Tuesday, July 31, 2018

Couples Therapy: "How Did I Get Here?"

“How did I get here?” is a phrase I often hear at the beginning of my couples work.  It is usually said out loud by one of the partners in front of me.  If it is not explicitly stated, it is conveyed.  This phrase references a marriage that is buried under the pressures of job, children, mortgages, multiple cars, expensive meals and extravagant holidays.  It is short hand for people who feel trapped in a life that they have actively and mutually participated in building, and now feel blindsided by how it turned out.  By the time they see me, they are stuck between the difficult options of either dialing back their lifestyle choices.  Or going forward and continuing to feel overwhelmed.  Usually the couple has been functioning for some time as “Co-CEO parents” of their family corporation instead of nurturing (in part) the intimacy of their husband-wife relationship.  One or both of them is carrying resentments toward the other.  They are emotionally isolated, disinterested in sex with the other, and there is palpable “grief” for the couple relationship they used to share.  Each in their own way just want the partner they used to have back!

In Narrative Therapy, which is a well-known form of psychotherapy, there is a concept referred to as “negative (and positive) identity conclusions.”   These are the beliefs we carry about ourselves and about our partners.  Examples of negative identity conclusions as they relate to relationships might be, “she is a narcissist who only thinks about herself,” or “he is lazy and doesn’t do anything during the day.”  Others identity conclusions that I sometimes hear are, “she is a complainer,” or “he is a party boy who never grew up.”  Negative identity conclusions are corrosive.  They create emotional isolation in a marriage and pull people apart.  They are the doom and gloom of marriage.  In Discernment Counseling there is a concept called “hard and soft reasons for considering divorce.”  They are decent predictors for whether a couple stands a chance of regrouping and setting their marriage on a healing path.  Examples of hard reasons for considering divorce are substance abuse and infidelity.  Examples of soft reasons are, “ we don’t communicate anymore,” or “we have fallen out of love.” 

In couples therapy one of the early tasks at hand is assessing how hard or soft the negative identity conclusions have become.  If a person has “married” their conclusions about the other then in Discernment language I consider them hard.  The more entrenched (i.e. hard) the conclusions are, the poorer the prognosis for salvaging the marital relationship.  If instead I can assist a partner to “flirt” with their conclusions then we are in a soft realm.  And the marital prognosis is better. When negative identity conclusions are verbalized impulsively in front of the other they are damaging and I can almost literally see a partner’s heart closing toward the other.  When said to me privately as part of the therapy, while important, they can perpetuate a negative feedback loop that points the speaker in the direction of divorce.  “How did I get here” is a cumulative effect that occurs over time.  Its building blocks are stored up resentments.  These resentments calcify into negative conclusions.  The challenge lies in counterbalancing these negative conclusions about the other with more positive ones.  These are called in Narrative terms, positive identity conclusions.  These types of conclusions hold the other person in a more favorable, more loving light.  In the light that used to exist before one or both presumably “got here.”

Friday, July 20, 2018

Leaning In and Out of Couples Therapy

Usually in Discernment counseling a couple presents where one of them is “leaning in” and the other is “leaning out.”  The former wants the marriage to work and is invested in anything that will help.  The latter is ambivalent and somewhere along a continuum of being done with the marriage to considering reconciliation if some major changes were to take place.  The beginning point of couples therapy is not dissimilar.  It is rare for a couple to arrive for a 1st session in agreement about saving (or dissolving) their marriage.  The ideal trajectory of couples therapy is that 2 people come to therapy equally motivated to “communicate better” and get their relationship back on track.  Before I learned about discernment counseling I used to start my couples therapy work from this assumption.  The couple wanted to work on their marriage because they said so.  And I would eagerly get to work with them with this shared goal in mind.   

As I learned to deconstruct my work however I realized that if one person said they wanted assistance I assumed both did.   I allowed the quieter person to hang back in the shadows of our therapy. I didn’t clearly explore their motivation for seeking my services.  As I have previously mentioned in other posts, discernment counseling research has shown that approximately 30% of couples approach divorce with some amount of ambivalence.  I am not aware of the percentage of couples that approach couples therapy in some similar state of ambivalence.  I suspect that a similar percentage of couples approach couples therapy with ambivalence.  Currently as a practicing discernment counselor and a couples therapist, I now assume in both that I am sitting in front of a leaning in/leaning out couple.  I conduct the early part of my couples therapy work from this starting point.  I believe to do so in any other way would be a mistake that is commonly committed by well-meaning couples therapists--I used to be one of them!

The early stage of couples therapy (and Discernment Counseling) looks like this:  the leaning in person needs to be calmed and encouraged to give their partner space so their partner doesn’t feel emotionally suffocated.  The leaning in person is usually ready to accept their faults and reluctant to challenge their partner to accept any of theirs.  They have been “walking on thin ice” and continue to do so in my office.  This person is easy to spot.  This leaning in person needs to signal an understanding of their part in the problem, a desire for their partner to perhaps do the same, and a direct and clear signal about their own desire to change regardless.  On the other hand, the leaning out person needs to be acknowledged as ambivalent.  Exploration also needs to occur with this person about whether they are here to work on their marriage or to “check a box.”  Or in some cases whether they plan to leave their spouse with me to take care of them after they leave. The leaning out person who is usually standing on “more solid ice” also has to be encouraged to take a systemic understanding of the problem.  This is a technical way of saying they need to look at their part in how they both consciously and unconsciously collaborated to get to where they are now.  If the leaning out person can accept their part, even somewhat, and can be moved away from finger pointing then the couple is better poised for a productive couples therapy experience.  If the leaning in person remains urgent to fix things and the leaning out person remains unsure, then the couple will probably drift in half hearted couples therapy until they drop out.

Wednesday, July 4, 2018

Substance Abuse and Discernment Counseling

I’ve decided to write a bit more about Discernment Counseling, specifically another “hard reason for considering divorce:” substance abuse/addiction. To review for a moment, Discernment Counselors refer to hard versus soft reasons for considering divorce; hard reasons are considered the more challenging issues, which often lead to a divorce decision, as opposed to soft ones (i.e. poor communication), which are presumed to be more “workable.”  As I have previously mentioned in other posts, the research has shown that approximately 30% of couples approach divorce with some amount of ambivalence.  As such these are the couples that could benefit from Discernment Counseling, a structured process for couples to explore their options before making a final decision about staying together and working on their marriage or pursuing divorce.

Alcohol/drugs, as well as Internet pornography are the more common addictions that present in my practice.  For the sake of simplicity I will focus this post on drug and alcohol abuse.  In Discernment language, there are usually  “leaning in” and  “leaning out “ partners.  The leaning in partner prefers to work on the marriage in an attempt to salvage it.  The leaning out person is more ready to pursue divorce.  Sometimes I have seen the substance abuser present in therapy leaning in and other times leaning out.  In the leaning in scenario, this person shows up desperate to save the marriage despite abusing substances for some time, creating chaos and resentment in their wake.  As such, the non-abusing partner is usually leaning out and largely ready to end the relationship having given up on any hope for change.  Usually they are hurt and feel disrespected by their partner’s actions.  Alternatively, there is also the scenario where the addict presents as leaning out, “hell bent on maintaining a marriage” with substances over their partner.  In this case, the non-abusing partner continues to lean in, often motivated by worry about emotionally or financially disrupting their children, and/or fears about custody issues down the line (i.e. potentially leaving their children alone with an “unsafe” parent).  

If the addict is leaning in, preferring to stay and work on their marriage, then they have to face abstinence.  As I wrote in my prior post about infidelity, the substance abuser has to be ready to give up substances, at least during the 6-month period of couples therapy.  This is easier said than done for someone who has an active addiction.  In graduate school l was taught the addiction continuum: use to misuse to abuse.  Misuse and abuse pose the more difficult scenarios.  While abstinence is ideal, I have worked with couples where a decision is made to accept substance use in the form of what is called “warm turkey” as opposed to “cold turkey.”  This means some form of use (but not misuse or abuse), jointly agreed upon by the couple.  Warm turkey is unconventional in the world of addiction and psychotherapy.  As I have learned through my clinical experiences however, use is often an easier 1st step to make for the substance-abusing spouse.  With 12-step support (or something akin) the goal is to gradually assist the substance abuser, with the participation of their spouse, to move toward substance elimination.  The goal is total abstinence with a recovery program in place.  If a couple can get to this point, despite substance abuse/addictions being viewed as a hard reason, then there is some hope for saving the marriage.  If not, chances for salvaging a marriage are usually slim.