETHING GOES WRONG
F3= SEXUALLY TRANSMITTED DISEASES (i.e., AIDS)
F4= EFFECTS OF MEDICINE AND DRUGS
F5= USEFULADDRESSES
F6= LITERATURE
F7= SEXOLOGICAL SOFTWARE

TYPE A FUNCTION KEY: F10 = STOP

 Louis Sommeling 57

with one and a half million members of their electronic meetings

(Lewis, 1986); the Minitel program Sexolog in Paris with a thou­
sand consultations per month (Waynberg, 1989); and the here men­
tioned Sexpertise programs in Rotterdam, Holland. Professionals or
laymen can get information or put, during day or night, questions in
an electronic mail box and be answered in a matter of days.
The Sexpertise program as outlined here reports in the period
09-89 till 12-90, a monthly average of 345 consultations. In an
inquiry 70% of general practitioners are intended to consult the
programs 4-20 times a year. The professional version is used by
therapists, in some clinics and also for training programs. The per­
sonal version-next to use at home and in the context of therapy-has
now been used for some years in introductory weeks for entering
university students.
This article outlines some perspectives for treatment of today’s
sexual problems of couples. A paradigm is suggested and concrete
applications are described. I hope that both, this article and the
computer programs will be a contribution to the solution of a typical
problem of our time: finding a way for self confident women and
men-both modem autonomous beings-to lead a life of inner free­
dom and intimacy together.

NOTES

1. A favorable exception is the journal Psychotherapy, Volume 27/Fall

1990/Number 3.
2. Pesso: “Lacking adequate experience of limit-imposing interactions, the
child is unsure of his or her own boundaries and vulnerable to a sense of omnipo­
tence on the one hand and powerlessness on the other.”
3. In a lecture at the World Congress of Sexology, Amsterdam, 1991.
4. For homosexual couples these problems are more or less comparable.
When in heterosexual couples it is the female partner who has more outspoken
sexual needs, paradoxically it is my experience that there is probably a problem of
a different nature, which lies beyond the scope of this article.
5. A Jesuit adage (St. Ignace of Loyola).
6. We tend to think, stereotypically of men as coming to rapid arousal and
being “mechanical” in sexual activity; it is also possible for women to behave in
a similar manner.
7. The solophase can be perceived as a metaphor for the existential aloneness
of people. The concepts of solophase and individuation are related associatively.
58 Attraction and Attachment: Understanding Styles of Relationships

Only when individuation is developed to autonomy are people able to communi­

cate truly and intimately.
8. Primary problems always were there, secondary problems arise later on af­
ter periods of no problem.
9. Autonomy is a discussed concept. We don’t have in view the 19th century
concept of a liberal moral culture. Within a Kantian tradition it is through domi­
nating our emotional lives that we assert our autonomy, which is a feature of rea­
son alone. True autonomy has to transcendent false polarities, it is both dependent
and independent, emotional and rational, tender as well as strong (Seidler, 1988).
It is adult “stand on your own.” Autonomy and individuation are different things:
autonomy is the area of the real self, individuation is the boundary of that area.
10. According to Whitaker and Lieberman (1964) each group session is a com­
promise between a wish and an anxiety. By describing these successive Group Fo­
cal Conflicts we “discovered” the stages.
11. You can order an English copy of Personal Sexpertise by paying $ 65 .-to
Amro Bank-Groningen, the Netherlands, number 46.72.63.787, mentioning the
disk format (5.25 or 3.5). The programs are IBM-compatible. If you are interested
in translation of Sexpertise Professional, write to the Publisher: Mediware, soft­
ware for healthcare, Zemikepark 2, 9747 AN Groningen, the Netherlands, tel.
50-745707, fax (31)50-634556. Author’s address: Louis Sommeling, Eikenlaan
45, 9321 GC Peize, the Netherlands (Fax: University, Sommeling, 50-637111).

INFORMATION
Publisher of the Sexpertise computer programs: Mediware, Groningen, the
Netherlands. More information: see note 11.

AUTHOR NOTE
Louis Sommeling is author of Volumes in the Computer Assisted Humanistic
Psychology Applications Series (Sexpertise and Dreamanalysis). At present he is
working on a book about Male Desire.

REFERENCES
Aghassy, G. (1984). Sexual contact between client and psychotherapist. Universi­
ty, Amsterdam.
Aghassy, G. and Noot, M. (1990). Sexuele kontakten binnen psychologische hulpver-
leningsrelaties. Ministerie van Sociale Zaken en Werkgelegenheid. Den Haag.
Binik, Y. (1988). Intelligent computer-base assessment and psychotherapy. An
expert system for sexual dysfunction. Journal of Nervous and Mental Disease,
176, 387-400. Williams and Wilkins. Baltimore: Preston.
 Louis Sommeling 59

Everaerd, W. and Dekker, J. (1981). A comparison of sex therapy and commu­

nication therapy: Couples complaining of orgastic dysfunction. In: Journal of
Sex and Marital Therapy, 7, 278-289.
Fisher, S. (1973). Female orgasm. Psychology, physiology andfantasy. New York:
Basic Books. (Summary in the Penguinbook: Understanding the female or-
gasm.)
Kaplan, H. (1974). The new sex therapy. New York: Brunner/Mazel.
Lewis, H. and M. (1986). The electronic confessional: a sex book of the 80's. New
York: Clinical Communications, Inc. By arrangement with M. Evans and Com­
pany, Inc.
Masters W. and Johnson, V. (1966). Human sexual response. Boston: Little,
Brown.
Nelson, J. (1991). Male sexuality and masculine spirituality. Subcongress Sex and
Religion of the World Congress of Sexology, Amsterdam. (The subcongress-
proceedings will be published 1992. Amsterdam-Atlanta: Ridopi).
Ibid. (1988). Male sexuality, masculine spirituality. Philadelphia: The Westmin­
ster Press.
Pesso, A. and Crandell, J. (1992). Moving psychotherapy. Brookline Books.
Reitman, R. (1984). The use of small computers in self help sex therapy. In M.
Schwartz: Using computers in clinical practice. New York: The Haworth Press,
Inc.
Schwartz, M. (1984). Using computers in clinical practice. New York: The Ha­
worth Press, Inc.
Schmidt, G. (1974). Sexuele motivation und kontrolle. Sexual Medizin, 5,60-65.
Seidler, V. (1988). Fathering, authority and masculinity. In: Chapman, R. and
Rutherford, J., Male order, unwrapping masculinity. London: Lawrence and
Wishart
Sommeling, L. (1990). Treatment of sexual problems in group dynamic groups
for couples. Dutch Journal of Group Psychotherapy, 25, J, 3-10.
Sommeling, L. (1990). Computer assisted treatment of sexual problems. Journal
of Dutch Sexology, 14, 29-38.
Sommeling, L. (1991). Shaping male sexual desire. Journal of Dutch Sexology,
16,174-183.
Tripp, C. (1976). The homosexual matrix. New York: New American Library.
Vennix, P. (1981). De regels van het spel. In N. Amsberg, Zin en onzin over seks.
Deventer, Holland: v. Loghum Slaterus.
Whitaker, D. and Lieberman, M. (1964). Psychotherapy through the group pro-
cess. Chicago: Aldine Publishing Company.
Waynberg, J. (1989). Sexolog-a computerized information service on sexuality.
In: Entre nous, 13,11-14.
Winnicot, D. (1965). The maturational processes and the facilitating environ­
ment. London: Hogarth Press.
Zilbergeld, B. (1978). Male sexuality. Boston: Little, Brown.
This page intentionally left blank
 The Mating Game:
What We Know
and What We Don’t Know
Joan Atwood

SUMMARY. Mate selection processes of couples have been of in­

terest to a multitude of disciplines ranging from biology to psycholo­
gy to social psychology. Debates usually center around “like marries
like” or “opposites attract.” While generally the research indicates,
at least with regard to social variables, that similarities among cou­
ples is the norm, little systematic empirical research exists which ex­
amined this basic belief. Family therapists, also adhering to this ba­
sic assumption in their notions of couple selection, collusion, and
reciprocal patterns of interaction, have not empirically tested this as­
sumption either. The present paper examines the literature from the
biological, psychological, and social psychological disciplines and
discusses these assumptions in family therapy theory. A discussion
of the implications for couple therapy is then presented.

Who mates with whom has been a subject of intense interest

among researchers ranging from biology to psychology to social

Joan Atwood, PhD, CSW, is Coordinator of the Graduate Programs in Mar­

riage and Family Therapy and Director of the Marital and Family Clinic at
Hofstra University, Hempstead, NY 11550. She is the author of Treatment Tech­
niques for Common Mental Disorders (NY: Aronson, 1987) and Family Therapy:
A Cognitive-Behavioral Approach (release 2/92), has done extensive research and
written numerous journal articles in the field of marriage and family therapy.
[Haworth co-indexing entry note]: “The Mating Game: What We Know and What We Don’t
Know/* Atwood, Joan. Co-published simultaneously in the Journal of Couples Therapy (The Haworth
Press, Inc.) Vol. 4, No. 1/2, 1993, pp. 61-87; and: Attraction and Attachment: Understanding Styles of
Relationships (ed: Barbara Jo Brothers) The Haworth Press, Inc., 1993, pp. 61-87. Multiple copies of
this article/chapter may be purchased from The Haworth Document Delivery Center [1-800-3-HA-
WORTH; 9:00 a.m. - 5:00 p.m. (EST)].
© 1993 by The Haworth Press, Inc. All rights reserved. 61
62 Attraction and Attachment: Understanding Styles of Relationships

psychology and sociology. Although researchers have proposed

numerous theories to describe the processes by which individuals
select their mates, these processes have received little systematic
scientific scrutiny. After reviewing the literature, these theorists
from the different disciplines primarily adhere to a position analo­
gous to “like marries like.” While the biological, psychological,
and social psychological theorists agree that this is generally the
case, family therapists, who also have never systematically empiri­
cally tested this belief hold strongly to a similar position in their
notion of equal levels of psychological maturity in relationships. It
is the purpose of this paper to briefly review the current findings of
the mate selection literature and examine this assumption in family
therapy theory and discuss its implications for couple therapy.

BIOLOGICAL THEORIES OF MATE SELECTION

Biological theories of evolution and natural selection influenced
theories of marital choice. Darwin’s theory of sexual selection sug­
gested that individuals competed with members of their own sex for
reproductively relevant resources held by members of the opposite
sex (Buss, 1988); Campbell (1886) believed that scientific match­
making was unnecessary because evolution weeded out mis match­
ings of the race; and Weininger argued that a man possesses pre­
dominantly masculine characteristics in his cells and some female
cells and that each characteristic seeks its opposite in the opposite
sex; hence a purely masculine type would be drawn to a purely
feminine type. Other biologists such as Westermarck (1936) stated
that monogamy was the most advanced evolutionary form of mar­
riage; other forms such as polygamy were survivors of earlier stages
of evolutionary development; while Szondi (1937) proposed the
theory that marital choice is directed by the latent recessive genes,
by the common ancestors that reappear and formally reincarnate in
later generations after having been repressed for periods.
Biological explanations of mate selection also tend to center
around instinct or genetics. Here, biologists believe that instincts
are basic to human behavior and are at the basis for male/female
mate selection. Related to the theory of instinct is the genetic simi­
larity theory (Rushton, Russell, and Wells, 1985) which states that
 Joan Atwood 63

genetically similar others have a tendency to seek each other out

and provide supportive environments. Biologist Weinrich (1957)
takes instinct theory a step further and puts forth a sociobiological
“courtship theory” where he discusses courtship as the series of
steps and signals by which two individuals communicate and per­
haps consummate their desires to have sexual relations.
Another biologist, Trivers (1972), posits that mate selection is
driven in part by different levels of investment by males and fe­
males in their offspring (Bateman, 1948). He believes that in spe­
cies with much parental involvement, such as Homo Sapiens (Alex­
ander and Norman, 1979), the females seek to mate with males who
have the ability and willingness to provide resources related to
parental investment such as food, shelter, territory, and protection.
Males prefer attributes in potential females associated with repro­
ductive value or fertility (Buss, 1987). Biologist Dyer (1988) has
examined the notion of “ love at first sight,” i.e., physical attraction
or “sexual chemistry” He pointed out that when individuals are
sexually aroused, or when they meet someone who they define as
attractive, their sympathetic nervous systems begin to create two
hormones-norepinephrine and dopamine. These hormones affect
the pleasure center in the brain and are directly responsible for what
people feel when they report that they have “fallen in love.”

SOCIAL PSYCHOLOGICAL THEORIES

OF MATE SELECTION
At a more macro level of analysis, sociologists also believe that
mate selection is determined; but, instead of instincts or genetic
similarity being the causal factor, they posit that sociocultural fac­
tors act as filters which help to define a pool of eligible spouse
candidates from which a choice is then made (Eckland, 1982). The
bulk of the sociological literature on mate selection centers around
the dispute between those who claim that “opposites attract” and
that “like attracts like.” Sociologists have found that correlations
exist between several physical and social characteristics and mate
selection. These characteristics are: age, social class, residential
propinquity, socioeconomic status, ethnicity, intelligence, race,
religion, education, physical attractiveness, personality variables,
64 Attraction and Attachment: Understanding Styles of Relationships

self-concept, self-esteem, similar role definitions, similar values

and social exchange. Generally, these theorists believe that the ten­
dency to marry someone like oneself, at least in terms of macro
social criteria, is very strong (Buss, 1985).
Age is highly correlated between mates. In the United States,
most single persons select their mates from a closely related age
group. In 1989, the median age at first marriage was 24.4 for males
and 22.5 for females (U.S. Bureau of the Census, 1989). With
regard to social class, there is a definite and marked tendency for
individuals to marry within their own socioeconomic group (Eck-
land, 1982). Sociologists have also found that many individuals
select their marriage partners from among those who live near them
geographically (residential propinquity). People marry people who
are socially and economically similar. In 1960, about three quarters
of the married couples in the United States were of the same ethnic­
ity. However, Carter and Glick (1976) state that with the continuous
advances in communication, mobility, and the resultant increased
assimilation, ethnic homogamy could conceivably approach chance
levels by the fourth generation. Assoitive mating for intelligence
yields mixed results. For a review of studies done in this area,
please see Richardson, 1939; Snyder, 1966; Vandenberg, 1972; and
Watkins and Meredith, 1981.
Nowhere are homogamy norms more widely held to than in the
area of race. Even though the number of interracial husbands has
been on the rise since 1960 for most combinations of races, they
still only involve one percent of all marriages with most interracial-
ly married couples being Black-White couples, involving primarily
black husbands and white wives (Leslie & Korman, 1989; Mur-
stein, 1986; and White and Hatcher, 1986). Studies have found that
the number of people who marry within their own religion is far
greater than chance occurrence can explain. However, this could be
changing. While rates of religious intermarriage rates began to in­
crease during the 1960’s and 1970’s, they skyrocketed during the
1980’s. In 1985, it was estimated that 27.6 percent of all marriages
were interfaith marriages. Half of all Catholics, half of all Protes­
tants, and one third of all Jews now many outside their respective
faiths (Davis-Brown et al., 1987). With regard to education, there
appears to be a greater likelihood for men and women with similar
 Joan Atwood 65

levels of education to pair (Bentler and Newcomb, 1978; and Mur-

stein, 1986). When they do differ, males tend to marry females of
slightly lower educational achievement (Jacobsohn and Methany,
1962).
Physical attractiveness appears to play an important role in mate
selection within a community of eligible mates with similar socio­
cultural characteristics. Buss and Barnes (1986), in their study of
mate preferences, found that physical attractiveness was ranked
fourth out of thirteen available characteristics that subjects had to
choose from to describe an ideal mate. The physically attractive
characteristic was preferred significantly more by men than by
women (Buss and Bames, 1986). Most of the studies in this area
indicate that as courtship continues, couples differing in attractive­
ness are more likely to break up than those more similar in attrac­
tiveness (Feingold, 1981; Folkes, 1982; Murstein and Christy,
1976; Price and Vandenberg, 1980; and White, 1980). Kalick and
Hamilton (1986) found that while people may prefer highly attrac­
tive partners, “real world considerations” (p. 675) result in the
necessity of most people to lower their expectations and to couple
with others having a level of attractiveness similar to their own.
Kendrick, Sadalla, Groth, and Trost (1990) found that females
were more selective overall particularly on status linked variables.
Males had lower requirements for a sexual partner than did females
but were nearly selective as females when considering a long-term
partner. Similarly, Townsend and Levy (1990) found that women
are more likely to prefer or insist that sexual intercourse occur in
relationships that involve affection and marital potential, and
women place more potential than men do on partner’s masculine
traits such as employment, financial, and intellectual status, and
valued commitment in a relationship more highly than men did
(Davis, 1990). Men emphasized stereotypically desirable feminine
traits (appearance). These findings were supported by Buss (1989).
A careful review of the studies examining personality variables
indicates that personality traits are moderately matched for couples
but that no one variable stands out as being consistently related to
high assortive matching. (For a review of these studies, please see
Centers, 1975; Farley and Mueller, 1978; Price and Vandenberg,
1980; and Sindberg and Roberts, 1972.) The role of self-concept in
66 Attraction and Attachment: Understanding Styles of Relationships

the mate selection process is an important factor. Mittlemen (1956)

proposed that individuals enter relationships which reaffirm their
self-concepts. Thus, the manner in which individuals perceive their
own capabilities and limitations may influence their behavior with­
in their social environment in terms of initiating a relationship with
a potential mate.
Social psychologists also present theories of mate selection. For
example, they believe that role and value agreement are other factors
involved in mate selection. According to role theory, persons would
tend to choose mates on the basis of courtship and marital role
agreement. The role itself is not as important as the consensus of the
partners with regard to the role (Eshleman, 1988). Similarly, value
theory posits that interpersonal attraction is facilitated when die part­
ners share or perceive themselves as sharing similar values (Ber-
scheid and Hatfield, 1978). Other social psychologists believe that
positive and negative social exchanges are related to whether or not a
dating relationship will endure. Social exchange theory states that
enduring love and attraction are most likely to develop when each
person in a relationship perceives an advantageous exchange be­
tween received and contributed resources (Thibaut and Kelly, 1959).
A variation of this theory was put forth by Centers (1975) who stated
that in any relationship individuals attempt to pair with someone with
whom association brings the most rewards and the fewest costs.
Kerckhoff and Davis (1962) hypothesized that certain social attrib­
utes and personality relationships operate differently depending on
the particular stage of courtship. The results of their study indicate
that value consensus operates in the early stages of courtship and
need-complementarity later on. However, further replication (Lev-
inger, Senn, and Joigensen, 1970) has failed to support this theory.
One of the first social psychologists to focus on the on-going
development of relationships was Ira Reiss (1960) who postulated a
wheel theory o f love. He stated that the spokes of the wheel are
rapport, self revelation, mutual dependency and personality need
fulfillment. These are the necessary stages leading to persons fall­
ing in love. The wheel spirals and this leads to increasingly deeper
rapport, and greater self revelation, and so forth. It may also unwind
leading to less rapport, which successively weakens each stage.
Theorists have found that a norm of reciprocity develops so that the
 Joan Atwood 67

levels of intimacy revealed are comparable (Worthy, Gary, and

Kahn, 1969) and are also related to the extent of love (Rubin, Kill,
Peplau and Durkel-Schette, 1980) lending support to the theory.
Another sequential type theory was developed by Murstein
(1970). Murstein’s basic premise is that mate selection results from
a bargaining process in which self-acceptance is considered a nego­
tiable asset. Murstein suggested that most couples pass through
three stages before they marry. People are at first attracted to each
other by their perceptions of their attractive qualities. This is re­
ferred to as the “ stimulus” stage and is highly influenced by physi­
cal attractiveness. Next, they enter into the “value” stage where
they begin to discover whether they share similar values and atti­
tudes. If there is agreement, the relationship progresses to the
“role” stage. At this point, the couple’s interaction provides them
with a good idea of what they would be like if they were married.
Solomon (1986) recently examined and found support for some of
Murstein’s original hypotheses. Cate and Koval (1983) questioned
the adequacy of all the sequential models and pointed out that
replications have not provided much support for the hypothesized
stages. In addition, they suggested that in many cases dating pro­
ceeded into a marital relationship without much intimacy, and that
often external factors such as social pressures and lack of attractive
alternatives propel relationships to marriage.
In sum, as Buss (1985) believes: assortive mating is the most
common human deviation from random mating in Western soci­
eties. In general age, education, race, religion, and ethnic back­
ground show the strongest assortment. The findings in this area are:

1. Males and females generally many those who are similar in age.
When there is a discrepancy, males are usually slightly older.
2. Males and females generally marry those with similar educa­
tion. As with age, when there is a discrepancy, males usually
are more educated.
3. Males and females usually many those of a similar race although
this is changing with slightly more interracial marriages occurring.
4. Males and females generally marry those of a similar religion
although this is changing with more interreligious marriages
occurring.
68 Attraction and Attachment: Understanding Styles of Relationships

5. Males and females usually marry those with a similar ethnic

background, although there have been major differences oc­
curring within the past thirty years with individuals from dis­
similar ethnic backgrounds marrying.

These stronger sociological similarities are followed by the social

psychological variables of intelligence, personality variables, self-
concept, self-esteem, values, and physical attractiveness.

PSYCHOLOGICAL THEORIES OF MATE SELECTION

Psychodynamic Theories o f Mate Selection

The psychoanalytic perspective views the composition and quali­

ty of courtship, mate selection, and marriage as being dependent on
the quality of personality development that each partner has
achieved (Eisenstein, 1956). Those individuals who have developed
a differentiated and individuated sense of self are predicted to expe­
rience a positive marital relationship. Well adjusted individuals are
believed to achieve this quality of personality organization by suc­
cessfully managing a series of developmental processes. Conse­
quently, prediction of marital choice is reportedly possible by un­
derstanding one’s early personality development and interpersonal
experiences (Poalino and McCrady, 1978).
Freud (1914) believed that a person tended to fall in love with
and marry a person similar to their opposite sexed parent. This is
generally unconscious and centers around the Oedipal/Electra
Complex. For Freud (1921), the concept of falling in love involved
the operation of intense narcissistic needs. The intermeshing and
responsiveness of these needs is a significant factor in the choice of
a mate. An individual is apt to seek out, consciously and uncon­
sciously, another individual who promises to provide gratification
for the unconscious narcissistic needs (Meissner, 1978). Benedek
(1959) concluded that lovers offer each other an exchange of ego
ideals. Ohmann (1947) stated that people fall in love with individu­
als who provide the missing parts of the personality which are felt
as ego deficiencies. Reik (1957) posited that, “One falls in love
 Joan Atwood 69

when one is dissatisfied with oneself and meets someone of the

opposite sex who has those characteristics that he or she desires but
has been unable to achieve” (p. 321). Through identification with
such an individual, one’s perceived deficiencies (the individuals’
failures to attain their own ego ideal) are eliminated.
Hartmann (1950) delineated three levels of object relations: pri­
mary narcissism, need gratification, and object constancy. Persons
at the first two levels have numerous difficulties in a marital situa­
tion. Blanck and Blanck (1968) considered the struggle to differ­
entiate oneself a continuous struggle throughout life. They believe
that mature love is only possible when the individual had a firm
sense of identity. Mahler, Pine, and Bergman (1975) provided ana­
lytic theorists with the separation-individuation process whereby
the child separated him/herself from the symbiotic relationship with
the mother and learned to tolerate both aloneness and non-symbiot-
ic closeness. Other theorists have utilized the separation-individua­
tion process in their discussions of mate selection (see Blanck and
Blanck, 1968; Gans, 1975; Joffe and Sandler, 1965; Roth-Puckett,
1977; and Winestone, 1973).
Thus, those individuals who are psychologically ready for mar­
riage are considered to be at the object constancy level of object
relations (Hartmann, 1950), having passed successfully through the
psychosexual stages of development (Freud, 1914), and to some
degree, to have successfully mastered the separation-individuation
process (Mahler, 1965). Those individuals who have not mastered
the developmental tasks preceding marriage are said to attempt to
complete themselves through a spouse (Freud, 1925); exchange ego
ideals (Benedek, 1959; Jung, 1953; and Reik, 1957), attempt to
protect themselves from hunger and aloneness (Schor and Sanville,
1978), and to distort their perceptions of their spouse in order to fill
in the gaps of their personality (Satir, 1967).
While the above theorists presented discussions concerning the
development of the capacity to successfully love another person,
the following theorist discusses what attracts individuals to each
other. While most theorists postulate that mate selection is due to
homogeneity in attitudes and personality traits (Burgess and Wallin,
1953), Winch proported that it is due to complementary needs.
Winch (1952, 1955,1958) and Winch, Ktones, and Ktones, (1954)
70 Attraction and Attachment: Understanding Styles of Relationships

postulated the theory o f complementarity o f needs. These authors

incorporated sociological findings with regard to background fac­
tors and psychoanalytic concepts concerning personality develop­
ment. This theory states that potential mates are first selected out of
a “field of eligibles” which is originally developed through homo­
gamy of social factors. Their belief was that even though mate
selection is homogamous with respect to age, social class, residen­
tial propinquity, race, religion, education, physical attractiveness,
etc., when it comes to psychological needs, mate selection tends to
be complementary rather than homogamous. Later research in this
area of assortive mate selection has concentrated on correspondence
between partners (e.g., Johnson, Ahem, and Cole, 1980; and Wat­
kins and Meredith, 1981) especially as it influences personal envi­
ronment (Synder and Gangestad, 1982) and adult personality devel­
opment (Buss, 1984). Thus, Winch believes that beyond the initial
similarities, mates are selected by means of “heterogamy of mo­
tives.” Heterogamy of motives refers to the concept of need com­
plementarity (Gurman, 1978). However, the vast majority of re­
search has generally failed to support Winch (see Murstein, 1976).
Family Theorists
Other clinicians have adopted a different theory of need comple­
mentarity with regard to the mate selection process (Aldous, 1973;
Aroaz, 1974; Dicks, 1967; Napier, 1971, 1988; and Sager, 1976).
While Winch’s theory focuses on individual selection factors (why
A chose B), the above listed clinicians have attempted to address
the process of how and why A and B choose each other as a joint
decision. Unlike the intrapersonal psychoanalytic position stated
earlier, these theorists examine the interpersonal process of mate
selection. This unspoken process is referred to as “collusion”
(Dicks, 1967; Willi, 1982); “ family projection process” (Bowen,
1966); “pseudo-identification” (Eidelberg, 1948); “trading of dis-
associations” (Wynne, 1971); or merging (Boszormenyi-Nagy and
Framo, 1967). These theorists suggest that an unconscious collabo­
ration exists where each partner chooses the other and enters into an
implicit agreement to fulfill the other’s needs (Sager, 1976).
Similarly, Miller, Nunnally and Wackman (1988) offers a theory
of mate selection that is founded on the notion that individuals
 Joan Atwood 71

choose partners who have similar concepts of the meaning of a

relationship. Driven by a desire to form an interpersonal union,
individuals choose each other as partners in such a way that their
own habits, feelings and ideals are confirmed. The formation of this
union is structured by the concept of collusion which encompasses
the notions that partners are joined on the basis of similar kinds of
unresolved conflicts around which an unadmitted and hidden inter­
play occurs. It is in this interplay that the partners take on roles
which create an impression that they are, characteristically, oppo­
sites of each other. But, in actuality, they are “polarized variants of
the same conflict” (p. 107).
Perhaps the most detailed process of mate selection is presented
by the object relations family theorists (Dicks, 1967; Fairbaim,
1952; Willi, 1982, 1984; Slipp, 1984, 1988; and Scharf and Scharf,
1957). Psychoanalytically oriented marital therapy theory focuses
on the unconscious determinants of marital choice (Nadelson,
1978). “The process of selecting a mate is not magical or mystical
but an expression of each individual’s personal needs and develop­
ment in a particular sociocultural context” (Nicols and Everett,
1986). The object relations theorists, like the earlier psychoanalytic
theorists, address the concept of the unconscious as being an active
agent in mate selection. Dicks (1967), Fairbaim (1952, 1963), and
Ackerman (1958) discuss in detail how individuals choose partners
based on their own previous relationships with significant objects in
their early lives. Willi (1984) states, “Collusive partner choice does
not appear to be a key-in-lock process where both personalities fit
tightly together. Instead, the couple emerges as a result of mutual
adjustment, a blending of the latent and manifest personality traits
of both partners” (p. 161). Ackerman (1958) stated, “Particularly
significant is the disguised motivational element of searching out a
mate who is likely to assuage or counteract one’s personal anxiety . . .
it is often said that one neurotic marries another . . . it is common
knowledge that the neurotic tendency of one marital partner
often complements that of the other. . . When one partner exhib­
its pathological anxiety responses, the other usually does too”
(p. 165).
Dicks (1967) saw the obscure process of mate selection as being
based on unconscious signals or cues by which partners recognize
72 Attraction and Attachment: Understanding Styles of Relationships

the other’s “fitness” for joint working through or repeating of still

unresolved splits or conflicts inside each other’s persons-at the
same time paradoxically sensing the guarantee that with that per­
son, they (conflicts) will not be worked through. Family therapist
Boszormenyi-Nagy (1965) commented, “What appears to be true
feedback between two partners may actually be programmed by
their internal relational events. Many marriages are essentially lived
between each partner and their respective introjects” (p. 110). Fra-
mo (1982) agrees, “Each partner unconsciously attempts to maneu­
ver the other into some earlier relationship pattern in their family of
origin: each has a disquieting feeling that some old tormenting
ghost has risen to haunt him. Of course, the partner must cooperate to
complete the process needed to maintain the relationship” (p. 89).
Minuchin (1974) does not necessarily describe a particular
theory of mate selection; however, he speaks of a process of mutual
accommodation or patterned transactions. It is through these pat­
terned transactions that each spouse triggers and monitors the be­
haviors of the other and is in turn influenced by the previous behav­
ioral sequence. These transactional patterns form an invisible web
of complementary demands that regulate family situations “When
partners join, each expects the actions of the spouse to take the
forms with which he is familiar. Each spouse will try to organize the
other spouse along lines that are familiar or preferred, and will push
the other to accommodate” (p. 27).
Virginia Satir (1988) discussed some of the effects of previous
relationships on an individual’s choice of a partner. “Without nec­
essarily knowing it, parents are the architects of their children’s
romantic and sexual selves. I believe that two people arc first inter­
ested in each other because of their sense of sameness, but they
remain interested over the years because of their ability to enjoy
differences” (Satir, 1988, p. 154). Another experiential family ther­
apist, Carl Whitaker, states, “ If you assume that the beginning of
the marriage is a transference phenomenon, then the choice of a
marital partner is infinitely accurate: It’s unconscious to the uncon­
scious” (Neill and Kniskem, 1982, p. 173). According to Whitaker,
mate selection is done with the same kind of exactness that you
would expect of a computer. The combination of a husband and a
wife is an extremely accurate one.
 Joan Atwood 73

Kirschner and Kirschner (1986) have given some consideration

to the way individuals seek out and choose a mate. Their theory is
based on the notion that spouses extend their self-definition to
include the other. Part of the self and/or parts of the personalities of
the parental figures are projected onto or unconsciously assigned to
a mate. Spouses choose partners similar to parental figures who are
also able to provide the reparental inputs they need. The Kirschners
also place significance on the role of the family of origin in deter­
mining a mate. They believe that “Marriage involves a thrust to­
ward completion and integration of the self. Spouses are chosen not
only on the basis of congruency in self-system structures, but also
out of a longing to promote growth of self and the other” (p. 148).
Scarf (1987) states that although the choice of the marital partner
often seems to have been made very quickly, on the basis of little
conscious knowledge, it turns out with great accuracy of comple­
mentarity and facts of personalities and even life experiences of the
partners. Couples quite often turn out to have striking similarities in
terms of childhood experiences. She believes that the marriage
partner is a person who connects us to parts of our beings which are
completely suppressed, lost to memory, and yet well remembered at
an almost cellular level. Nicols and Everett (1980) describe the
mate selection process as one in which an individual’s level of
personal development and historical need patterns link with those of
a mate in a new dyadic process.
Napier (1988) who gives considerable emphasis to the process of
mate selection states, “ If there is any single principle in our selec­
tion of mates, it is in my view that we marry someone who is a kind
of psychological twin. We are all indeed in search of someone who
will help us feel psychologically complete” (Napier, 1988, p. 218).
“ We are attracted to someone whose basic psychological situation
in his/her family of origin is similar to our own. That is, we identify
with this person’s core problems, dynamics that were shaped in the
early family” (Napier, 1988, p. 221).
Hendrix (1988) believes that in psychological development from
infant to adult a part of ourselves is repressed. He calls this the “ lost
self,” the part that is repressed due to its unacceptability. As indi­
viduals reach maturity they seek to fill an emptiness inside them­
selves caused by this repressed side of the personality. As a result,
74 Attraction and Attachment: Understanding Styles of Relationships

individuals seek mates whose personalities are complementary to

their own. They have a template, “Imago,” of what they long for in
a partner which in reality is the composite of all their impressions of
their original caretakers. When individuals find someone who
matches this imago, they become intensely excited because their
unconscious believes that this relationship will provide the nurtur­
ing they have been longing for and in this manner they will regain
their original wholeness.
Behavioral family therapists Jacobson and Margolin (1979) also
believe that often a relationship is based on one’s fantasy that a
spouse will provide the complementary behavior lacking in oneself.
Stuart (1980) addressed the theory of assortive mate selection in
noting that “ like marries like” (p. 77). Buss (1985) believes that
“ . . . it is rare to find partners who are more than two developmental
levels art. That amount of developmental discrepancy usually leads to
separation and divorce” (p. 16). In fact, Mehrabian (1989) after an
extensive review of the literature, found that there was greater inter­
spouse similarity in stable compared with unstable marriages.
Papp (1983) discusses the relationship between spouses in terms
of their patterns of reciprocity. She quotes several other researchers
and clinicians who address reciprocity in relationships. Reciprocity
is viewed as interlocking collusion (Winch, Ktones, and Ktones,
1954), “reciprocal functioning” (Bowen, 1960); “pseudo-mutual­
ity” (Wynne et al., 1958); “complementarity” (Jackson, 1957);
“bilateral reciprocity” (Dicks, 1967), “need complementarity”
(Mittleman, 1944), “hidden agenda” (Sager, 1967), “pattern of
reciprocal overadequacy and inadequacy” (Bowen, 1978), and
“unconscious deal” (Framo, 1982). Haley (1963) describes the
reciprocity in a relationship as one partner taking the helpless de­
pendent position in order to control the other partner and balance
the hierarchical power structure.
Jackson’s (1957) original notion of “complementarity” was fur­
ther explicated by Watzlawick, Beavin, and Jackson (1967). These
latter authors note their work was preceded by Bateson’s (1958)
description of relationship interactions in New Guinea tribes. The
similarity of complementarity and Bowen’s reciprocal functioning
may be seen in Watzlawick et al.’s “dominant” and “adaptive”
spouse stances. Watzlawick et al. (1967) relate that in a complemen­
 Joan Atwood 75

tary pair, there is an “ inequality” in the relationship often based on

one partner being “one up” and the other “ one down.” They also
use the term “symmetrical interaction” to describe relationships
said to be “equal” (i.e., the members of the pair are similar in their
behavior and there is “ minimization of difference” (p. 68-69).
Watzlawick et al. (1967) also use the term “metacomplementary”
to describe relationships in which “A” lets or forces “ B” to be in
charge of him (p. 69). This statement seems quite similar to Bo­
wen’s (1976) suggestion that in a marital pair, “one may assume the
adaptive role and force the other to be dominant” (p. 79).
The outcome of these relationship patterns also appears to have
similarity if one considers Watzlawick, Beavin and Jackson’s
(1967) and Bowen’s (1960, 1976, 1978) writings. The former au­
thors see symmetry as leading to conflict if members of the pair try
to be “more equal” or one up each other in a “ symmetrical escala­
tion” (Watzlawick et al., 1967, p. 107).
Bowen and Differentiation o f Self
Of all the family theorists, Bowen was the most articulate about
mate selection processes. A cornerstone of Bowen’s theory is the
concept of differentiation of self. “ It defines all people, from the
lowest to the highest possible level of human functioning, accord­
ing to one single denominator” (1972, p. 472). Bowen’s concept of
differentiation refers to an individual’s capacity to distinguish the
feeling and the thinking processes. At the highest level are those
with a separate self who can differentiate between their emotional
system and intellectual system; at the lower levels are those whose
intellectual and emotional systems are so fused that their lives are
controlled by their emotional system. Bowen states that these indi­
viduals are flooded with feelings which prevent them from separat­
ing thoughts from feelings. They always look for togetherness in
relationships and become amorphous “no selfs” in regard to their
own beliefs and convictions. It is interesting to note that what is
valued in Bowen’s system are the qualities for which men are so­
cialized and what is devalued are those for which women are social­
ized.
Bowen (1961, 1966, 1976, 1978) believed that clinical experi­
ence suggests that individuals tend to choose marital partners who
76 Attraction and Attachment: Understanding Styles of Relationships

have achieved an equivalent level of maturity, but who have

adopted opposite patterns of defensive organization (Meissner,
1978). Bowen believed that mating, marriage, and reproduction are
governed to a significant degree by emotional and instinctual forces.
The way in which an individual handles these forces in dating and
courtship and in timing and planning of marriage provide one of the
best views of differentiation of the spouses (Bowen, 1978).
These levels of differentiation are determined by the time s/he
leaves the family of origin (Gurman, 1978). An individual’s level of
differentiation is a crucial factor in determining a potential spouse.
“People pick spouses who have the same level of differentiation”
(Bowen, 1978, p. 376). Based on this premise, the selection of a mate
is not accidental. Each individual has the tendency to repeat the style
of relating learned in the parental family in all future relationships. In
this regard, poorly differentiated individuals seek out equally depen­
dent relationships in which they can borrow enough strength to
function (Bowen, 1976). According to Bowen (1961, 1966, 1976,
1978), “ Individuals seek a partner based on the ability of that partner
to help the individual repeat early family experiences, the partner’s
level of differentiation, and the expectation that the partner will help
the individual make up for the developmental failures” (Gurman,
1978). According to his theory, an individual’s level of differenti­
ation is fundamental to his/her selection of a mate in that individuals
are predisposed to many others with levels of differentiation similar
to their own (Atwood, 1992; Goldenbeig and Goldenberg, 1991).
Similar to the object relations theorists, Bowen (1961) discusses
opposite patterns of defensive organization to the levels of differ­
entiation as necessary factors in selecting a mate. He states that one
spouse or partner will assume a dominant role in response to the
other assuming an adaptive role or vice versa. Bowen believes that
these roles are not determined by gender but in response to the
position each partner maintained in his/her family of origin. These
characteristics play a major role in the original choice of each other
as partners (Bowen, 1978, p. 377).
Blatt and Wild (1976) emphasized the role of boundaries in a
discussion of differentiation. They examined the development from
a state of autism to symbiotic fusion with the need gratifying object,
to separation, individuation and the beginning of mature object
 Joan Atwood 77

relationships. The developmental task of differentiation was be­

lieved to be achieved in marriage after the couple has accepted and
accommodated to their individual differences in style, needs, and
role expectation (Pineo, 1960).
Bowen maintained that life style, thinking, and emotional pat­
terns at various levels of the scale differed so much that people
choose their spouses and close friends at equal levels of differenti­
ation as themselves. Moynihan and Ingraham (1971), Kear (1978),
and Weinbeig (1978) have presented data substantiating this claim in
the case of selecting a spouse. Citrin (1982) examined the relation­
ship between individuals’ level of development and interpersonal
perception. He found that individuals choose their spouses at the
same level of differentiation as themselves. Bamett (1971) discussed
a rigid pattern which was strongly influenced by and influenced
perceptions of spouses, obsessive compulsive/hysteric relationships.
In this culturally reinforced relationship, the obsessive compulsive
(usually the male) was attracted to the hysteric’s (usually the female)
aliveness and promise of emotional nurturance. The hysteric was
similarly attracted to the obsessive-compulsive’s structure, depend­
ability, and intellect. In both cases, the individuals sought in each
other what they have not been fully able to develop in themselves.

DISCUSSION
In order to present the reader with a general flavor for the re­
search findings and theorizing in the area of mate selection, the
biological theories of mate selection, the social psychological vari­
ables associated with mate selection, along with a discussion of the
psychological theories associated with mate selection was pre­
sented. In addition, the basic assumption of family therapy theory-
persons of equal levels of differentiation and psychological maturi­
ty marry-was presented. From the above discussion it is obvious
that family therapy theorists hold certain assumptions around mate
selection processes. Some of these major assumptions are:
1. Spouses in a relationship tend to be at equal levels of psychologi­
cal maturity (Meissner, 1978; and Sonne and Swirsky, 1981).
2. People tend to recreate their interpersonal world in relation­
ships by recreating patterns of interaction that were estab­
78 Attraction and Attachment: Understanding Styles of Relationships

lished by early caretakers and maintained in family of origin

systems (Abies and Brandsma, 1977; and Willi, 1984).
3. Couples collude, cooperate with each other, to maintain the rela­
tionship (Blanck and Blanck, 1968; Dicks, 1963; and Willi, 1984).

The problem is that these assumptions have yet to be systemati­

cally and empirically tested. To briefly summarize, in general, bio­
logical, psychological, and social psychological research and theo­
ries on mate selection assume that “like marries like.” Family
therapy theorists, building on psychodynamic or object relations
family therapy theory, have consequently assumed that “like mar­
ries like” psychologically as well. Family therapy theory then takes
as its basic assumption that persons of equal psychological maturi­
ty, emotionality, and self-esteem marry. While this belief has never
been empirically tested by these theorists, it continues to be a cor­
nerstone of the therapeutic practices of clinicians grounded in the
family therapy paradigm.
The implications for family practice are enormous. For example,
if a clinician believes that psychological equality in relationships
exists, then reciprocity in couples is assumed. If there is the belief
that equivalent levels of maturity/immaturity and self differenti­
ation exist in couples, then there is the belief that there is a tendency
for marital partners to be operating at equivalent levels. This puts
clinicians on guard because when they find signs of pathology/dys­
function in one marital partner, they keep an eye open for induc­
tions of a similar level of personality organization in the other. If
this basic assumption that “like marries like” is incorrect, or if it is
correct under only certain instances, then clinicians could be
searching for (possibly creating) non-existent pathology so that
what a couple therapist may mistake for pathology may in fact be
complementarity.
Research which examines specific variables affecting choice of
marital partners, successful and unsuccessful factors related to these
specific variables and the variables which lead to “happy” lasting
marriages will surely lend information on successful coupling, will
help us to delineate die “ workable” issues in premarital counseling,
will familiarize us with the traps and pitfalls associated with unsuc­
cessful mating, the variables related to more successful mating, and
 Joan Atwood 79

hopefully lead us to a clearer understanding of the mating game. At

this time, over 55% of married individuals will eventually divorce.
This rate is even higher among second marriages. Divorce is typi­
cally considered a negative state in this society as is evidenced by
the high stress during the transition and the problems often
associated with the children of divorce. Research which could con­
tribute to a more detailed understanding of the mate selection pro­
cess might help couples thwart off future divorce. For example,
what variables are relevant in the mate selection process in the first
place? What variables are important in keeping the initial attraction
alive over the course of the marriage or relationship? What vari­
ables are important determinants in a couple’s decision to stay
together? What variables are important in determining marital satis­
faction? Are there intervening variables? If yes, what are they?
These and other questions would shed some light on the coupling
process and in so doing help couple therapists understand couple
dynamics in a more holistic way. Once therapists have a better
understanding of the effects of mate selection processes, they can
begin to theorize about a couple therapy that is more grounded and
supported by research.
However, as Napier (1988) suggests, “ . . . the process of choos­
ing a mate is so bewilderingly complex that no one fully under­
stands it. No one.” (p. 207). TTius, while not completely a random
process, i.e., there is the existence of determinable biological and
social psychological patterns and correlations, it appears that mate
selection is not either a fully conscious process in that it is strongly
influenced by individual psychological perception and definition. It
is this aspect of the mate selection process that appears to limit our
ability to fully understand one of the most basic of human activities:
intimate interpersonal relationships.

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This page intentionally left blank
 An Overview of the Historical
and Empirical Antecedents
in the Development
of the Codependency Concept
Frank P. Troise

SUMMARY. This paper offers a general overview of the historical

and previous empirical studies leading up to the contemporary con­
ceptualization of codependency theory. In addition the author in­
cludes a seemingly lone research attempt to examine a major person­
ality trait universally attributed to codependents-their hypothesized
diminished capacity for intimacy.
The current concept of codependency was used to understand the
non-alcoholic spouse’s behaviors and psycho-pathology in relation

Frank P. Troise, DSW, BCD, would like to thank Mr. Michael Aymar for his
research assistance in developing this paper.

Frank Troise June 15, 1948-May 15, 1993

Between the time of writing this article and its publication, Frank Troise
died suddenly in New York City on May 15,1993. We regret this loss to the
mental health community-and that we will be receiving no more such
thought-filled articles from him.
Dr. Troise’s brother Don, also a social worker and also a psychothera­
pist, is Director of the New York City Department of Health HTV Counsel­
ling and Testing Group Services Program; he requested that publication
continue as planned. Please send correspondence to: Don Troise, CSW, 146
West 86th Street, #2C, New York, NY 10024.

[Haworth co-indexing entry note]: “An Overview of the Historical and Empirical Antecedents m
the Development of the Codependency Concept,” Troise, Frank P. Co-published simultaneously in the
Journal of Couples Therapy (The Haworth Press, Inc.) Vol. 4, No. 1/2,1993, pp. 89-104; and: Attraction
and Attachment: Understanding Styles of Relationships (ed: Barbara Jo Brothers) The Haworth Press,
Inc., 1993, pp. 89-104. Multiple copies of this article/chapter may be purchased from The Haworth
Document Delivery Center [I-8OO-3-HAWORTH; 9:00 a.m. - 5:00 p.m. (EST)].

© 1993 by The Haworth Press, Inc. All rights reserved. 89

90 Attraction and Attachment: Understanding Styles of Relationships

to his or her alcoholic spouse. This so-called diagnostic entity has

been broadened to include, in addition, non-alcoholic relationships
where the codependent selects a mate incapable of engaging in a
healthy emotionally intimate relationship. Therefore a pathological
interactional syndrome develops locking the codependent into cer­
tain self-defeating behaviors which are psychogenetically connected
to, and resonate with, the codependent’s dysfunctional family of ori­
gin. This paper focuses primarily on women, or codependents, who
are married to alcoholics.

INTRODUCTION

Despite the fact that codependency theory is a widely accepted

diagnostic entity in both the mental health and lay population its
validity has not been supported by empirical research (Kokin and
Walker, 1989). Cermak (1986) has argued for its inclusion in the
diagnostic and statistical manual. Others (Black, 1982; Subby,
1987; Wegsheider-Cruse, 1985;) have written self-help books on
the subject, developed treatment centers for codependency and lec­
tured extensively on the pervasiveness of codependency in contem­
porary culture. Furthermore, prior empirical studies (Bailey, 1967;
Jackson, 1954; Haberman, 1964), crucial to the development of
Codependency Theory, are conspicuously absent in the literature
with the exception of Kokin and Walker’s (1989) criticism of Code­
pendency Theory as it relates to wives of alcoholics. Despite the
absence or use of prior or present research codependency has been
legitimized as a valid diagnostic entity, supposedly characterized by
identifiable behaviors and interactional pathological syndromes
which are perpetuated by the codependent in a marriage to an alco­
holic. While the contemporary definition of codependency includes
both males and females, a review of the literature (Kokin and Walk­
er, 1989) strongly suggests that women are the predominate bearers
of this psychological condition. Their own psychogenetically
grounded “neurotic” predisposition to select floridly symptomatic
spouses makes them “enablers” (Subby, 1987) who are both “ vol­
unteers” and “victims” of their alcoholic spouses’ illness. Their
“enabling” behavior perpetuates their spouses’ alcoholism and
locks them into a pathological interactional syndrome which pro­
hibits a healthy marriage. Simply stated, such wives, or codepend­
 Frank P. Troise 91

ents, enter the marriage to the alcoholic with a pre-existing psycho­

pathology. Such a marriage is both painful to the codependent yet
pathologically gratifying given its familiarity and resonance with
her disturbed prior involvement with a “dysfunctional family” of
origin. Clearly, Codependency Theory strongly suggests psycho­
logical investment on the part of the codependent in her husband’s
illness. She is, therefore, a “volunteer-victim” both suffering from
her husband’s alcoholism yet exploiting it for psychopathologic
secondary gain. This basic etiologic and psychodynamic conceptu­
alization of codependency is consistent with previous psychoana-
lytically informed theories, developed in the 1950’s, which were
defined as the “Disturbed Personality Theory” (Futterman, 1953;
McDonald, 1956; Price, 1945) of wives of alcoholics. These psy­
choanalytic formulations inferred that the married alcoholic’s per­
sonality and drinking problems were intimately related to the patho­
logic need and security operations of the non-alcoholic spouse.
An overview of the “Disturbed Personality Theory” will be
presented following a general summary of Codependency Theory.
The paper will then trace the empirical challenges to the “Disturbed
Personality Theory” to include a feminist historical perspective on
the sociological climate in which this theory developed. Finally the
author will conclude with a seemingly lone empirical study (Troise,
1992) examining a primary personality characteristic attributed to
codependents-that is, the diminished capacity for experiencing inti­
macy amongst wives of alcoholics or codependents.

CONTEMPORARY CODEPENDENCY THEORY

Kokin and Walker (1989) have noted that the contemporary de­
scription of codependents is so broad that it is almost indistinguish­
able from other personality disorders or pathological interactional
syndromes. Some theorists (Black, 1982; Larsen, 1985; Subby,
1987) stress etiological factors which interact with the conflict and
stress generated by the alcoholic spouse. Others, while recognizing
etiological contributions grounded in the codependent’s dysfunc­
tional family of origin, focus on her maladaptive reactions to living
with an alcoholic (Wegsheider-Cruse, 1985). Given the wide range
of characteristics attributed to codependents the author has selected
92 Attraction and Attachment: Understanding Styles of Relationships

those behaviors and interactional syndromes agreed upon by most

codependency theorists. Again, these pathologic configurations
supposedly distinguish codependents from other diagnostic entities
and contribute to the codependent’s selection of an alcoholic or
pre-alcoholic mate, the perpetuation of the spouses’ alcoholism and
the disturbed interaction between the codependent and the alcoholic
spouse.
Larsen (1985) states that codependency is characterized by those
self-defeating learned behaviors or character defects that result in an
incapacity to initiate or to participate in loving relationships. In this
view the codependent seeks out a troubled person (i.e., alcoholic) for
a mate since this relationship defends the codependent against intra­
psychic conflicts concerning intimacy which resonate with their dys­
functional family of origin. These behaviors, or coping mechanisms,
would prevail throughout the codependent’s life and permeate signif­
icant relationships (Beattie, 1987). Generally stated these characteris­
tics are as follows: Codependents tend to come from dysfunctional
families, suffer from a lack of self worth and have major difficulties
in establishing and experiencing intimate relationships. The interper­
sonal boundaries in their relationships are fluid and characterized by
their attempts at controlling the object and denying their partners’
problems. They lack trust and are typically dependent. Codependents
find it hard to express their emotions and repress their anger. These
characteristics organize primarily around interpersonal interaction.
The common link amongst codependents is more readily detected in
their maladaptive behavioral patterns within the context of signifi­
cant relationships which require a mature capacity for intimacy.

THE “DISTURBED PERSONALITY” THEORY

The theory of “Disturbed Personality” was the first postulated to

account for psychological disturbance seen in wives of alcoholics
during the first half of this century (Edwards, Harvey, Whitehead,
1972).
As previously mentioned psychoanalytic social workers and psy­
chiatrists (Bailey and Haberman, 1962; Ballard, 1959; Clifford,
1960; Futterman, 1953; McDonald, 1956; Rae and Forbes, 1966)
suggested that women with certain personality types tend to select
 Frank P. Troise 93

alcoholics or potential alcoholics as mates in order to satisfy uncon­

scious needs of their own. These needs supposedly foster the con­
tinued drinking of the husband.
In one of the first articles devoted to such women, Lewis (1937)
described them as having found an outlet for their own anger in
their relationships with men who were dependent on them and who
created situations which forced the wives to ‘punish’ their hus­
bands. Boggs (1944) found that some wives fought their husband’s
attempts to get help, which undermined the treatment and kept the
husband ineffectual. He theorized that this behavior was a means of
justifying their own continued hostility and of camouflaging their
inadequacies and inner conflicts.
In his observational study of the wives of twenty alcoholics,
Price (1945) described the women as typically dependent persons
who had become hostile upon finding that their husbands were too
dependent. The women in this study often interpreted their hus­
bands’ drinking as a rejection of their dependency needs. To ‘get
even,’ Price’s subjects became more demanding or assumed inordi­
nate responsibility in their marriages making their husbands feel
even more inadequate. Price also observed that these wives would
usually fight treatment unconsciously. He concluded that they
“needed” the husband to be alcoholic as proof of their own superi­
ority and their husbands’ inferiority.
Whalen (1953) described wives of alcoholics, she saw in a family
service agency, as having married these men to fulfill certain per­
sonality needs of their own and because their husbands possessed
certain personality deficiencies that met these needs. She identified
‘types’ among the wives, including ‘martyrs,’ ‘punishers,’ ‘control­
lers’ and ‘needers.’ Whalen (1953), by attempting to identify cer­
tain types among women who chose alcoholic husbands because of
their own personality needs, and Price (1945), by noting their de­
pendence, foreshadowed some of the work currently called “Code­
pendency” Theory.
Futterman (1953) concluded, from clinical observation, that
wives of alcoholics, because of their own needs, seemed uncon­
sciously to encourage their husbands’ alcoholism. He theorized that
because of their strong identification with a dominant mother they
felt unconsciously inadequate and so chose a weak, dependent hus­
94 Attraction and Attachment: Understanding Styles of Relationships

band. He believed that when this symbiotic relationship was dis­

turbed, by the husband’s attempt to recover, the wife would ‘de­
compensate.’ That is, her personality would deteriorate with the
loosening of pre-existing psychological defenses resulting in an
increase in affective symptoms (i.e., depression and anxiety) and
decreased ability to function adequately. Some wives developed
psychosomatic illness during their husband’s recovery period.
McDonald (1956) examined Futterman’s notion of decompensa­
tion among eighteen patients of a state psychiatric hospital whose
husbands were alcoholics. He found eleven cases of decompensa­
tion connected to an improvement in the husband’s condition, one
associated with worsening alcoholism, and six in which there was
no change in the husband’s drinking patterns. McDonald noted that
although a number of the patients had diagnosable personality dis­
orders, they had shown no signs of deterioration until their hus­
band’s drinking patterns changed for the better.
While these pioneering studies were based primarily on clinical
observation, McDonald did fmd evidence that suggested that a sig­
nificant number of wives of alcoholics were, in some way, psycho­
logically invested in the maintenance of their husband’s alcoholism.
His work confirmed, to some degree, Futterman’s hypothesis that
many wives of alcoholics would psychologically decompensate
when the alcoholic spouse recovered.

THE “DISTURBED PERSONALITY THEORY”:

A FEM INIST PERSPECTIVE

During World War II the nation applauded women for their par­
ticipation in the national war effort. However, this applause rapidly
turned to criticism of women for having gone to work during the
war and thereby destroying the American family in the process.
Men returned from war and women were now defined as having
given up their femininity and maternal role to compete with men
causing their children to become delinquents and their husbands to
become alcoholics (Banner, 1974).
Freudianism, according to Banner, had begun to have a major
influence on American psychiatry and psychiatric social work prac­
tice. As previously noted, it was Freudian psychiatrists and psycho­
 Frank P. Troise 95

analytic social workers who developed the “Disturbed Personality

Theory.” They argued that women could attain emotional stability
only through domesticity and motherhood. Thus, women who now
worked denied their natural needs and threatened the family struc­
ture. This bitter anti-feminism of the immediate post-war years
echoed throughout the 1950’s, forming a body of thought that in­
fluenced sociologists, psychoanalysts, school teachers, etc., in a
way that clearly blamed women for the psychopathology of the
returning male draftees and the increase in alcoholism amongst
male war veterans. The “Disturbed Personality Theory” was bom
within this social context and was heavily influenced by Freudian
psychology which defined women’s burgeoning work identity and
independence as competitive and castrating towards men. Banner
concludes that such theories were a reaction to the threat that female
independence posed to men. Freudian psychology reinforced the
idea that such autonomy in women was designed unconsciously to
psychologically castrate men, rendering them susceptible to alco­
holism and covertly encouraging or perpetuating their illness for the
neurotic needs of die non-alcoholic spouses.

THE “STRESS” THEORY

The “ stress” or “reaction to stress” theory (Edwards et al.,

1972) developed as more and more social welfare agencies and
counselors began to take on the problems of the family as a unit
where one or both spouses were alcoholic.
An increased understanding of family systems theory in the
1950’s, and a desire to test the psychoanalytic observations gener­
ated by the “Disturbed Personality Theory” further prompted em­
pirical study which formed the basis for the “Stress Theory.”
Jackson and Kogan (1954) were the first to hypothesize that the
neurotic traits, affective symptoms and psychosocial disturbances,
commonly detected in the wives of alcoholics, were a reaction to
the stress of living with an alcoholic and the marital and family
conflict that the alcoholic provoked by his behavior. For example,
the “ stress theory” suggests that commonly observed uncoopera­
tive or dominant behavior on the part of the wife was a coping
mechanism developed to maintain family functioning and stability.
96 Attraction and Attachment: Understanding Styles of Relationships

Likewise, the wife’s tendency to ignore changes in her husband’s

behavior (i.e., recovery) and retain the same aforementioned “ cop­
ing” strategies were not a result of her pathological needs but a
realistic recognition of the husband’s undependability (Jackson and
Kogan, 1954). In this view the wife’s increased symptomatology
during the husband’s recovery was merely a continued reaction to
the impending threat that the alcoholic could relapse at any given
time. Therefore the wife, in this situation, maintained previous de­
fenses in an attempt to prepare for the “ inevitable” relapse.
In Jackson and Kogan’s study (1954) the “stress” hypothesis
was tested by comparing spouses whose husbands were abstinent
(but who had been heavy drinkers) with spouses of currently heavy
drinking alcoholics. They compared the MMPI (Minnesota Multi-
phasic Personality Inventory) scores of twenty-six wives of recov­
ering alcoholics with those of fifty wives of active alcoholics and
fifty wives of non-alcoholics. Wives of non-alcoholics had the low­
est rate of personality disturbance, wives of actively drinking alco­
holics had the highest rate and wives of recovered or inactive alco­
holics were in-between.
Bailey (1967) and Haberman (1964) found that women whose
husbands were abstinent (although problem drinking had occurred
earlier in the marriage) reported fewer psychophysiological symp­
toms (i.e., gastrointestinal problems) than women whose husbands
were cunendy drinking. Paolino and McCrady (1977) noted that
spouses of alcoholics in treatment showed significant decreases in
anxiety and depression as their partners’ drinking problems im­
proved. “Stress” theorists felt that these studies supported the “ reac­
tion to stress” hypothesis and disproved the “Disturbed Personality
Theory” since wives of abstinent alcoholics (who should be under
less stress) were less “impaired” than wives of active alcoholics.
Bailey, Haberman and Alksne (1962) attempted to examine both
“Disturbed Personality Theory” and “Stress Theories” as to whether
the disturbance observed in wives of alcoholics antedates the marriage
or stems from the cumulative stresses of the husband’s progressive
illness. Since the wife is assumed to play a primary role in the course
of the alcoholics’ illness and in his motivation to recover, the divergent
theoretical approaches were examined by Bailey et aL by comparing
groups of women whose marriages to alcoholics have had different
 Frank P. Troise 97

outcomes: divorce, recovery of the husband, or maintenance of the

marriage with an actively drinking spouse.
In order to determine the degree of psychological disturbance in
the wives in all three groups structured interviews were conducted.
The interviews included twenty-two questions in psychophysiolog-
ical and psychoneurotic symptoms extracted from the United States
Army Neuropsychiatric Screening Adjunct and Minnesota Multi-
phasic Personality Inventory. If it were true, according to the “Dis­
turbed Personality Theory,” that the wives’ psychological distur­
bance antedates the marriage to the alcoholic, and that these women
needed the alcoholic to drink in order to maintain their own psycho­
logical equilibrium, then it would be expected that they would
suffer an increase in symptoms once the marriage ended or the
husband recovered. If the “stress” theory were valid then these
wives would be expected to experience significantly less psycho­
logical disturbance once the marriage was terminated or the hus­
band was recovering. This group was compared to wives who re­
mained in marriages with actively drinking alcoholics.
The results revealed that the separated or divorced wives believed
they had improved after ending the marriage. Those wives whose
husbands achieved sobriety during the marriage saw themselves as
improved even more markedly than the separated or divorced group.
It was not possible to determine changes in the scores of wives of
actively drinking husbands since few of them could remember a
clear contrast period. That is, an earlier time during the marriage
when they had not been exposed to their husband’s drinking.
Historically, the quantitative and qualitative empirical research of
the proponents of the “Stress Theory” was accepted. The “ Dis­
turbed Personality Theory” was, for the most part, abandoned in
favor of the belief that wives of alcoholics were no different in their
psychological distress or personality disturbance, then any other
wives who were experiencing marital distress or conflict. The
theory that wives of alcoholics had a common unitary personality
disturbance, that underscored their involvement and investment in
the alcoholic spouses’ illness, was abandoned by most mental
health professionals by the late 1960’s (Edwards et al., 1972).
98 Attraction and Attachment: Understanding Styles of Relationships

EMPIRICAL STUDY OF THE CAPACITY FOR INTIMACY

IN WIVES OF ALCOHOLICS OR CODEPENDENTS

The codependent’s pre-existing diminished capacity for experi­

encing intimacy is central to the psychodynamic and interactional
psychopathology typically ascribed to this population. This primary
organizing personality deficit, which supposedly antedates the mar­
riage to the alcoholic, is viewed by Codependency Theorists (Black,
1982; Subby, 1987; Wegsheider-Cruse, 1985), as a primary contrib­
utor in the disturbed interactional pattern and “enabling” behavior
which perpetuates the alcoholic’s continued drinking. Simply stated
the codependent unconsciously needs the alcoholic to drink because
the conflict generated by the alcoholic protects the codependent
from a feared emotionally intimate relationship. This lack of inti­
macy and marital conflict, while painful, is familiar and safe for the
codependent given its resonance with disturbed interactional pat­
terns in her family of origin.
Given the primacy of the codependent’s hypothesized impaired
capacity for experiencing intimacy, in any significant relationship,
it is reasonable to assume that such an impairment would be evident
in the codependent’s relationship with her “ best” or “closest”
friend. An empirical study was conducted (Troise, 1991) in which
an experimental group (n = 120) of wives of alcoholics or code­
pendents were compared to a control group of wives of non-alco­
holics (n = 120) measuring the difference in the subjects’ capacity
for experiencing intimacy. Both groups were asked to complete the
Miller Social Intimacy Scale (Miller and Lefcourt, 1982) as it per­
tains to their experience of emotional intimacy in their relationship
to their “best” or “closest” friend. The hypothesis predicted that
the codependents would score significantly lower in their capacity
to experience intimacy in their relationship with their closest friend
when compared to controls.
There were no significant differences between the mean scores of
the codependents and the controls in their experience of emotional
intimacy with their respective “best” or “closest” friends. It is
important to note that the sample was stratified for adult children of
alcoholics. The hypothesis was not proven thereby offering some
support for the “reaction to stress” theorists’ findings which sug­
 Frank P. Troise 99

gested that there was no unitary personality configuration or psy­

chological disturbance which distinguishes wives of alcoholics or
codependents from other wives. Interestingly enough this empirical
study stands alone in the literature on Codependency Theory which
is primarily grounded in observations in clinical practice. Further­
more the codependency literature is conspicuously lacking in refer­
ence to previous empirical studies (“Stress Theory”) which were
unable to link wives of alcoholics together vis-a-vis a common
personality disturbance or traits.

DISCUSSION
This historical overview of the research which foreshadowed the
development of contemporary Codependency Theory reveals that
the basic theoretical construct, which informs Codependency
Theory, was abandoned by mental health researchers in the late
1950’s and early 1960’s. Attempts to link wives of alcoholics to­
gether with a shared personality disturbance, which contributed to
their selection of an alcoholic mate and the perpetuation of the
alcoholic’s illness, were put to rest by the findings of the “ Reaction
to Stress” theorists. Furthermore, history reveals that the original
“ Disturbed Personality Theory” of wives of alcoholics, which
clearly shares a similar theoretical foundation with contemporary
Codependency Theory, was intimately connected to long since
abandoned Freudian concepts regarding innate masochism in
women. In addition Banner (1974) has noted that this theory was
developed within a social climate which blamed the assertiveness of
women for the psychological difficulties of men returning from
World WarH.
Most codependency theorists attribute the codependent’s behav­
ior to a combination of failed coping attempts in dealing with the
alcoholic’s destructive behavior and a pre-existing psychopatholo­
gy which attracts the codependent to a disturbed relationship there­
by perpetuating and exploiting it for psychopathologic gain (i.e.,
repetition compulsion). Nevertheless the notion of codependents as
“enablers” in their symptomatic spouses’ illness, strongly suggests
a blaming of the victim who is married to someone who is creating
havoc in the marriage due to his alcoholism.
100 Attraction and Attachment: Understanding Styles of Relationships

Bowen (1978) has noted that the symptoms of one spouse may be
needed by the other mate in order to mask or defend the non-symp-
tomatic spouse against personality deficits. In such an instance the
symptomatic spouses’ illness is needed to maintain homeostasis in
the relationship. Merikangas (1982) found that individuals who are
symptomatic but have a vulnerability to develop a psychiatric disor­
der (i.e., alcoholism) and therefore display behavioral anomalies,
withdrawal, and a lack of social skills are less likely to develop
mature intimate healthy relationships. Consequently, these individ­
uals are either selected out of the “ marital pool” or marry individu­
als who are similarly impaired. Clinical observation of married
couples in conflict often reveal that the florid symptoms of one
spouse are needed and exploited for psychopathologic gain by the
non-symptomatic spouse. However the widespread acceptance of
codependency as a distinguishable diagnostic entity, without the
benefit of empirical validation or recognition of previously related
research, encourages pre-conceived sweeping notions regarding
women who marry alcoholics by mental health professionals.
Kokin and Walker (1989) have stated that the concept of code­
pendency is firmly grounded in antiquated and empirically un­
founded Freudian beliefs that women enjoy their suffering based on
innate biologically grounded masochistic tendencies. They argue
that expert professionals find it difficult to diagnose and treat alco­
holism yet when the wife of the alcoholic or codependent flounders
in dealing with her alcoholic spouse she is accused of perpetuating
his illness for psychopathologic gain. They further state that believ­
ing that women are codependents takes the focus off the alcoholic
himself and provides some relief since alcoholism is so difficult to
treat and recovery rate is so low. Furthermore it encourages the
blaming of women for yet another problem. Women-blaming in our
culture is a widely accepted activity as it was in the 1940’s and
1950’s when the related disturbed “Personalty Theory” was bom.
Interestingly enough both time periods were characterized by in­
creased female independence and demands for equal status with
men. Kokin and Walker suggest that Codependency Theory has
created a whole new set of jargon and counterintuitive principles
giving bewildered and frustrated professionals a sense of control,
power and efficacy as they now speak a new language that lay
 Frank P. Troise 101

people cannot understand. Lastly the non-alcoholic spouse, or code­

pendent, is eminently more treatable, and in many cases quite will­
ing to assume blame or personality disturbance in a marriage to an
alcoholic. In such an instance the alcoholism clinician can more
easily experience some measure of success in treatment of the code­
pendent as opposed to regular treatment failures with the alcoholic
spouse. The patient who defines herself as “enabler” or a contribu­
tor to her failing marriage, based on her own codependent personal­
ity disorder, maintains and perpetuates the illusion that she can have
some influence over her husband’s alcoholism vis-a-vis treatment
for her codependency.
In summary, a historical overview of the empirical research and
theories regarding wives of alcoholics, which foreshadowed the
development of Codependency Theory, strongly suggests the need
for integration of prior research and the empirical study of contem­
porary Codependency Theory. Sweeping acceptance of this theory,
by both mental health and the lay population, has proceeded with­
out the benefit of coordinated empirical research.
Undoubtedly there are those patients who suffer from psycho­
pathology, consistent with codependence. Others inadvertently en­
ter marriage to an alcoholic and become victims of the stress and
conflict generated by the alcoholic’s destructive behavior. Prior
research, conspicuously absent in contemporary codependency lit­
erature, has failed to provide convincing evidence that wives of
alcoholics or codependents share any unitary personality configura­
tion-healthy or pathological. Premature acceptance of this theory
and diagnostic entity seriously influence and limit the mental health
clinician’s understanding and treatment of a population that has
already been traumatized, confused, blamed and misunderstood
given the chaotic nature of the alcoholic marriage. To ascribe cer­
tain personality deficits as contributing factors which “enable” or
perpetuate the alcoholic’s illness to wives of alcoholics amounts to
perpetuating the blame of such wives for their husbands’ disease. It
further perpetuates the illusion that the wife, were she to alter her
“enabling” behavior, would then have some significant impact on
her husband’s alcoholism.
Some attempts by wives of alcoholics or codependents to cope
with the disturbance generated by their alcoholic spouse inadver­
102 Attraction and Attachment: Understanding Styles of Relationships

tently allow the alcoholic to continue drinking. Many wives are not
familiar with the alcoholic syndrome and unknowingly support the
alcoholic’s denial through various attempts to maintain marriage,
family and social or employment obligations. Such attempts often
prolong the alcoholic’s recognition of the erosive effects that alco­
holism is having on his family, marriage, social and employment
life. However, to define the wife’s attempts at coping with such an
unfamiliar mental health problem as pathologically gratifying ob­
fuscates the essence of the difficulty the non-alcoholic spouse is
having in coping with such a marital trauma. Given the almost all
inclusive diagnostic picture attributed to codependents and the will­
ingness of many wives of alcoholics to assume some blame for their
husbands’ alcoholism many so-called codependents will readily
conform to and accept a codependent diagnosis. Kokin and Walker
offer a simple yet profound example of the basic adaptive function
of the codependent in dealing with the alcoholic’s destructive be­
havior. They say that if the codependent assumes responsibility for
driving an automobile, with children in it, because the husband is
too drunk to drive she is merely protecting her family from potential
disaster. While this example is somewhat obvious it is metaphori­
cally significant in terms of the so-called “enabling” behaviors
attributed to codependents. The psychopathology or “enabling”
behavior of the wife of the alcoholic, so defined by codependency
theory, is more often than not the only option available to a wife
who must assume responsibility for her and her family’s welfare
given her alcoholic husband’s inability to do so. While such behav­
ior may inadvertently perpetuate the alcoholic’s disease it must be,
at first, considered as an attempt to legitimately and reasonably
cope with the trauma imposed on her by her alcoholic husband.
Clinical wisdom suggests that certain interactions between flor­
idly symptomatic spouses and their “non-symptomatic” partners
are often perpetuated and exploited for psychopathologic gain by
the “non-symptomatic” spouse. Codependency Theory, however,
returns full circle to a theory, previously abandoned through empiri­
cal research, which obliterates differential diagnosis, ignores the
impact of reality trauma of alcoholism on the non-alcoholic spouse
and is seemingly a thinly disguised version of previously aban­
doned Freudian concepts which blame women for the difficulties of
 Frank P. Troise 103

men. Further empirical study of contemporary Codependency

Theory along with integration of prior empirical studies, which
foreshadow the development of Codependency Theory, are needed
before mental health professionals and the lay population accept
this theory as if it is a valid diagnostic entity.

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tions.
Troise, F. P. (1991). “The Capacity For Intimacy in Wives of Alcoholics.” Un­
published dissertation. Adelphi University School of Social Work, Garden
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Wegsheider-Cruse, S. (1985). Choice-Making. Pompano Beach, FL: Health Com­
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Whalen, T. (1953). Wives of alcoholics: Four types observed in a family service
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 Codependency and Depression:
A Correlational Study
Betsey Backe
Erin L. Bonck
Marie L. Riley

SUMMARY. The focus of this study was to investigate a correlation

between codependency and depression. The instruments that were
used for the study were the Beck Depression Inventory (BDI) and
The Awareness Activity: How Codependent Are You? Results of this
study were based on 149 paired inventories. The individuals who
volunteered to complete the inventories were selected from three
clinical settings in the New Orleans area. Subjects utilized were
adults of both sexes and all ages. There was a strong, positive cor­
relation between the two variables, codependency and depression, of
.5966 (p < .00001). When the relationship between codependency
and depression was assessed for each of the separate groups, the
same trend prevailed across all three groups.
While one cannot conclude from this study that codependency
and depression are equal, one may suggest that a relationship exists
between them. These findings indicate that if a person reports him­
self/herself to be highly codependent, he/she is likely to experience
an elevated level of depression.

Betsey Backe, MS, MSW, is Director of the Divorce Center in Slidell and New
Orleans, LA.
Erin L. Bonck, MSW, is Director of Social Services and Field Operations for
Metro Home Health Care, Inc. in Marrero, LA.
Marie L. Riley, RN, LMSW, is affiliated with Clayton Country Mental Health
Center in Jonesboro, GA.
[Haworth co-indexing entry note): “Codependency and Depression: A Correlational Study/’ Backe,
Betsey, Erin L. Bonck, and Marie L. Riley. Co-published simultaneously in the Journal of Couples
Therapy (The Haworth Press, Inc.) Vol. 4, No. 1/2,1993, pp. 105-127; and: Attraction and Attachment:
Understanding Styles of Relationships (ed: Barbara Jo Brothers) The Haworth Press, Inc., 1993, pp.
105-127. Multiple copies of this article/chapter may be purchased from The Haworth Document Deliv­
ery Center [l-8(X)-3-HAW0RTH; 9:00 a.m. - 5:00 p.m. (EST)].
© 1993 by The Haworth Press, Inc. All rights reserved. 105
106 Attraction and Attachment: Understanding Styles of Relationships

This correlational study attempted to identify if a relationship ex­

ists between codependency and depression. Furthermore, this study
attempted to give empirical legitimacy to a codependency inventory,
The Awareness Activity: How Codependent Are You? (also referred
to in this paper as the codependency inventory). For the purpose of
this paper, codependency is defined as an emotional, psychological,
and behavioral condition that manifests itself in exaggerated depen-,
dency and the extreme need for external validation which results in a
loss of a sense of self (Cermak, 1986). Depression is defined as a
multifaceted syndrome that features a disturbance of mood and man­
ifests itself in such symptoms as hopelessness, helplessness, and self
depreciation (Millon & Kotik, 1985).
The instruments that were used for the study were the Beck De­
pression Inventory (BDI) and The Awareness Activity: How Code­
pendent Are You? (see Appendix A). Although the BDI is well estab­
lished, the Awareness Activity that was used to assess codependency
had not been established empirically. Therefore, this study was also a
further reliability and validity test of The Awareness Activity: How
Codependent Are You?
For this study the hypothesis was made that there would be a posi­
tive correlation between a measure of depression and a measure of
codependency. In addition, a second hypothesis was made that
women would show a higher statistically significant degree of code­
pendency than men.

Codependency has become a trendy psychological label used to

describe or characterize dysfunctional interpersonal relationships. Hie
ever-growing popularity of this emerging concept has warranted an
attempt on the part of some professionals to develop an understanding
of the dynamics involved in codependency. Depression, on the other
hand, is a concept that has been exhaustively researched with ever-in­
creasing progress towards assessment, diagnosis, and treatment. little
consensus exists concerning depression and codependency theory or
application. J. K. Wing and P. Bebbington (1985) suggest that prob­
lems arise in study of any disorder where there is disagreement regard­
ing criteria for definition, and that any associations found can only
provide clues of hypotheses as to the direction of cause and effect.
Therefore, in order to begin developing hypotheses on codependency,
researchers must establish a generally agreed upon criteria for defini­
tion. Warner Mendenhall (1989) proposes that healthcare professionals
need to choose a vocabulary that facilitates communication among
each other while also meeting the needs of the patient. Once a vocabu­
 Backe, Bonck, and Riley 107

lary delineating the criteria of codependency has been established,

professionals must empirically test the variables contained in the crite­
ria. In an attempt to clarify the dynamics of codependency, many
authors have contributed by formulating definitions.
In his article, “ Inside the Chemically Dependent Marriage: De­
nial and Manipulation,” Robert Subby (1984) identifies codepen­
dency as “ an emotional, psychological, and behavioral condition
that develops as a result of an individual’s prolonged exposure to,
and practice of, a set of oppressive rules-rules which prevent the
open expression of feeling as well as the direct discussion of per­
sonal and interpersonal problems” (p. 26). The rigidity of this set of
rules traps the individual into a dysfunctional spiral of coping and
problem solving which is maintained within and outside of the
family system. As a result, family members interact with each other
and with others by portraying their false selves rather that freely
revealing their true selves.
Sharon Wegscheider-Cruse (1985), in Choicemaking, defines co­
dependency as “a specific condition that is characterized by preoc­
cupation and extreme dependence (emotionally, socially, and some­
times physically) on a person or object” (p. 2) which eventually
becomes pathological in all relationships. Similar to Subby, Weg-
scheider-Cruse contends that this learned behavioral response will
be maintained within and outside of the precipitating system.
Sondra Smalley and J.C. Coleman (1987), in their article, “Treat­
ing Intimacy Dysfunctions in Dyadic Relationships among Chemi­
cally Dependent and Codependent Clients,” prescribe that code­
pendency is “ an easily identifiable (overt) or carefully disguised
(covert) learned pattern of exaggerated dependency and extreme
and painful external validation, with resulting identity confusion”
(p. 231). Furthermore, the authors believe that codependency is a
set of learned patterns (emotional, attitudinal, and behavioral) that
can be either personality traits or personality disorders.
Mendenhall (1989), as mentioned earlier, stresses the importance
of agreement of terms in the vocabulary of alcoholism/codependen-
cy as a result of the already existing myths and misconceptions
surrounding this subject. He asserts that family members develop
problems in response to the behavior of the alcoholic, not in re­
sponse to the disease itself. Therefore, Mendenhall defines code-
108 Attraction and Attachment: Understanding Styles of Relationships

pendency as a condition that results from the stress of being in a

relationship with an alcoholic or addict. Consequently, this stress
permanently depletes a person’s ability to adapt.
Ronald and Patricia Potter-Efron (1989), in their article, “Assess­
ment of Codependency with Individuals from Alcoholic and Chemi­
cally Dependent Families,” defines a codependent as “someone who
has been significantly affected in specific ways by current or past
involvement in an alcoholic, chemically dependent or other long
term highly stressful family environment. Specific effects include:
(a) fear, (b) shame/guilt; (c) prolonged despair, (d) anger, (e) denial;
(f) rigidity; (g) impaired identity development; (h) confusion” (p. 39).
Inclusive of the above mentioned definitions and others, Charles
L. Whitfield (1989) has developed his own definition of codepen­
dency. Whitfield perceives codependency “as a disease of lost self­
hood,” or more specifically, “as any suffering and/or dysfunction
that is associated with or results from focusing on the needs and
behavior of others” (p. 19). The historical background of codepen­
dency is most closely related to earlier descriptions of dependent
personality traits or disorders. In her book, Neurosis in Human Un­
derstanding, Karen Homey (1950) describes dependency similarly
to codependency. Homey asserts that healthy adults are capable of
autonomous functioning while depending on the physical and emo­
tional presence, support, and caring of others. This interdependence
promotes personal growth and the realization of individuality. Simi­
lar to codependency, according to Homey, neurosis would result if an
individual relied too heavily on others for self-fulfillment. As a result
of not being able to provide reliable or valid support for her descrip­
tion of dependent personality traits or disorders, her insightful ideas
were not influential with either the public or with other professionals.
When examining codependency, Margit K. Epstein and Eugene K.
Epstein (1990), in their article, “Codependence as Social Narrative,”
view this concept from a systems perspective considering the “cur­
rent social, political, and cultural narratives” (p. 7). Furthermore,
Epstein and Epstein suggest that prevailing cultural messages must
be taken into consideration when examining causality and treatment.
Hence, the concept of codependency must be explored within the
context of person-in-environment. Women have been socialized to
be nurturers and caretakers within our culture. A description of code­
 Backe, Bonck, and Riley 109

pendency includes obtaining one’s own sense of self from nurturing

and caring for others. Epstein and Epstein go on to state that “ It is
not surprising, then, that the population defined as being codepend­
ent is made up primarily of women” (p. 6).
In his book, Disorders o f Personality, Theodore Millon (1981)
devised diagnostic criteria to provide an explanation of dependent
personalities on human behavior. He distinguished Dependent Per­
sonality Disorder as a pattern of behavior in which the individual
passively allows others to take full responsibility for significant life
activities. Furthermore, as a result of not having the self-confidence
to function independently, the dependent person adopts a helpless/
hopeless identity. Although similarities exist between dependent
personality traits and disorders, Timmen L. Cermak (1986) has
devised diagnostic criteria for codependent personality traits and
disorders in order to provide clarity for this confusing term.
Cermak (1986) attributes confusion around the term codepen­
dency to not having an integrated definition that equals other diag­
nostic categories in The Diagnostic Statistical Manual Third Edi­
tion (DSM HI) and to the lack of empirical evidence. Each of these
two factors are important to accurately assess, diagnose and treat
codependent persons.

Without such criteria, no standards exist for assessing the pres­

ence and depth of pathology, for developing appropriate treat­
ment plans, or for evaluating the effectiveness of therapy.
Treatment team members are hindered in their efforts to com­
municate clearly and understandably about specific patient,
and comparison studies of codependence are not possible. Un­
less we can begin gathering reliable and valid research data,
codependence will remain confined to clinical impression and
anecdote. (Cermak, 1986, p. 3)

The diagnostic criteria that Cermak (1986) identified was devel­

oped with the intention of providing an explanation of human behav­
ior in order to help alleviate the physical, emotional, and intrapsychic
suffering that results from dysfunctional interpersonal relations. Cer­
mak (1986) lists the essential features of codependency as follows:
110 Attraction and Attachment: Understanding Styles of Relationships

(а) continual investment of self-esteem in the ability to influ­

ence/control feelings and behavior in self and others in the face
of obvious adverse consequences; (b) assumption of responsi­
bility for meeting other’s needs to the exclusion of acknowl­
edging one’s own needs; (c) anxiety and boundary distortions,
in situations of intimacy and separation; (d) enmeshment in
relationships with personality disordered, drug-dependent
and impulse disordered individuals; and (e) exhibits-in any
combination of three or more: (1) excessive reliance on de­
nial; (2) constriction of emotions with or without dramatic
outbursts; (3) depression; (4) hypervigilance; (5) compulsions;
(б) anxiety; (7) substance abuse; (8) recurrent physical or
sexual abuse; (9) stress-related medical illnesses; and/or (10) a
primary relationship with an active substance abuser for at
least two years without seeking outside help. (p. 11)

As mentioned earlier, the concept of depression has been rigor­

ously studied resulting in various avenues to explore the possible
causes, associations, and dynamics. Brian F. Shaw, T. Michael Val-
lis and Scott B. McCabe (1985) discern that depression is an ubiqui­
tous term that has been used in a variety of ways. As a result, Shaw
et al. (1985) indicate that from a clinical perspective it is important
to differentiate conditions where the symptoms of depression are
concomitants of another disorder rather than a primary diagnosis.
Therefore, the coexistence of depression with other disorders as
well as respective models of depression must be examined.
Theodore Millon and Doreen Kotik (1985), in their article, “The
Relationship of Depression to Disorders of Personality,” suggest
the possibility that personality patterns are etiological and, thus, are
formed before the onset of depression. Therefore, personality pat­
terns establish the susceptibility for the development of depressive
symptoms. Depending on the premorbid personality, depressive
symptoms, such as hopelessness, helplessness, and self-depreca­
tion, may induce secondary gains. For example, Millon and Kotik
(1985) define secondary gains as eliciting nurturance from others,
avoiding unwanted responsibilities, rationalizing poor performance,
or as a method for safely expressing anger towards others.
 Backe, Bonck, a/uf Riley 111

Of the personality disorders, three in particular demonstrate

depressive qualities; they are the dependent, the histrionic, and the
borderline personality. Critical in dependent personalities’ propen­
sity toward depression are their beliefs that they are ineffective,
inferior, and unworthy of regard. Depression in the dependent per­
sonality manifests itself as helplessness with a poor self-concept
and the inability to function autonomously. Millon and Kotik
(1985) assert that this negative view of the world is central to Aaron
Beck’s cognitive theory of depression. Histrionic personalities’ ex­
treme need for attention and approval lend themselves to feelings of
depression when their needs are not met. Millon and Kotik (1985)
state that there may be the presence of underlying depression which
is obscured in the histrionic by their dramatic behavioral styles. The
borderline personality is characterized by intense mood swings and
dependence on others with strong contradictory feelings such as
love, rage, and shame. Grinker, Werble, and Drye (1968) in their
research study on the borderline personality discuss depression in
all of the four borderline subtypes:
The Group I patients characterized by inappropriate and nega­
tive behaviors as well as hostile, angry depression; the Group
II or “core” borderlines exhibiting a vacillating involvement
with others and acting out of expressions of anger, alternating
with a lonely, hopeless depression; the Group Ill’s schizoid
personality, with a withdrawn, affectless depression; and the
Group IV borderlines characterized by gross defects in self-es-
teem and confidence and a depressive quality not associated
with anger or guilt feelings, (p. 729)
Of the models to be examined, Beck’s cognitive model of depres­
sion proposes that depression is primarily a result of the tendency to
view the self, the future, and the world in an unrealistically negative
manner (Sacco and Beck, 1985). More specifically mentioned in
Billings and Moos’ (1985) article, “Psychosocial Stressors, Cop­
ing, and Depression,” Beck’s theory suggests that “persons with a
strong predisposition to assume personal responsibility for negative
outcomes are prone to depression; they are filled with self-blame
that may cause depression and their pessimistic view of their future
effectiveness can adversely affect their coping responses” (p. 947).
112 Attraction and Attachment: Understanding Styles of Relationships

The learned helplessness model, however, proposes that at the core

of many forms of depression is an expectation of response-outcome
independence engendered by experience with uncontrolled events
(Peterson & Seligman, 1985). Billings and Moos (1985) suggest that
merging these models would create “the paradoxical situation of
individuals blaming themselves for outcomes they believe they nei­
ther caused nor controlled” (p. 947). In addition, the learned help­
lessness model introduces the question of sex differences. Wing and
Bebbington (1985) concur that depressive disorders are more com­
mon in women than in men and further suggest that young, married
women with small children are particularly at risk for depression.
Gender difference and depression have long been the topic for
research studies. Billings and Moos (1985) report that, “ depression
is more common among women than among men, but the determi­
nants of this gender difference remain controversial” (p. 960).
However, Lin, Woelfel, and Dumin (1986) suggest that the possibil­
ity for this finding may be that women are more interested in health
and are, therefore, more likely to report symptoms. Men, on the
other hand, are less willing to view themselves as being depressed
and, therefore, less willing to acknowledge symptoms.
Cermak (1986) suggests that codependents experience depression
as evidence of inadequacy and the failure to stay in control as they
turn their anger inward, repress unresolved grief, and chronically
restrain their feelings. Furthermore, he denotes denial as being char­
acteristic for codependents. Admitting that one is depressed means
admitting that one has needs, and co-dependents, by definition, al­
ways place the needs of others above their own in importance.

METHODOLOGY

The findings of this study are based on a sample of 149 individu­

als who completed two self-inventories: The Beck Depression In­
ventory and an Awareness Activity: How Codependent Are You?
All information was obtained anonymously. The only identifying
information on each inventory was the individual’s sex, age, and
marital status.
 Backe, Bonck, and Riley 113

Instruments

The Beck Depression Inventory (BDI) is a screening tool that

determines an individual’s level of depression based on his feeling
state. Each section of the multiple choice questionnaire is read by
the individual and a circle is put around the number next to the
answer that best reflects how he has been feeling during the preced­
ing week. Each question is given five possible choices, each choice
assigned a weight of zero, one, two, or three points. Scoring con­
sists of adding up the numbers. Based on the total score, individuals
are categorized into five levels of depression ranging from normal
to severe depression. The reliability and validity of the BDI is well
established, indicating a consistent relationship between BDI scores
and a person’s depressive state.
The “ Awareness Activity: How Codependent Are You?” (see
Appendix A) was constructed by Robert Edwards, doctoral student,
for the purpose of measuring an individual’s level of codependency.
He adapted two instruments: (1) the 16 Personality Factor Ques­
tionnaire (16 PF) developed by Raymond B. Cattell, Ph.D, D.Sc.
and IPAT staff and; (2) the Self-Esteem Questionnaire developed by
Barry K. Weinhold, Ph.D. (Weinhold and Weinhold, 1989).
The 16 PF is a test of normal adult personality that measures
levels of assertiveness, emotional maturity, shrewdness, self-suffi­
ciency, tension, and eleven other primary traits. Edwards used eight
construct-selected scales of the 16 PF and converted them to code­
pendent categories based on Cermak’s proposed DSM HI category.
Edwards then administered Weinhold’s self-esteem Questionnaire
to the same population. He had an across the category’s correlation
of the 16 PF to the Weinhold Questionnaire of .891.
The Awareness Activity: How Codependent Are You? is a multi­
ple choice questionnaire. Twenty statements are read by the individ­
ual and a number from one to four is selected to indicate the degree
of agreement. Scoring consists of adding up the numbers. Based on
the total score, individuals are categorized into four levels of code­
pendency ranging from a very high degree of codependency pat­
terns to a few codependency patterns.
114 Attraction and Attachment: Understanding Styles of Relationships

Subjects and Procedure

Permission was granted to conduct this study by the institutions

involved. The individuals who volunteered to complete the invento­
ries were selected from three clinical settings in the New Orleans
area:
Group I-The Centers for Psychotherapy (The Westbank Center
and The Slidell Center) are private mental health centers staffed by
psychiatrists, psychologists, clinical social workers and educational
consultants. During the month of July 1990, clients were asked at
the time of their initial appointment to complete the two inventories.
Forty-one clients completed the inventories; all were usable.
Group H-Northshore Psychiatric Hospital, a private inpatient
facility, held a community education program entitled “Sexuality
and Spirituality” on July 5,1990. Forty-one participants completed
the inventories; thirty-six were usable.
Group Ill-New Freedom Inc. is a private outpatient clinic that
offers psychological and educational services for the treatment of
alcoholism and chemical dependency. They sponsored two commu­
nity education programs at Southern Baptist Hospital on August, 15,
1990 and September 19,1990. The topic of the program on August
15th was “Conflict Resolution” and on September 19th was “The
Art of Successful Communication.” Combining these two programs,
101 participants completed inventories; seventy-two were usable.

RESULTS

Results of this study are based on 149 paired inventories obtained

from three clinical settings. A composite score was derived from
the sum of the twenty items on the codependency inventory and was
used to assess the level of codependency. An index of depression
was derived from a composite that subjects gave in response to the
Beck Depression Inventory. The major focus of this study was to
investigate a correlation between codependency and depression.
The resulting data are summarized in Table 1. There was a strong,
positive correlation between the two variables, codependency and
depression, of .5966 (p < .00001), meaning that approximately 36
 Backe, Bonck, and Riley 115

TABLE 1

Summary of Data

N Sample BDIa Codependencea

Total 149* 12.81* 49.54*

Group I 41 11.69 48.33

Group II 36 12.76 47.13

Group III 72 13.43 51.47

Female 102 14.02 51.28

Male 47 10.17 45.62

Note.

Group I Westbank and Slidell Centers for Psychotherapy

Group II Northshore Psychiatric Hospital Program on

Sexuality/Spirituality

Group III New Freedom Inc. Programs (2)

a Mean Value

* Correlation between codependency and depression.

B = .5966, ft < .00001.

percent of the variance in codependency (the criterion) was ac­

counted for by BDI (the predictor).
When the relationship between codependency and depression was
assessed for each of the separate groups, the same trend prevailed
across all three groups. There was a correlation of .5537 between
codependency and depression in Group I, and correlations of .5726
and .6509 between the same two variables in Group II and Group ID
116 Attraction and Attachment: Understanding Styles of Relationships

respectively. The largest correlation did not differ significantly from

the smaller (p = .2246 in the test for difference between independent
correlations), suggesting that the positive relationship between the
two variables was essentially uniform over the three groups.
The total codependency scores for the three groups were
compared. An analysis of variance (ANOVA) showed that the dif-.
ferences between the groups on codependency was not significant.
The relationship between a measure of codependency and gen­
der was also examined (see Table 1). The females averaged 51.31
while the males averaged 45.57; a statistically significant differ­
ence (t (147) = 2.950, p = .0036) (see Figures 1 & 2).
The composite scores derived for each subject on the BDI were
also not significantly different across the three groups (see Table 1).
The composite scores for both codependency and depression were
essentially the same for all three groups. Similarly, the correlation
between the two variables was essentially the same across the three
groups as well as for the genders (see Figures 3,4 & 5). In addition,
a post hoc comparison was made between the genders in the mea­
sure of depression (see Table 1). A significant difference was not
found (see Figures 6 & 7). In comparing the relationship of code­
pendency and depression, there was not a significant difference for
the predictor variables of either marital status or age.
The internal consistency of the codependency inventory was
quantified from the data by means of both a matrix of simple cor­
relations between each of the twenty items on the inventory, the
total score, and Chronbach’s coefficient alpha, which measures the
split-halves reliability of a test. All of the simple correlations be­
tween individual items and the total were positive, suggesting that
each individual item made a positive contribution to the composite
score. The average of the intercorrelation was .3965 which indicates
a significant r of .1935 (p < .05). This further attests to the internal
consistency of the inventory.
Chronbach’s alpha uses the variance of the composite of the 20
scores, and the variances of sub-composites, derived from subsets
of the total set of items. Chronbach’s alpha for these data was found
to be .48, which attests to the internal consistency of the twenty
items that comprise the codependency inventory. The first sub-com­
posite for codependency was derived by adding the ten odd-num-
 Backe, Bonck, and Riley 117

FIGURE 1. FEMALE

8 -

25.0 30.0 35.0 40.0 45.0 50.0 55.0 60.0 65.0 70.0 75.0
RAW SCORES ON CODEPENDENCY INVENTORY
Frequency Distribution of Codependency for Females: Number of Women who Tested at the Codependent
Level Indicated.

bered items and the second sub-composite for codependency was

derived by adding the ten even-numbered items. The correlation
between the two sub-composites was .9138, and the correlations of
each sub-composites with the total score were .9755 and .9735 for
sub-composites one and two with the total, respectively.

DISCUSSION

Our first hypothesis was that there would be a positive correla­

tion between a measure of depression and a measure of codepen­
dency. The results of this study confirm our hypothesis. While one
118 Attraction and Attachment: Understanding Styles of Relationships

FIGURE 2. MALE

*■r j i j 11 | Ti iTj i
21.0 26.0 31.0 36.0 41.0 46.0 51.0 56.0 61.066.071.0
RAW SCORES ON CODEPENDENCY INVENTORY
Frequency Distribution of Codependency for Males: Number of Males who Tested at the Codepen­
dent Level Indicated.

cannot conclude from this study that codependency and depression

are equal, one may suggest that a relationship exists between them.
These findings indicate that if a person reports himself/herself to be
highly codependent, he/she is likely to experience an elevated level
of depression. The degree to which codependency and depression
relate would need to be addressed in further research efforts.
When one starts to look at a positive correlation between a mea­
sure of codependency and a measure of depression, the possibility of
dysfunctional patterns emerge. Millon and Kotik (1985) suggest a
relationship exists between personality patterns and the susceptibility
 Backe, Bonck, and Riley 119

FIGURE 3. RESEARCH SAMPLE

79.0

69.0*

59.0*

49.0

39.0*

29.0-

19.0*

9.0-

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 55.0 60.0
RAW SCORES ON DEPRESSION INVENTORY
Codependency as a Function of Depression in both Genders:
Individual raw scores for both the Beck Depression Inventory and the Codependency Inventory.

for the development of depressive symptoms. These dysfunctional

patterns may give rise to the development of personality disorders. In
reviewing the literature on the relationship of depression to personal­
ity disorders, one may question whether personality patterns estab­
lish a susceptibility to the development of codependency traits as
they do to the development of depressive symptoms. Further, is there
a positive correlation between a measure of codependency and a
measure of personality disorders? The literature review suggests that
depression is an integral part of personality disorders such as the
histrionic, borderline, and dependent personality. Is it also possible
that depression is an integral part of codependency?
120 Attraction and Attachment: Understanding Styles of Relationships

FIGURE 4. MALE

69.0

59.0

49.0

39.0

29.0

19.0

9.0
0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

RAW SCORES ON DEPRESSION INVENTORY

Codependency as a function of Depression in Males: Individual raw scores of men for both the Beck
Depression Inventory and the Codependency Inventory.

This study may give further credence to Shaw et al. who reported
the idea that depression may not be a primary disorder but rather a
concomitant disorder; in this case depression in relation to codepen­
dency. One area of further research may include looking at code­
pendency levels in patients already diagnosed as being depressed;
the reverse of this may also prove useful.
Our study also tested the internal reliability and validity of The
Awareness Activity: How Codependent Are You? This study sup­
ported the validity of this inventory. By empirically testing the
 Backe, Bonck, and Riley 121

FIGURE 5. FEMALE

73.0

63.0

53.0

13.0

33.0

23.0

13.0
0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 55.0 60.0

RAW SCORES ON DEPRESSION INVENTORY

Codependency as a Function of Depression in Females: Individual raw scores of women for both the Beck
Depression Inventoiy and the Codependency Inventory.

reliability and validity of the codependency inventory and by sug­

gesting that a positive correlation exists between a measure of code­
pendency and a measure of depression, a step may have been taken
towards meeting Cermak’s diagnostic criteria for Codependent Per­
sonality Disorder. This is beyond the scope of this paper. However,
further research in this area may place codependency within the
framework of DSM-III-R Personality Disorders.
Our second hypothesis was that women would show a higher
statistically significant degree of codependency than men. The re­
sults of this study confirm our hypothesis, suggesting that women
are more codependent than men. Epstein and Epstein (1990) de­
scribe codependency as obtaining one’s own sense of self from
nurturing and caring for others. They state that the codependent
 122 Attraction and Attachment: Understanding Styles of Relationships

FIGURE 6. FEMALE

cUJ/>
_J
CL

O
0LUc
CD

1 I ' ' I' 1 I* I' I .

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 55.0 60.0

RAW SCORES ON DEPRESSION INVENTORY

Frequency Distribution of Depression for Females: Number of women who Tested at the Depression Level
Indicated.

population is primarily composed of women. Our study, however,

suggested that both men and women can have a high degree of
codependency; although women showed a higher statistically sig­
nificant degree of codependency than men.
We also decided post hoc to compare the levels of depression
between men and women. Billings and Moos (1985) and Lin et al.
(1986) report finding a higher level of depression in women than
 Backe, Bonck, and Riley 123

FIGURE 7. MALE

5 -

co 3 -

2 -

1 -

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0

RAW SCORES ON DEPRESSION INVENTORY

Frequency Distribution of Depression for Males: Number of Males who Tested at the Depression Level
Indicated.

men. However, our study did not confirm their findings which may
raise the question of why the results of our study were different.
Perhaps the variance is due to the constraints of our sampling tech­
nique; the population of men tested being more health conscious
than that of the general population. Consequently, the outcome of
our study may have been different if a random sample had been
used. In our study, the sample was individuals who showed an
124 Attraction and Attachment: Understanding Styles of Relationships

interest in their symptomatology. This may indicate that further

research should include a random sample.
This study supported the validity of The Awareness Activity:
How Codependent Are You? which indicates the value of further
replications as a measure of codependency. By supporting the reli­
ability and validity of this inventory, we may have contributed to
the empirical legitimacy of a measure of codependency. Therefore,
in order to facilitate the process of assessment and treatment of
codependency, further research utilizing the codependency invento­
ry as a diagnostic tool is recommended.

AUTHOR NOTE
This article was submitted in partial fulfillment of the requirements for the
degree of Master of Social Work.

REFERENCES
American Psychiatric Association. (1980). Diagnostic and statistical manual of
mental disorders (3rd ed.). Washington, DC.: Author
American Psychiatric Association. (1987). Diagnostic and statistical manual of
mental disorders (3rd ed.-revised). Washington, DC: Author
Billings, A. G. & Moos, R. H. (1985). Psychosocial stressors, coping and depression.
In E. E. Beckham & W. R. Leber (Eds.), Handbook of depression: Treatment\
assessment, and research (pp. 940-974). Homewood IL: The Dorsey Press.
Cermak, T. L. (1986). Diagnosing and treating co-dependence. Minneapolis:
Johnston Institute Books.
Cermak, T. L. (1986). Diagnostic criteria for codependency. Journal of Psychoac­
tive Drugs. 18(1), 15-20.
Epstein, M. K., & Epstein, E. K. (1990). Codependence as social narrative. Read­
ings: A Journal of Reviews and Commentary in Mental Health, 5(3), 4-7.
Grinker, R. R., Werble, B., Drye, R. C. (1968). Borderline Syndrome. New York:
Basic Books.
Homey, K. (1950). Neurosis in human growth. New York: Norton.
Lin, N., Woelfel, M., & Dumin, M. (1986). Gender of the confident and depression.
In N. Lin, A. Dean & W. Ensel (Eds.), Social support, life events, and depression
(pp. 283-306). Orlando, FL: Academic Press Inc.
Mendenhall, W. (1989). Co-dependency definitions and dynamics. Alcoholism
Treatment Quarterly. 6(1), 3-17.
Mendenhall, W. (1989). Co-dependency treatment. Alcoholism Treatment Quarter­
ly. 6(1), 75-86.
 Backe, Bonck, and Riley 125

Millon, T. (1981). Disorders of personality: DSM-III Axis II. New York: Wiley-In-
terscience.
Millon, T. & Kotik, D. (1985). The relationship of depression to disorders of
personality. In E. E. Beckham & W. R. Leber (Eds.), Handbook of depression:
Treatment, assessment, and research (pp. 700-744). Homewood IL: The Dorsey
Press.
Peterson, C. & Seligman, M. E. P. (1985). The learned helplessness model of
depression: Current status of theory and research. In E. E. Beckham & W. R.
Leber (Eds.), Handbook of depression: Treatment, assessment, and research (pp.
914-939). Homewood EL: The Dorsey Press.
Potter-Efron, R. T. & Potter-Efron, P. S. (1989). Assessment of co-dependency with
individuals from alcoholic and chemically dependent families. Alcoholism
Treatment Quarterly. 6(1), 37-57.
Sacco, W. P. & Beck, A. T. (1985). Cognitive therapy of depression. In E. E.
Beckham & W. R. Leber (Eds.), Handbook of depression: Treatment, assess­
ment, and research (pp. 3-38). Homewood IL: The Dorsey Press.
Shaw, B. F., Vallis, M., & McCabe, S. B. (1985). The assessment of the severity and
symptom patterns in depression. In E. E. Beckham & W. R. Leber (Eds.),
Handbook of depression: Treatment, assessment, and research (pp. 372-407).
Homewood EL: The Dorsey Press.
Smally, S. & Coleman, E. (1987). Treating intimacy dysfunctions in dyadic rela­
tionships among chemically dependent and codependent clients. Journal of
Chemical Dependency Treatment. 7(1), 229-243.
Subby, R. (1984). Inside the chemically dependent marriage: Denial and manipula­
tion. In Co-dependency: An emerging issue (pp. 25-29). Pompano Beach, FL:
Health Communications Inc.
Wegscheider-Cruse, S. (1985). Choicemaking. Pompano Beach FL: Health Com­
munications, Inc.
Whitfield, C. L. (1989). Co-dependence: Our most common addiction-some physi­
cal, mental, emotional, and spiritual perspectives. Alcoholism Treatment Quar­
terly, <5(1), 19-36.
Wing, J. K. & Bebbington, P. (1985). Epidemiology of depression. In E. E. Beckham
& W. R. Leber (Eds.), Handbook of depression: Treatment, assessment, and
research (pp. 700-744). Homewood EL.: The Dorsey Press.
126 Attraction and Attachment: Understanding Styles of Relationships

APPENDIX A
MARITAL STATUS
SEX
_____AGE

AWARENESS ACTIVITY: HOW CODEPENDENT ARE YOU?

The following self-inventory may help you determine the degree
to which co-dependency is present in your life. Please answer
these questions honestly. Usually the first answer that comes to
you is the most honest and most accurate.
A SELF-INVENTORY
TYPICAL CHARACTERISTICS OF CO-DEPENDENT PEOPLE
Directions: Place a number from 1 to 4 in the space before each
question to indicate the degree of your response.
1* Never
2= Occassionally
3= Frequently
4* Almost always
( ) I tend to assume responsibility for others feelings and/or be­
havior.
( ) I have difficulty in identifying my feelings-happy, angry, scared,
sad or excited.
( ) I have difficulty expressing my feelings.
( ) I tend to fear or worry how others may respond to my feelings
or behavior.
( ) I minimize problems and deny or alter truth about the feelings
or behavior of others.
( ) I have difficulty in forming or maintaining close relationships.
( ) I am afraid of rejection.
( ) I am a perfectionist and judge myself harshly.
( ) I have difficulty making decisions.
( ) I tend to be reactive to others rather than to act on my own.
( ) I tend to put other people's wants and needs first.
 Backe, Bonck, and Riley 127

APPENDIX A (continued)
( ) I tend to value the opinion of others more than my own.
( ) My feelings of worth come from outside myself, through the
opinions of other people or from activities that seem to validate
my worth.
( ) Ifind it difficult to be vulnerable and to ask for help.
( ) Ideal with issue self-control by attempting to always be in
control or, the opposite, by being careful never to be in a posi­
tion of responsibility.
( ) I am extremely loyal to others, even when that loyalty is unjusti­
fied.
( ) I tend to view situations with “all or none” thinking.
( ) Ihave a high tolerance for inconsistency and mixedmessages.
( ) Ihave emotional crises and chaos in my life.
( ) I tend to find relationships in which I feel “needed” and attempt
to keep it that way.
Scoring: Add the numbers to get a total score. Use the following
ranges to help interpret your level of co-dependency:

60-80 - A very high degree of co-dependent patterns

40-59 • A high degree of codependent patterns
30-39 - Some degree of co-dependent and/or counter­
dependent patterns
20-29 - A few co-dependent and/or a high degree of counter­
dependent patterns.

Source: Weinhold, Breaking Free, 16.

This page intentionally left blank
 The Acceptability
of Alternative Treatment Formats
of Relationship Therapy:
Ratings by Premarital Subjects
Marian R. Flammang
Gregory L. Wilson

SUMMARY. One hundred fifty premarital subjects evaluated the

acceptability of alternative therapeutic formats commonly employed
in relationship therapy. Unmarried individuals who were currently
involved in premarital relationships were randomly assigned to ex­
perimental conditions including two types of educational informa­
tion (descriptive and group-oriented) presented across three treat­
ment formats (i.e., individual, conjoint, and group). The Treatment
Evaluation Inventory and the Semantic Differential served as prima­
ry dependent variables. Results revealed that conjoint format was
most acceptable followed by group and individual, respectively.
However, subjects who had been involved in a relationship longer
than one year rated the group and conjoint formats as equal in ac­
ceptability. Additionally, group-oriented information increased sub­
jects’ ratings of group format.

Acceptability refers to the appropriateness, fairness, and intru­

siveness of treatment procedures as judged by patients, lay persons,

Marian R. Flammang and Gregory L. Wilson are affiliated with Washington

State University.
[Haworth co-indexing entry note]: “The Acceptability of Alternative Treatment Formats of Rela­
tionship Therapy: Ratings by Premarital Subjects,” Flammang, Marian R., and Gregory L. Wilson.
Co-published simultaneously in the Journal of Couples Therapy (The Haworth Press, Inc.) Vol. 4, No.
1/2, 1993, pp. 129-140; and: Attraction and Attachment: Understanding Styles of Relationships (ed:
Barbara Jo Brothers) The Haworth Press, Inc., 1993, pp. 129-140. Multiple copies of this article/chapter
may be purchased from The Haworth Document Delivery Center [ 1-800-3-HAWORTH; 9:00 ajn. -
5:00 pjn. (EST)].
© 1993 by The Haworth Press, Inc. All rights reserved. 129
130 Attraction and Attachment: Understanding Styles of Relationships

and professionals (Kazdin, 1980a). Acceptability is an important

criterion for evaluating relationship treatments because it offers a
means to discriminate among equally viable treatment formats.
Also, highly acceptable treatments may be frequently selected and
better adhered to than those which are rated as less acceptable
(Pickering, Morgan, Houts, & Rodrigue, 1988; Wilson & Flam-
mang, 1990; Wilson & Wilson, 1991).
Recently, Wilson and Flammang (1990) examined the accept­
ability of four alternative treatment formats used in the resolution of
dysfunction: individual, concurrent, conjoint, and marital group.
Subjects were randomly assigned to experimental conditions which
included two forms of information (i.e., descriptive versus research-
oriented). Conjoint treatment was consistently rated as most accept­
able, followed by concurrent, group, and individual, respectively.
Interestingly, providing efficacy information about alternative for­
mats did not alter acceptability ratings.
Later, Wilson, Flammang, and Dehle (in press) evaluated three
forms of information (i.e., descriptive, research-oriented, and group-
oriented) and two differing case histories were presented across the
same treatment formats. Again, conjoint treatment format was rated
as most acceptable followed by concurrent, group, and individual,
respectively. The type of information which was given to subjects
did not affect acceptability ratings, neither did varying case histories.
One limitation of the previous relationship acceptability studies
is that college students were employed as subjects. There has been
considerable controversy over the use of nonclinical populations in
acceptability studies. By using distressed and nondistressed premar­
ital individuals as subjects, this study surveyed the population that
is most likely to seek relationship therapy for purposes of premarital
therapy or relationship enhancement.
Another important question in acceptability research concerns
whether the use of educational information influences acceptability
ratings. Some acceptability research has produced results revealing
that educational information increases acceptability ratings for in­
terventions with children (Von Brock & Elliott, 1987; Tingstrom,
1989; Singh & Katz, 1985). However, marital acceptability research
has yet to demonstrate similar findings.
In an attempt to examine the relative influence of educational
 Marian R. Flammang and Gregory L. Wilson 131

information presented to premarital subjects, two types of education­

al information were used in this study: (1) descriptive, which defined
the three different formats of relationship therapy; and (2) group-ori-
ented, which summarized the advantages of group relationship thera­
py. Thus, the current investigation compared the acceptability ratings
of distressed and nondistressed premarital subjects who received
different forms of information across three commonly employed
therapeutic formats.

METHODS

Subjects

One hundred and fifty premarital subjects (75 males and 75 fe­
males) who were currently involved in intimate relationships were
utilized as participants in this study. Length of relationship ranged
from 2 months to 6 years (M = 1.59 years, SD = 1.14 years). The
median length of relationship across subjects was 1 year. These
subjects ranged in age from 17 to 39 years (M = 19.89, SD = 2.82).
Fifty subjects (33%) scored in the distressed range on the Dyadic
Adjustment Scale. Scores on the Dyadic Adjustment Scale ranged
from 77 to 151 points (M = 108.69, SD = 16.28). Nineteen percent of
the subjects had previously participated in therapy. Of those subjects
who had previous therapy experience, individual treatment was most
common (12%), followed by family treatment (10%). None of the
subjects had previously participated in relationship treatment.

Assessment

Dyadic Adjustment Scale (DAS; Spanier, 1976). The DAS is a

widely used self-report questionnaire which provides a global mea­
surement of marital or relationship satisfaction. Spanier (1976) re­
ports that the DAS has excellent reliability (Cronbach’s alpha = .96)
and substantial criterion-related validity as well as construct validity.
Wilson and Bomstein (1986) recommend using the DAS as a
screening device to differentiate between satisfied and dissatisfied
couples because of its ease of administration, high stability over
132 Attraction and Attachment: Understanding Styles of Relationships

time, well-established norms, and applicability with unmarried cou­

ples. Individuals who scored below 100 points were classified as
being in a “distressed” relationship, while those scoring 100 points
or more were classified as “nondistressed.”
Treatment Evaluation Inventory (TEI; Kazdin, 1980a, 1980b).
The TEI consists of 15 items on a seven-point Likert scale which
asks subjects to evaluate such factors as the acceptability of treat­
ment, suitability of procedures for the individuals, and the likely
effectiveness of the procedures. It was modified so as to conform
with an evaluation of relationship therapy. Previous research on the
inventory (Kazdin, 1980a, 1980b) has shown that it is able to dis­
criminate between alternative treatments. In an earlier analysis of
the TEI, Wilson and Flammang (1991) found the instrument to have
high reliability (Cronbach’s alpha = .96, split-half reliability = .96).
Higher scores on the TEI are representative of greater acceptability.
Semantic Differential (SD; Osgood, Suci, & Tannenbaum, 1957).
The form of the SD used in acceptability research consists of 15
bipolar adjectives, rated on a one-to-seven Likert scale. These 15
adjectives are divided into three subscales (Evaluative, Potency, and
Activity) each of which consists of 5 adjective pairs. The adjectives
which subjects used to rate treatment formats on the Evaluative
subscale included good-bad, valuable-worthless. Adjectives com­
prising the Potency subscale include strong-weak, hard-soft. Adjec­
tives such as active-passive, fast-slow are characteristic of the Ac­
tivity subscale. Extensive research with the SD indicates that it is a
psychometrically sound and reliable instrument. Osgood et al.
(1957) reported a test-retest reliability coefficient of .85.
Recently, Wilson and Flammang (1991) found the SD to be highly
reliable when used in acceptability research: Evaluative Scale (Cron­
bach’s alpha = .93; split-half reliability = .95), Potency Scale (Cron­
bach’s alpha = .85; split-half reliability = .90), Activity Scale (Cron­
bach’s alpha = .71; split-half reliability = .80). Across all subscales,
higher scores are representative of greater endorsement of that partic­
ular construct (e.g., “high potency” versus “low potency”).
Procedures
Each subject was given instructions explaining the purpose of the
study followed by a packet which included a brief description of the
 Marian R. Flammang and Gregory L. Wilson 133

three treatments: individual, conjoint and group. Each packet also

contained a written description of a couple seeking treatment for
relationship dysfunction. Each subject read the first treatment de­
scription and then completed the dependent measures for that vi­
gnette. When dependent measures for the first treatment were com­
pleted, each subject then proceeded to the next treatment description
and completed the attached set of questionnaires for that format of
intervention. This procedure was followed until all treatment formats
had been evaluated by each subject.
Case Description
A case description of a couple seeking relationship therapy was
presented to subjects so that they could apply the various treatment
formats to this specific case description. The case description was
modified from material presented by Nadelson (1978), which was
representative of actual clients and problems frequently seen in
outpatient clinical settings.
Informational Materials
Two forms of educational information were presented to subjects
in order to evaluate the relative influence of descriptive and group-
oriented information on acceptability ratings. Descriptive informa­
tion consisted of a definition of acceptability, a description of its
importance in relation to the purpose of the study, and definitions of
the three different treatment formats for relationship therapy. The
group-oriented information section included the descriptive informa­
tion and a summary of research findings that detailed the effective­
ness of group relationship therapy. Moreover, subjects were told that
group treatment provides special opportunities for learning by work­
ing with other couples experiencing similar concerns; it also in­
creases the availability and sources of helpful feedback from others;
and it can promote positive expectations through witnessing im­
provements among other couples.
Treatment Conditions
In order to test the relative significance of the various treatment
formats, all treatment descriptions included similar content (e.g., be-
134 Attraction and Attachment: Understanding Styles of Relationships

havioral exchange, expressive and receptive communication skills,

training in a nine-step problem-solving approach). However, the thera­
py process (e.g., talking directly to partner in conjoint sessions; sharing
information and suggestions with other couples in group format) was
varied significandy depending upon the specific format being de­
scribed. The therapy descriptions were based on the principles of
behavioral marital therapy (Jacobson & Margolin, 1979; Bomstein &
Bomstein, 1986). The specific focus of successive sessions paralleled
the treatment outcome procedures employed by "Wilson and his col­
leagues (Wilson, Bomstein, & Wilson, 1988; Wilson, 1989; Montag &
Wilson, 1991). The therapy descriptions were written in such a way as
not to identify whether the therapist was male or female. Treatment
sessions lasted for 90 minutes per week for a total of 8 weeks in all
conditions. A brief sample of the treatment description follows.
Individual Treatment. Following the initial interview, the thera­
pist recommended that the female partner be treated individually to
more directly address her underlying depression, which co-existed
with the couple’s marital distress. Specifically, therapy focused on
several causes of her depression. Treatment strategies included ac­
tivity scheduling and increasing rates of pleasant events in her daily
life. In addition, the couple was told that the female partner would
describe the package of relationship techniques and strategies that
she learned in therapy to her partner at home.
Conjoint Treatment. During conjoint sessions, the therapist facil­
itated a dialogue between the couple. The therapist provided feed­
back concerning their use of communication and conflict resolution
skills that were exhibited in session. Both partners met with the
therapist for every session.
Group Treatment. The couple was described as participating in a
group with four other couples who were attempting to improve their
relationships. Group interactions incorporated feedback from partici­
pants and the therapist in communication tactics and problem-solv-
ing strategies.

RESULTS

The scores of the TEI and the SD-Evaluative Scale were analyzed
as a summed score because they were found to be highly intercorre­
 Marian R. Flammang and Gregory L. Wilson 135

lated. Pearson product-moment correlation coefficients of these two

dependent measures ranged from .75 to .85 (ps < .001). Likewise, the
SD-Activity and Potency Scales were summed, correlation coeffi­
cients ranged from .58 to .64 (ps < .001). These dependent measures
were summed because they cannot be regarded as independent mea­
sures, and the combined score taps more of the true variance of the
construct of acceptability than does either score alone.
An initial 2 x 3 (Level of Distress X Treatment Format) series of
univariate analyses of variance (ANOVAs) were conducted and
failed to reveal significant findings for the Level of Distress main
effect or the Level of Distress X Treatment Format interaction.
Therefore, we collapsed across Level of Distress for all remaining
analyses.
Results were analyzed v i a a 2 x 2 x 2 x 3 (Information x
Gender of Subject X Length of Relationship x Treatment Format)
multivariate analysis of variance (MANOVA), with repeated mea­
sures on the final factor, across all dependent variables. Subjects
were divided into long-term (over 1 year) and short-term (less than
1 year) length of relationship based on a median split procedure.
The MANOVA showed a significant main effect for Treatment
Format, Wilks’s lambda = .53, F (4, 139) = 30.61, p < .001. In
addition, a significant Information X Treatment Format interaction
was revealed, Wilks’s lambda = .93, F (4, 139) = 2.76, p < .05. A
significant Length of Relationship x Treatment Format interaction
was also observed, Wilks’s lambda = .91, F (4,139) = 3.60,p < .01.
All other main effects and interactions proved nonsignificant. Sum­
mary data for each dependent variable across treatment format are
presented in Table 1.
Subsequent ANOVAs on dependent variables revealed signifi­
cant Treatment Format main effects on the combined TEI/SD-Eval-
uative Scale, F (2, 284) = 55.81, p < .001; and on the combined
SD-Potency/Activity Scale, F (2, 284) = 32.91, p < .001. Neuman-
Keuls multiple comparison tests on both the combined TEI/SD-
Evaluative Scale and the combined SD-Potency/Activity Scale re­
vealed that all treatment formats were rated as significantly
different from one another with conjoint treatment format being
evaluated as most acceptable followed by group and individual
treatment formats, respectively.
136 Attraction and Attachment: Understanding Styles of Relationships

TABLE 1. Comparison of Mean Scores Across Treatment Formats on Each Dependent

Measure

Conjoint Group Individual

TEI/SD - Evaluative***

M 105.91a 96.25b 80.13c

18.69 22.24 26.44

SD - Potency/Activity***

M 46.80* 44.57b 39.23°

£Q 8.98 8.85 9.74

*** * .001 level of significance.

Mean scores that share a common superscript are not significantly different.

Subsequent ANOVAs also demonstrated a significant Length of

Relationship X Treatment Format interaction on the TEI/SD-Eval-
uative Scale, F (2,284) = 7.25, p < .01; and on the SD-Potency/Ac-
tivity Scale, F (2, 284) = 4.35, p < .05. Neuman-Keuls analyses
demonstrated that subjects who had been in a relationship longer
than 1 year rated the group and conjoint treatment formats as equal
in acceptability as measured by both the TEI/SD-Evaluative and the
SD-Potency/Activity Scales. The individual treatment format was
rated as least acceptable on both measures. Additionally, subjects
who were involved in a relationship less than 1 year rated the
individual treatment format as significantly more acceptable than
did subjects who had been involved in relationship for longer than 1
year. Summary data for the Length of Relationship X Treatment
Format interaction is presented in Table 2.
ANOVAs also revealed a significant Infonnation x Treatment
Format interaction on the TEI/SD-Evaluative Scale, F (2, 284) =
3.86, p < .05. Neuman-Keuls analyses showed that when group-ori-
ented information was given to subjects, the conjoint and group
formats were found to be equivalent and both were rated as more
 Marian R. Flammang and Gregory L. Wilson 137

acceptable than individual treatment. All other main effects and

interactions proved nonsignificant. Summary data for the Informa­
tion X Treatment Format interaction is presented in Table 3.
Finally, subjects were also given the opportunity to indicate treat­
ment format preference ratings. Once again, these results clearly
indicated the superiority of conjoint /n = 85), followed by group (n =
49), and individual (n = 16), Chi Square = 47.64, df= 2,p< .001.
In order to evaluate the relative influence of previous therapy
experience on acceptability ratings of alternative relationship for­
mats, a series of 2 x 3 (Previous Therapy Experience X Treatment
Format) posthoc ANOVAs were completed. No interaction or main
effect involving previous therapy was found. Subjects were also
asked to rate themselves in terms of their likelihood to participate in
relationship therapy. Fifty-one percent rated themselves as being
likely to participate, 20% rated themselves as unlikely, and 29%
remained uncommitted.

TABLE 2. Comparison of Mean Scores Across Treatment Format as a Function of Length

of Relationship

Conjoint Group Individual

Longer Shorter Longer Shorter Longer Shorter

Term Term Term Term Term Term

TEI/SD - Evaluative**

M 107.46a 104.39a 100.77* 91.84b 75.30° 84.61d

SD 18.51 18.86 22.66 21.05 25.06 27.10

SD - Potency/Activity*

M 46.77a 46.83a 45.49a 43.68ab 37.28c 41.13b

SD 9.62 8.38 9.22 8.43 9.74 9.42

* = .05, ** = .01 level of significance.

Mean scores that share a common superscript are not significantly different.
138 Attraction and Attachment: Understanding Styles of Relationships

TABLE 3. Comparison of Mean Scores Across Treatment Format as a Function of Informa­

tion

Conjoint Group Individual

Descriptive Group- Descriptive Group- Descriptive Group-

Oriented Oriented Oriented

TEI/SD - Evaluative*

M 107.433 104.42a 91.18b 101.18a 76.86° 83.08°

3D 19.62 17.73 21.63 21.85 26.62 26.08

* = .05 level of significance.

Mean scores that share a common superscript are not significantly different.

DISCUSSION
The results of this study clearly indicate that: (a) conjoint treat­
ment format was generally rated as most acceptable, followed by
group and individual interventions, respectively; (b) similarly,
when asked to choose between the three therapy formats, signifi­
cantly more subjects chose the conjoint condition as the most pre­
ferred format; (c) subjects who had been involved in a relationship
longer than one year rated group and conjoint treatment formats as
equal in acceptability; (d) additionally, subjects who had been in­
volved in a relationship less than one year rated the individual
treatment format as significantly more acceptable than did all other
subjects; (e) educational information appears to influence accept­
ability ratings in that subjects who received group-oriented in­
formation rated group treatment as more acceptable than did sub­
jects who received only descriptive information.
In previous acceptability studies regarding relationship treatment
formats, educational information did not influence acceptability
ratings (Wilson & Flammang, 1990; Wilson, Flammang, & Dehle,
in press). However, these studies employed college students as
 Marian R. Flammang and Gregory L. Wilson 139

subjects. Thus, it appears that the response to educational informa­

tion differs between premarital individuals and college students.
One reason for this finding may be that individuals currently in­
volved in relationships found the educational information more
salient. Moreover, a significant percentage of the premarital sub­
jects in this study (51%) rated themselves as being likely to partici­
pate in relationship therapy. Therefore, it may be assumed that
premarital subjects have higher levels of anticipated involvement in
relationship therapy than do college students, and thus, educational
information may be more relevant for premarital subjects.
Choice of treatment format is an important consideration because
it influences the outcome of treatment interventions (Beutler &
Clarkin, 1990). Since all of the subjects who participated in this
study were involved in intimate relationships, these results provide
valuable information which may help clinicians decide which for­
mat of relationship therapy to offer clients.

AUTHOR NOTE
This research is part of the dissertation project that Marian R. Flammang com­
pleted as partial fulfillment for the doctor of philosophy degree at Washington State
University. Gratitude is expressed to Herb Cross, and James Whipple who served
on her committee. Address correspondence to Marian R. Flammang, M.S., Depart­
ment of Psychology, Washington State University, Pullman, WA 99164-4820.

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targeted therapeutic interventions. New York: Brunner/Mazel.
Bomstein, P. H., & Bomstein, M. T. (1986). Marital therapy: A behavioral-com-
munications approach. New York: Pergamon Press.
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 Change, Vulnerability, Fear,
and Taking Risks-
An Interview with Virginia Satir
Sheldon Starr

[Early in 1985 I asked Virginia Satir if she was willing to be

interviewed on videotape concerning her thinking about family
therapy at that time and especially with regard to any ideas she
might wish to share with the family therapy community. The inter­
view took place on March 15, 1985 at Virginia’s home in Menlo
Park, California. The transcript of the interview is 60 pages, and this
is the sixth and final one of a series of segments from that interview
covering different themes.]

[The use of brackets [ ] and underlining below are editorial

additions for the purpose of clarity and/or emphasis.] S.S.

Sheldon Starr, PhD, was founder and director for 15 years of the Family Study
Unit, a family therapy training and treatment program at the V.A. Medical Center,
Palo Alto, CA when this interview was conducted. Dr. Starr is presently Professor
of Psychology (part time) at Pacific Graduate School of Psychology and is in
private practice, both in Palo Alto, CA. His association with Virginia Satir
spanned 25 years, first as student, then as associate and long-time friend. Corre­
spondence may be sent to 770 Welch Road, #161, Palo Alto, CA 94304.
A highly condensed and edited summary of the entire interview appeared in
the AFTA Newsletter, Fall 1985 and that version consisted of less than 20% of the
interview.
[Haworth co-indexing entry note]: “Change, Vulnerability, Fear, and Taking Risks-An Interview
with Virgnia Satir,” Starr, Sheldon. Co-published simultaneously in the Journal of Couples Therapy
(The Haworth Press, Inc.) Vol. 4, No. 1/2, 1993, pp. 141-45; and: Attraction and Attachment: Under­
standing Styles of Relationships (ed: Barbara Jo Brothers) The Haworth Press, Inc., 1993, pp. 141-145.
Multiple copies of this article/chapter may be purchased from The Haworth Document Delivery Center
[ 1-800-3-HAWORTH; 9:00 a.m. - 5:00 p.m. (EST)].

© 1993 by The Haworth Press, Inc. All rights reserved. 141

142 Attraction and Attachment: Understanding Styles of Relationships

STARR: You know there’s been a relatively newer sub-specialty

in the Family Therapy field called Family Systems Medicine. Fami­
ly Systems Medicine is maybe a variant of what in the ’60’s was
called, for individuals, Holistic Medicine. Be that as it may, what do
you feel and think about the application of Family Systems to
strictly medical areas?

SATIR: [I think of] Bill Offencost in 1955. Bill was a medical

person and he was at the University of Chicago. In 1955, Bill
delivered a paper on treating, the family as the unit of treatment for
medical problems. He did a whole lot of work. Somebody came in
with some kind of problem, and he did a history and examination of
the whole family. So it makes absolute and complete sense because
the rules in the family are going to manifest themselves in some
way. And I think it’s absolutely important. When I was working at
the Illinois State Psychiatric Institute and training Family Thera­
pists, I was doing something called Family Dynamics in 1955. I
read all the cases that came to the State Hospital every month
because I was picking out cases for the residents. And I watched the
histories of these families because in those days we could get a lot
of history and I watched how there would be depression and then
some form of acting-out and then some kind of physical illness.
Then there might be some gross kind of mental disturbance like
paranoia in these families. So it seems to me that it is time that we
take a look. I can see it in terms of a cellular wholeness, in any unit,
any life unit, every cell carries with it the picture and the ability to
develop the whole thing whether it’s a dog or human or whatever. It
also carries its specific function, it carries both. Alright, what inhib­
its you from doing your job is a whole of the entire relationship
between the thinking, the feeling and the physical reaction. And
that’s what we call Medicine, the physical reaction of something.
All of the things we know about family rules [are] bound to be
enlightening for the way in which medical problems emerge in
families.
STARR: See I have an opinion, a bias. It’s cost efficient to ap­
proach a medical problem from a systemic standpoint.

SATIR: Of course it is.

 Sheldon Starr 143

STARR: But what do you think we’d have to do to convince

insurance companies who often would have to pay for that. Most
insurance companies have cut out Family Therapy benefits. That’s
rather short sighted I think.
SATIR: Let me tell you something. See you’ve raised this ques­
tion in another form several times. That’s when I ask myself, “How
do I change something?” Just that question. How do I get some­
body who’s behaving in a certain way to behave another way?
What’s the difference between getting an insurance company to
open up to see what’s going on as compared to getting a family to
let their kids decide [something]? No difference at all. How do you
initiate change? Alright. From where I am the way change gets
initiated is that three things have to happen. Someone has to get the
insurance companies against the wall so that they then conduct a
study from which they would see that treating families would be
cheaper than individuals. Then there is a second one which is that
there are some enlightened people out there who didn’t know for
sure how well it was going, but it looked “ right” because they were
using their [common] sense to do it. Then there will be a number of
insurance companies after some of them start, [covering families]
that will go along because of the bandwagon. There’s a lot of
bandwagon business. So what we need to do is some research. A lot
of people have this information clinically, and they know it. But a
clinical hunch doesn’t pass for hard research. So what we need to do
is get people to start research on this so that we can show the
insurance companies what can really happen.
STARR: Where are we? The kind of person that we’re talking
about would have to have a good sense of security or self-confi­
dence because I work in a system (Veterans Administration) where
people who are in a position to change are too scared. They’re
frightened and afraid to change.
SATIR: What’s different between that and a patient who comes in
and says, “I want to change but I’m scared?”
STARR: There is no difference except for prerogatives.
SATIR: I don’t see any difference at all. And I face people with
that and I pray. So what’s wrong with taking a risk and doing what
144 Attraction and Attachment: Understanding Styles of Relationships

you know fits? See that’s exactly what happened in Germany. A lot
of people cared [but did nothing].

STARR/SATIR (together): Yeah, but they were too scared.

SATIR: Now what is it that we work on? In fact there’s a marvel­

ous book that’s coming out. It’s called Dying to Live and it’s written
by a man named Telly Birkin. And what he demonstrates so clearly
is that fear is more powerful than our common sense. So what we
have to do is go beyond fear, and his book is about that. And I
highly recommend it to people. Dying to Live by Telly Birkin.

STARR: Catchy title.

SATIR: But going on, well that’s what he did. He died so he could
live. Anyway, the point you’re making is a very important one. If I
violate my common sense and do something else because I think
that somebody will like it or I don’t want to be out there vulnerable,
then I’m in trouble. See, my history was I didn’t do that. I took
whatever steps I know how to take. But the reason that I could do
that were two. Number one is because I was sort of nice and I didn’t
make fun of people or put them down because they may have
questioned me and so they would come [to therapy]. They were
interested. And the other thing was that I worked with the people no
one else wanted, so it was too late by the time we got there. But fear
is everywhere, and when professionals say to me, “I can’t do it
because I’m afraid” and when “I’m afraid” translates into “What
will they say?” , I say, “I don’t know what they’ll say. Why don’t
you ask them? But in the meantime, what kind of prostitution are
you getting into yourself, to say you know something that fits but
you don’t do it?” And what difference is that?

STARR: Okay. Let me play devil’s advocate.

SATIR: Sure.

STARR: Joan of Arc stuck with her principles and she burned at
the stake; Galileo recanted, but we still know that the earth is not the
center of the universe.
 Sheldon Starr 145

SATIR: Okay. Well, that might be the outcome that some of us

have to face.

STARR: Well, so what you’re saying is that maybe some people

don’t want to take the lumps.

SATIR: Right.

STARR: They’ll go with it and that’s an individual choice that

people make.

SATIR: We can do more in this context of the world than before

[in an earlier era], and there are different ways.

STARR: I believe that. Yeah.

SATIR: (Strongly) Because I think [nowadays] it’s more open; it has

been more open so we can do more, but the fact of it is, can I
guarantee you anything? Nothing. (Strongly and with emotion.) But
what is the sense of living with yourself and feeling OK, but that when
you turn around you [discover that you are] prostituting yourself!

STARR: Well, okay, yeah, yeah. You’re not talking with an adver­
sary because I feel that way also. The VA Family Study Unit in
1970 were treating homosexual couples. We just didn’t talk about it
publicly because at that point they’d (VA) have killed the program.
Now we can do that. You see, now that’s out in the open, but we
were doing it way back then.

SATIR: We’ve got more of that, more people need to take risks,
and learning how to take risks is important. Many people behave as
though they’ve only two possibilities, to attack and rebel or capitu­
late. Those [certainly] are two you can use, but you can also do
something quite different. It’s the same thing as when you get a
double level message. You can respond to one or the other [level] or
simply say you know there are two things here and comment on the
presence of what is going on and ask for something else.