Object relations family and couple therapy

1. Introduction

Version followed: the object relations couple and family therapy of Jill Savege Scharff and David E. Scharff (International Psychotherapy Institute, IPI), as Jill Scharff describes it in her psychotherapy.net interview, as set out in J. S. Scharff & D. E. Scharff (1997, American Journal of Psychotherapy) and D. E. Scharff (2003, Journal of Applied Psychoanalytic Studies) abstracts, and in D. E. Scharff (1992; IPI e-book 2020) Refinding the Object and Reclaiming the Self, chapters 1–3. The founding books, Object Relations Family Therapy (1987) and Object Relations Couple Therapy (1991), are not drawn on. Material that rests on them comes through a secondary summary and is tagged [uncertain]. [source: Jill Scharff interview; Scharff & Scharff 1997 abstract; D. Scharff 2003 abstract; D. Scharff 1992/2020]

Object relations couple and family therapy (ORFT/ORCT) is a psychoanalytic conjoint therapy. It rests on Fairbairn's theory of internal object relations, Klein's projective and introjective identification, Winnicott's holding and Bion's containment. It applies these ideas to the couple's "marital joint personality" (a concept from Dicks) and to the family as a group. [source: Scharff & Scharff 1997 abstract; D. Scharff 1992/2020 ch. 2–3] The theory says the mind is built through relationships, starting with the infant's family. Families and couples in difficulty show three things: failures of holding and containment, distorted shared projective identification, and attacks on linking. [source: D. Scharff 2003 abstract]

The theory of change runs as follows. The couple or family re-create their internal object relationships with each other and with the therapist. The therapist takes these in through countertransference, contains and thinks about them, and gives them back as interpretation. Over time members re-own what they had projected into each other. The unit's capacity to hold its members is restored, and the couple or family can return to the developmental tasks of their life stage. The group transference and the therapist's countertransference are "the fulcrum" of the work. [source: D. Scharff 2003 abstract; D. Scharff 1992/2020 ch. 3; Prezi summary of Scharff technical goals, secondary]

This is a clinical approach, not a licensed programme. It has no certification requirement and no fidelity monitoring. The IPI offers training, and Jill Scharff advises new therapists to get their own treatment first, then supervision, then courses. [source: Jill Scharff interview; psychotherapy.net expert pages]

2. Framework

The sources describe an open-ended psychodynamic course, not a sessional protocol. Phase labels below follow the sequence the sources describe: consultation, recommendation, mid-phase working through, termination. [source: Jill Scharff interview; Prezi summary] [synthesis: grouping into phases]

Phase A: Consultation / assessment (about 2–3 sessions)

Goals: let the couple or family experience the therapist's way of working and judge the fit; let the therapist see how they use space, respond to interpretation and tolerate links to the past. The consultation is explicitly not yet therapy. [source: Jill Scharff interview]
Format: usually conjoint, with no questionnaires. Seat choice is observed. The intimate and sexual relationship is asked about routinely. Individual meetings are added only when there is a specific indication. [source: Jill Scharff interview]
The 1987/1991 books set out a formal list of assessment tasks: providing space, showing defences, exploring the underlying anxiety, testing the response to interpretation, formulating, recommending. That list is not drawn on here. [uncertain]
Move on when the couple or family can use interpretation, can consider the past and accept the frame, and both partners (or the key family members) agree. Couples who refuse any look at the past, or want a short, directive approach, are referred elsewhere. [source: Jill Scharff interview]

Phase B: Recommendation and contract

Options: couple or family therapy; individual therapy or rehab for a dominant individual problem such as entrenched substance misuse; a trial period; referral to a briefer, more structured model. For specific sexual problems a behavioural (sex-therapy) component is added. [source: Jill Scharff interview]
Frame agreed in advance: once or twice weekly; about 45 minutes, or 60–90 minutes for couples who travel far, fixed beforehand and never stretched on the spot. Confidentiality belongs to the couple (or family) as a unit. [source: Jill Scharff interview]

Phase C: Mid-phase and working through (open-ended)

Goals: recognise and rework the mutual projective and introjective identifications; improve the shared holding capacity so members meet each other's needs for attachment, autonomy and growth; restore a centred holding relationship, seen in empathy, intimacy and sexuality; support each member's individuation. [source: Prezi summary of Scharff technical goals, secondary] [uncertain: primary wording]
Format: open, nondirective sessions. Patterns are named repeatedly in the session's "laboratory", linked to the past and to the transference. [source: Jill Scharff interview] Working through is often slow and repetitive. [source: Prezi summary, secondary]
Duration: brief developmental work (settling a fight, a decision about having a child) can resolve in a few sessions. Character-level couple work takes about two years. [source: Jill Scharff interview]

Phase D: Termination

Criteria: the couple or family has reached a level appropriate to their stage and has tools for future challenges. They can go on with life and relationship without the therapist. Success means they keep coping after leaving. A breakup that reflects real differentiation is not automatically a failure. No routine follow-up; families may return when life events overwhelm their tools. [source: Jill Scharff interview; Prezi summary]
Termination indicators for practice: the technical goals above are visibly met in the room (members re-own projections, hold one another's anxiety, the sexual relationship has resumed or improved, development is back on track). [synthesis from the goals list]

3. Guiding principles

The couple or family is the patient. Hold a firm commitment to the unit, and think in terms of a "couple's state of mind" (Scharff interview). In practice: interpret what the unit is doing together, not one member's pathology. [source: Jill Scharff interview]
Equal partiality (neutrality). Be equally partial to both partners. Keep no preference about lifestyle, which object relations should win out, or outcome, including whether they stay together. In practice: when you find yourself drifting toward one side, stop and examine the drift before saying anything. [source: Jill Scharff interview; Prezi summary]
A secure, consistent frame. Time, frequency and confidentiality are fixed in advance. In practice: do not extend sessions or keep secrets, and treat attacks on the frame as material. [source: Jill Scharff interview; Prezi summary]
Confidentiality belongs to the couple. In practice: anything said in an individual meeting has to come back to the joint sessions, and say so before any individual meeting. [source: Jill Scharff interview]
Nondirective listening, waiting, containing. In practice: open with an invitation to speak rather than questions, and resist the pull to act quickly or give advice. [source: Jill Scharff interview]
Always follow the affect (Scharff interview). In practice: track tone, rhythm, pauses, hesitations and slips, and speak to the feeling under the content. [source: Jill Scharff interview]
Contextual and focused holding. Contextual ("arms-around") holding is the safe setting the therapist provides. Focused ("I-to-I") relating is direct engagement as an object of love, hate or fear. In practice: first secure the setting, then work with what is directed at you. [source: D. Scharff 1992/2020 ch. 1–3]
Transference and countertransference are the fulcrum. In practice: your own feelings in the room (overfilled, silenced, excluded, intrusive) are your main data on the family's object relations. [source: D. Scharff 2003 abstract; D. Scharff 1992/2020 ch. 1, 3; Jill Scharff interview]
Negative capability / use of the self. Take a receptive, unfocused stance and do little, so that understanding can come out of your own experience. In practice: tolerate not knowing rather than reaching for technique. [source: Prezi summary, secondary] [uncertain: primary wording]
Therapy as laboratory. In practice: work with patterns as they happen in the room, including toward you, rather than with reports of fights at home. [source: Jill Scharff interview]
Defence before anxiety, and say why. Interpret the defensive function of a pattern and the anxiety under it, linked by a "because" clause. In practice: name what they do, what it protects against and what is feared. [source: Jill Scharff interview; Prezi summary]
Link present to past. In practice: show how partners treat each other the way earlier figures treated them, and how each was chosen to fit (valency). [source: Jill Scharff interview; D. Scharff 1992/2020 ch. 2]
Layers of anxiety. Beneath conscious fears of rejection or abandonment, the core couple anxiety concerns "the death of the couple" (Scharff interview). In practice: listen for loss and ending beneath surface quarrels. [source: Jill Scharff interview]
Development, not symptom removal, is the aim. In practice: goals stay open and may shift as members grow. [source: Prezi summary; Jill Scharff interview]
Theory stays in the background. In practice: consult theory mainly when the work is stuck, not to drive each session. [source: Jill Scharff interview]
The therapist's own treatment. In practice: personal analysis or intensive therapy is the precondition for using countertransference safely, with supervision alongside. [source: Jill Scharff interview; Prezi summary]

4. Intervention inventory

The Scharffs prefer "technique" to mean a general way of working (listening, observing, waiting, containing, following affect) rather than discrete tools. The items below are the procedures the sources name, in the order they usually come up. Where a step sequence is not spelled out in the sources it is marked [synthesis]. [source: Jill Scharff interview; Prezi summary of Scharff & Scharff technique list, secondary]

4.1 Consultation (assessment) sessions

Purpose / when: at the start. Lets the couple or family sample the work, and lets you judge suitability and choose a format.
Steps:
1. Offer about 2–3 consultation meetings and say plainly that this is a consultation, not therapy yet. [source: Jill Scharff interview]
2. See everyone who lives together and is involved, conjointly. For couples, see both partners together. Use no questionnaires. [source: Jill Scharff interview] For families, include the children. [uncertain: family assessment composition from the 1987 book]
3. Let them choose their seats, and note distance, alignment and who sits nearest you. [source: Jill Scharff interview]
4. Open with a general invitation to speak, then follow what emerges. Note the surface interaction (turn-taking, interruptions, who holds the floor) and your own responses alongside it. [source: Jill Scharff interview; D. Scharff 1992/2020 ch. 1]
5. Ask directly and without embarrassment about the sexual and intimate relationship, and about each partner's family history. [source: Jill Scharff interview]
6. Offer one or two trial interpretations or links to the past and watch the response: curiosity, use of the link and new associations, versus dismissal. [source: Jill Scharff interview]
7. In the last consultation session, give a formulation of the pattern you have seen and the anxiety under it. Then recommend couple or family therapy, individual work, combined work, a trial, or referral to a briefer model. [source: Jill Scharff interview] [synthesis: ordering]
Example language (illustrative): "We'll meet two or three times to see whether this way of working makes sense for you both. It's a chance for you to see how I work, too." / "I notice that each time one of you mentions your mother, the other changes the subject. I wonder what that protects."
Watch for: refusal to consider the past (poor candidacy). One partner arriving with a hidden agenda such as an affair or a plan to leave. A dominant individual disorder (e.g., entrenched substance misuse) that needs individual treatment or rehab first. [source: Jill Scharff interview] It is working when they bring associations to your links and come back interested.

4.2 Setting and maintaining the frame

Purpose / when: at contracting and throughout. A secure, consistent setting in which sensitive feelings and fantasies can be explored without feared consequences. [source: Prezi summary, secondary]
Steps:
1. Agree frequency (once or twice weekly), session length (default about 45 minutes; longer by advance agreement for distant couples) and the start date. [source: Jill Scharff interview]
2. State the confidentiality rule: what is said belongs to the couple or family; individual material comes back to the joint setting; you will not hold secrets. [source: Jill Scharff interview]
3. Agree fees, cancellations, holidays and what happens if one member cannot come. [synthesis]
4. Keep to the frame. Treat lateness, missed sessions, requests to extend or calls between sessions as communications to be understood (contextual transference, 4.8). [source: Prezi summary; D. Scharff 1992/2020] [synthesis: specific examples]
Example language (illustrative): "If either of you tells me something on your own, I'll need it to come back into our joint meetings. I can't hold secrets in couple work."
Watch for: pressure to bend the frame for one member, which recruits you to one side. It is working when frame breaches can be talked about rather than just acted out.

4.3 Choosing and combining formats (conjoint, individual, family, sex therapy, referral)

Purpose / when: at assessment, and again whenever the work breaks down or an individual problem dominates.
Steps:
1. Default to conjoint sessions. [source: Jill Scharff interview]
2. Add individual meetings only for a specific indication. Examples: entrenched substance misuse (consider individual treatment or rehab); a partner who is a therapist, where the other partner may need a separate space to find words; joint work that has broken down, where one partner may use you more freely as a container on their own. [source: Jill Scharff interview; D. Scharff 1992/2020 ch. 1]
3. Before any individual meeting, restate that its content returns to the joint setting. [source: Jill Scharff interview]
4. For specific sexual dysfunction, add a behavioural sex-therapy component inside the analytic frame (see 4.15). [source: Jill Scharff interview]
5. Refer couples who want a shorter, more structured or more directive approach. [source: Jill Scharff interview]
Example language (illustrative): "I'd like to meet each of you once on your own, and then bring what we learn back here together."
Watch for: individual sessions turning into a split, with one partner "my patient" and the other excluded. Process the other partner's reaction in the next joint session. [synthesis]

4.4 Creating psychological space and the holding environment (contextual holding)

Purpose / when: from the first session, and especially with frightened, grieving or chaotic families. It provides the "arms-around" safety in which painful material can surface. [source: D. Scharff 1992/2020; Prezi summary; psychotherapy.net ORFT video description]
Steps:
1. Keep the frame steady and your manner calm, unhurried and non-intrusive. [source: Jill Scharff interview]
2. Model self-examination: think aloud, tentatively, about what is happening, including in yourself. [source: Prezi summary, secondary]
3. Take in the anxiety of unconscious material and process the projective identifications inside yourself before you respond. Do not hand anxiety straight back as advice or reassurance. [source: Prezi summary; D. Scharff 1992/2020 ch. 3]
4. Notice whether the couple or family reciprocates the holding by coming, staying and thinking. Holding needs both sides. [source: D. Scharff 1992/2020 ch. 1]
5. In grief work, use the held space to let the family begin to mourn a loss it has avoided (the published video shows a family's unresolved grief over a son's suicide). [source: psychotherapy.net ORFT video page]
Example language (illustrative): "There's no hurry here. We can take time to see what this silence is about."
Watch for: the family gradually taking over the space and using it themselves to handle present and future anxiety. That is the sign the holding is being internalised. [source: Prezi summary, secondary]

4.5 Nondirective listening and following the affect

Purpose / when: the basic mode of every session.
Steps:
1. Open with an invitation to speak, not a question. [source: Jill Scharff interview]
2. Listen in a socially ordinary, unobtrusive way. Do not routinely ask how people feel. [source: Jill Scharff interview]
3. Track tone, rhythm, hesitations, pauses and slips of the tongue to find the feeling under the words. [source: Jill Scharff interview]
4. Follow whatever carries the most affect, even when it is off the stated topic. [source: Jill Scharff interview]
5. Listen for unconscious themes running through the associations of both partners or all members. [source: Prezi summary, secondary]
Example language (illustrative): "You paused just then, before saying 'fine'." / "Something went flat in the room when the holiday came up."
Watch for: your own urge to fill silence or steer, and keep it in check. It is working when members begin to notice affect shifts themselves.

4.6 Observing interaction and the use of space

Purpose / when: throughout. Surface behaviour carries the unconscious pattern.
Steps:
1. Note seating and changes in seating. [source: Jill Scharff interview]
2. Note turn-taking, interruptions, monologues and phrases that grab control (e.g. demands to be allowed to finish). [source: D. Scharff 1992/2020 ch. 1]
3. Hold surface and depth together. Do not discard the observable pattern in favour of inferred depth, or the other way round. [source: D. Scharff 1992/2020 ch. 1]
4. Pick the moment to name the pattern (see 4.11). [source: D. Scharff 1992/2020 ch. 1]
Example language (illustrative): "When you came in today, you each moved your chair a little further away than last week."
Watch for: observations delivered as accusations. Frame them as shared puzzles.

4.7 Equal partiality and using the pull to take sides

Purpose / when: whenever you feel drawn to one member's view, feel sorry for one or irritated by another, or are explicitly recruited.
Steps:
1. Notice the pull privately. [source: Jill Scharff interview]
2. Treat it as material: who started it and who allowed it? [source: Jill Scharff interview]
3. Name the skew as a joint creation that probably recurs at home. [source: Jill Scharff interview]
4. Rebalance your attention evenly across each member's inner life, their interaction, and their shared relation to you. [source: Prezi summary, secondary]
Example language (illustrative): "I notice I've been talking mostly with you, Sam, and Ellen has gone quiet. I wonder if this is how it goes at home too: one of you speaks for both, and the other lets it happen."
Watch for: both partners recognising the pattern as shared rather than as the therapist's bias.

4.8 Working with contextual, focused and shared transference

Purpose / when: throughout. It is the central route to the unit's object relations. [source: D. Scharff 2003 abstract]
Steps:
1. Watch the contextual transference: reactions to the frame, to you as provider of holding, and resistance to the setting (lateness, fee disputes, attacks on the time). In conjoint work this usually comes first. [source: D. Scharff 1992/2020; Prezi summary]
2. Watch the focused transference: you are treated as an intimate object (desired, hated, feared), usually by one member at a time. [source: D. Scharff 1992/2020; Prezi summary]
3. Watch for a shared transference: the couple or family together direct a common projection at you, for example joining to treat you as useless or intrusive. [source: D. Scharff 1992/2020 ch. 1]
4. Use the transference to invite curiosity rather than to confront. Ask everyone to join in understanding what is going on with you. [source: Prezi summary, secondary]
5. Interpret contextual transference before focused transference in conjoint work. [uncertain: inferred from the primacy of holding; not confirmed in a primary text]
Example language (illustrative): "Today you've both cancelled once and arrived late once. I wonder whether coming here has started to feel risky." / "It seems you two have joined together to treat me as the one who just doesn't get it. Perhaps that's easier than feeling misunderstood by each other."
Watch for: transference interpretations that land as blame. It is working when members start noticing their own transference reactions.

4.9 Use of the therapist's self: countertransference as data (negative capability)

Purpose / when: continuously. It is the main source of understanding, and it matters most when you are confused, bored, excluded, overfilled or attacked. [source: D. Scharff 2003 abstract; D. Scharff 1992/2020 ch. 1, 3]
Steps:
1. Take a receptive, unfocused stance and do little at first. [source: Prezi summary, secondary]
2. Register your experience: feeling filled up, silenced, attacked, intruding into the "bedroom", excluded, guilty for trying to get in, confused or rejected. [source: D. Scharff 1992/2020 ch. 1; Jill Scharff interview]
3. Ask whose experience this is. Is it concordant (identified with a member's self) or complementary (identified with someone's internal object)? [source: D. Scharff 1992/2020 ch. 3 introduces Racker's concordant identification; complementary identification is in the text but is not drawn on here] [uncertain: clinical application of complementary identification]
4. Contain it. Take it in, think about it, and let it be modified before you use it. [source: D. Scharff 1992/2020 ch. 3]
5. Turn it into an interpretation of the couple's or family's pattern (4.10–4.11), usually without disclosing the feeling raw. [source: D. Scharff 1992/2020 ch. 1] [synthesis: non-disclosure guideline]
6. Separate your own personal history from what the family induces. This is why your own therapy and supervision are needed. [source: Jill Scharff interview]
Example language (illustrative): "I find myself feeling shut out, as if I'm intruding on something private. I wonder if one of you knows that feeling of being on the outside."
Watch for: acting on countertransference (rescuing, lecturing, siding) instead of thinking about it. Discuss strong or persistent reactions in supervision.

4.10 Recognising and reworking projective identification (the couple fit)

Purpose / when: when one partner seems to carry a feeling or trait for both (one is "all anger", the other "all calm"), or when a child is the family's symptom-bearer.
Steps:
1. Map who carries which disowned part for whom. Look for the complementary fit (Bion's valency) and for one partner acting as the "organ of expression" for the other. [source: D. Scharff 1992/2020 ch. 2]
2. Look at how each takes in what the other projects: introjective identification, including extractive introjection (Bollas). [source: D. Scharff 1992/2020 ch. 1]
3. Show the exchange happening in the session, as a joint process. [source: D. Scharff 2003 abstract; Jill Scharff interview]
4. Help each member re-own the projected part. For example, the calm partner finds their own anger, and the angry partner finds their own wish for peace. [source: Prezi summary of goals, secondary] [synthesis: example]
5. In families, look at how a child is made to carry the family's disowned part and gradually relieve the child of it. [source: D. Scharff 2003 abstract mentions distorted family projective identification] [synthesis: steps]
Example language (illustrative): "It's as if Mark does all the worrying for both of you, so you can stay relaxed, and you do all the relaxing for him. I wonder what would happen if you each kept a bit of both."
Watch for: the carrier briefly getting worse as the projection is returned. Expect this; it is part of re-owning, not failure. [synthesis]

4.11 Naming repeating patterns, then interpreting defence, anxiety and fantasy (the "because" clause)

Purpose / when: once a pattern has recurred in the room enough times to be recognisable.
Steps:
1. Describe the repeating pattern concretely, as a joint creation. [source: Jill Scharff interview]
2. Ask why the couple or family needs it: what defensive function does it serve? [source: Jill Scharff interview]
3. Name the anxiety under the defence. Go from conscious fears (rejection, abandonment) to the deeper fear of the couple's death or loss. [source: Jill Scharff interview]
4. Link defence and anxiety with a "because" clause: "you do X because you fear Y". [source: Prezi summary, secondary]
5. Optionally use Ezriel's three-part frame: a "required" relationship that defends against an "avoided" relationship, both preferred over a feared "calamity". [source: Prezi summary attributing the use to the Scharffs] [uncertain: primary wording]
6. Expect to repeat it. Naming once rarely changes a pattern; link it again to new material. [source: D. Scharff 1992/2020 ch. 1]
Example language (illustrative): "Each time you get close to talking about the baby, one of you starts a fight about money. Maybe the fight is safer, because the money row keeps you from feeling how frightened you both are of losing each other."
Watch for: too much, too intense, too soon. Defer premature interpretations of sensitive themes. [source: D. Scharff 1992/2020 ch. 1] It is working when they add to the interpretation, or the pattern softens and then reappears in a weaker form.

4.12 Linking present to past (constructions)

Purpose / when: once a pattern is recognised. It shows how internal object relations from each family of origin are being re-enacted.
Steps:
1. Collect each member's family history as it becomes relevant, not as a fixed history-taking. [source: Jill Scharff interview; Prezi summary]
2. Every so often, offer a construction of what has been happening: the repeating interaction plus its links to early experience. [source: Jill Scharff interview]
3. Show how partners treat each other as earlier figures treated them, or as they were treated, and how each may have chosen a partner who fits. [source: Jill Scharff interview; D. Scharff 1992/2020 ch. 2]
4. Invite both partners' associations to the link. [source: Jill Scharff interview]
Example language (illustrative): "When Jo goes silent, you hear your father withdrawing, and you push harder, the way you used to with him. And Jo, the pushing sounds like your mother's criticism, so you withdraw further."
Watch for: history used as blame ("it's your mother's fault"). Keep both histories in view.

4.13 Couple dream work

Purpose / when: whenever a dream is brought. Once shared, a dream becomes the couple's dream and opens their shared unconscious life. [source: Jill Scharff interview]
Steps:
1. The dreamer tells the dream. [source: Jill Scharff interview]
2. Ask the dreamer for associations. [source: Jill Scharff interview]
3. Ask the partner for associations. [source: Jill Scharff interview]
4. Let the couple discuss it together. [source: Jill Scharff interview]
5. Draw on your own associations and on the feelings the dream stirs in the room. [source: Jill Scharff interview]
6. Build an interpretation about the state of the relationship and each partner's wishes for it, including the transference where it applies. [source: Jill Scharff interview; Prezi summary]
Example language (illustrative): "What comes to mind about the house with no doors? … And what comes to your mind, as you hear Chris's dream?"
Watch for: the non-dreamer dismissing the dream as "just theirs". Bring it back as shared material.

4.14 Working with fantasy, play and very young children in family sessions

Purpose / when: family sessions that include young children, who speak through play rather than words.
Steps: Jill Scharff published a paper on play and very young children in ORFT (2004), but its content is not drawn on here. The steps below are a [synthesis] consistent with the holding and transference principles above, not the Scharffs' own procedure:
1. Keep simple play materials in the room (drawing materials, small figures, a doll family), and tell the family that children can play while adults talk. [synthesis]
2. Treat the child's play as a communication about the family's shared unconscious fantasy, and watch how the play changes when adults raise particular topics. [synthesis]
3. Describe the play to the whole family and link it to what the adults are discussing. [synthesis]
4. Notice which adult attends to or interrupts the play, as data about holding. [synthesis]
Example language (illustrative): "While Mum and Dad were talking about Grandpa being ill, Lily built a wall round the little house. Maybe she's showing us how everyone is trying to keep the worry out."
Watch for: adults using the child's play to blame the child. Keep the interpretation at the family level. [uncertain: whole section]

4.15 Exploring the sexual relationship and integrating sex therapy

Purpose / when: sexuality is part of every couple assessment, and a behavioural component is added for specific dysfunctions. [source: Jill Scharff interview] David Scharff's The Sexual Relationship (1982) is the main text on this. It is not drawn on here. [uncertain]
Steps:
1. Ask about the intimate and sexual relationship directly, without inhibition, as part of routine assessment. [source: Jill Scharff interview]
2. Read the sexual relationship as an expression of the couple's centred holding and mutual projective identifications. [source: Prezi summary of goals, secondary]
3. Where a specific dysfunction is present, add a structured behavioural sex-therapy component (for example graded, non-demand sensate focus exercises the couple do at home), and keep exploring the anxieties and object relations the exercises bring up. [source: Jill Scharff interview states a behavioural component is used] [uncertain: which specific exercises the Scharffs use was not confirmed]
4. Treat avoidance of or difficulty with the exercises as material for interpretation, in the same way as other frame breaches. [synthesis]
Example language (illustrative): "Can you tell me about your sexual relationship now, and how it has changed over time?" / "You didn't get to the exercise this week. Let's look at what made it hard to start."
Watch for: your own discomfort or sense of intruding on the "bedroom", which can stop you asking. [source: Jill Scharff interview]

4.16 Addressing failures of holding and attacks on linking

Purpose / when: in traumatised or very disturbed families, where members cannot hold one another, or where any connection that forms (between members, or between a thought and a feeling) is quickly broken. [source: D. Scharff 2003 abstract]
Steps: the abstract names these as targets but gives no procedure. The steps below are [synthesis] from the holding and containment principles:
1. Strengthen the contextual holding first: steady frame, calm pacing, fewer and shorter interpretations. [synthesis]
2. Notice the moment a link is broken (a subject change, a joke, an interruption, a child acting up) and gently draw attention back to the link just before it broke. [synthesis]
3. Name the anxiety that connection seems to bring, and contain it yourself until members can bear it. [synthesis]
Example language (illustrative): "Just as you two began to agree about Tom, Sophie knocked the blocks over and we all lost the thread. Perhaps agreeing feels dangerous here."
Watch for: links that survive longer in the session. [synthesis]

4.17 Working with enactments in the session

Purpose / when: when the couple or family pull you into a role, or when an attack on you freezes the session.
Steps:
1. Recognise that an enactment is under way, from your countertransference and the shift in atmosphere. [source: D. Scharff 1992/2020 ch. 1]
2. Do not retaliate or withdraw. Ask about the feeling under the attack, for example the loss or humiliation behind it. [source: D. Scharff 1992/2020 ch. 1]
3. When the member can reflect, the frozen enactment becomes mobile and can be thought about. Link it to the couple's pattern at home. [source: D. Scharff 1992/2020 ch. 1]
Example language (illustrative): "You're very angry with me right now. I wonder if what I said felt humiliating, as if I'd taken your side away."
Watch for: your own urge to defend yourself. It is working when the attacking member can reflect on the attack.

4.18 Facilitating family mourning

Purpose / when: when a family is stuck around an unmourned loss (a death, a suicide, a lost child, a lost hope), often showing up as a member's "uncooperative" symptom. [source: psychotherapy.net ORFT video page]
Steps: the video page describes the aim (a holding environment in which the family can begin to mourn, countertransference as a guide, interpretations that let the family see a symptom in a new light), not a stepwise method. Steps 1–4 below are [synthesis]:
1. Provide holding, and allow silence and tears. [synthesis]
2. Use your own sadness, deadness or avoidance as a clue to the unmourned loss. [source: video page on countertransference] [synthesis: detail]
3. Reframe the symptom-bearer's behaviour as carrying grief or protest for the family. [source: video page] [synthesis: wording]
4. Help members speak about the lost person and about how each has grieved, or not. [synthesis]
Example language (illustrative): "I wonder if Pam's refusing is the only way anyone in the family is still protesting that Victor is gone." (illustrative wording built on the published case outline)
Watch for: suicide risk in bereaved-by-suicide families. Assess current risk with standard practice (see 5.9).

4.19 Working through

Purpose / when: the mid-phase. The same defences and conflicts are met and reinterpreted many times in new contexts. [source: Prezi summary, secondary]
Steps:
1. Expect slow, repetitive, sometimes dull work, and do not mistake this for failure. [source: Prezi summary, secondary]
2. Re-link each new appearance of the pattern to earlier interpretations, the transference and the past. [source: Jill Scharff interview; D. Scharff 1992/2020 ch. 1]
3. Track small signs of re-owning: members catching their own projections, or holding each other's anxiety without you. [synthesis]
Example language (illustrative): "Here's that familiar moment again, but this time you noticed it before I did."
Watch for: boredom in you, which may signal a defensive deadness to interpret rather than a lack of progress. [synthesis]

4.20 Termination

Purpose / when: when the goals are substantially met and the couple or family can carry on using their own tools. [source: Jill Scharff interview; Prezi summary]
Steps:
1. Review the criteria: they are back at their developmental stage; their holding capacity is restored; they re-own projections; there is intimacy and sexuality; they have tools for future stresses. [source: Jill Scharff interview; Prezi summary]
2. Set an ending date with enough time to work on the feelings the ending stirs. These will include echoes of the core anxiety about the couple's death or loss. [synthesis; anxiety concept from Jill Scharff interview]
3. Expect old patterns to resurface and use them as a last round of working through. [synthesis]
4. Say they can come back if life events overwhelm their tools. No routine follow-up is scheduled. [source: Jill Scharff interview]
5. If the couple separates, help them end the relationship with differentiation rather than enactment. [source: Jill Scharff interview notes breakup can reflect differentiation] [synthesis: procedure]
Example language (illustrative): "You've been handling things between you that used to need me. Let's think about setting an ending, and about what ending here brings up."
Watch for: abrupt flight at the point of ending. Name it, and leave the door open.

5. Handling problems

Items tagged [source] come from the cited texts. Items tagged [synthesis] are this guide's own guidance, consistent with the model but not found in a primary source.

5.1 A secret disclosed individually (an affair, a plan to leave). Because confidentiality belongs to the couple, ask the partner to bring it into the joint sessions. If they will not, you may be unable to continue the couple work. [source: Jill Scharff interview] Set this rule before any individual meeting (4.2–4.3). Offer the partner individual support to decide and a referral if couple work ends. [synthesis]
5.2 Being recruited to one side. Treat the pull as material, then name the skew as a joint pattern, showing who initiated it and who allowed it (4.7). [source: Jill Scharff interview] If one partner keeps feeling unheard, check your balance in supervision. [synthesis]
5.3 Refusal to look at the past or wish for advice. At assessment, this is a candidacy question: offer a trial with an open choice, or refer to a shorter, more directive model. [source: Jill Scharff interview] Mid-treatment, interpret the wish for advice as a defence against the anxiety the past stirs, and ask what they fear would happen if they looked. [synthesis]
5.4 Stuck sessions and repeating patterns that do not shift. Expect to name the pattern repeatedly and link it to new material, since one naming rarely changes it. [source: D. Scharff 1992/2020 ch. 1] Use theory, which is held in the background, when you are stuck. [source: Jill Scharff interview] Check your countertransference for boredom or deadness as a clue (4.9, 4.19). Get supervision. Consider whether an individual problem is blocking the work and needs individual treatment (4.3). [synthesis]
5.5 Monologues, interruptions, control of the floor. Read these as control or resistance inside the couple, and name them as a joint pattern, not as one partner's rudeness. [source: D. Scharff 1992/2020 ch. 1] Watch the timing and manner of your own interruptions, because both partners may resent them. [source: D. Scharff 1992/2020 ch. 1]
5.6 Ruptures and abrupt dropout. Couples who leave in anger have left the "bad object" in the therapist, and "the bad object always returns" (Scharff interview). [source: Jill Scharff interview] Name anger at you openly when it appears, and use 4.17 rather than defending yourself. [source: D. Scharff 1992/2020 ch. 1] After a dropout, send a brief note that leaves the door open. [synthesis]
5.7 Feeling excluded, intrusive or guilty. Jill Scharff names feeling like an intruder into the couple's "bedroom", feeling excluded, and feeling guilty for trying to get in, as normal parts of the work. [source: Jill Scharff interview] Use the feeling to understand who in the couple's history was shut out or intruded upon (4.9). [synthesis]
5.8 Overwhelm and trauma. Prioritise contextual holding. Slow the pace, delay deep interpretation (avoid "too much, too intense, too soon"), and contain rather than probe. [source: D. Scharff 1992/2020 ch. 1] The Scharffs' trauma book (Object Relations Therapy of Physical and Sexual Trauma, 1994) is not drawn on here. [uncertain] Add individual trauma treatment where one member's symptoms swamp the conjoint setting. [synthesis]
5.9 Suicide risk, self-harm, or bereavement by suicide. Use current standard risk assessment for any member at risk, including individually where needed. Create a joint safety plan, and do lethal-means counselling (secure storage or removal) with the family. The conjoint, nondirective frame is put on hold for this. [synthesis]
5.10 Intimate partner violence or coercive control. Not addressed in the sources. Screen each partner separately and safely. Do not do conjoint work while there is ongoing violence or fear. Prioritise safety planning and specialist referral. [synthesis]
5.11 Child protection concerns in family sessions. Not addressed in the sources. Mandatory reporting duties override the couple and family confidentiality frame; tell the family about this limit at contracting. [synthesis]
5.12 Substance misuse. Entrenched substance misuse may call for individual treatment or rehab before or alongside couple work. [source: Jill Scharff interview]
5.13 A partner who is a therapist. The non-therapist partner may need an individual session to find words for emotional experience. Also watch for the therapist-partner taking the role of co-therapist. [source: Jill Scharff interview] [synthesis: the second point]
5.14 Non-attendance by a family member, or one partner coming alone. Not addressed in the sources. Treat the absence as a family communication and interpret it with those present. Do not let it become individual therapy by default. Invite the absent member, and decide with the family whether to continue. [synthesis]
5.15 Non-adherence to sex-therapy exercises. Explore it as resistance and anxiety, not compliance failure (4.15). [synthesis]
5.16 Decision to separate. A breakup can reflect differentiation and is not automatically a failure. [source: Jill Scharff interview] Help the couple separate thoughtfully, especially for the children's sake, and offer each partner a referral. [synthesis]
5.17 Therapist's own blind spots. Get your own treatment, supervision and continued study. Jill Scharff calls couple work "the hardest work we do". [source: Jill Scharff interview]

Sources

Sources:

Further reading (not drawn on; orienting only; content from them is tagged [uncertain]):

Scharff, D. E., & Scharff, J. S. (1987). Object Relations Family Therapy. Jason Aronson.
Scharff, D. E., & Scharff, J. S. (1991). Object Relations Couple Therapy. Jason Aronson.
Scharff, D. E. (1982). The Sexual Relationship: An Object Relations View of Sex and the Family. Routledge & Kegan Paul.
Scharff, J. S., & Scharff, D. E. (1994). Object Relations Therapy of Physical and Sexual Trauma. Jason Aronson.

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