Couples Therapy: Marriage Counseling Approach

What can you expect from your couples therapy or marriage counseling session? In this article I shall endeavor to give you an overview on psychotherapy with couples in my practice.

couples therapy

 

I am influenced by the principles introduced by Bob and Rita Resnick, who together with their faculty of GATLA have been my mentors for many years. I have personally experienced their work by being a model couple at a workshop in Slovenia, 2015.

“Two becomes one, and then there is none.”  Bob Resnick

This quote explains how almost all relationships begin with blissful passion only to evolve with time into something less — often much less.

Falling in love involves meeting a person different from ourselves

Falling in love is about meeting someone, and realizing a “chemistry” with that person. In love, all you want to do is to be with the person to feel his or her presence. There exists interest, curiosity and need. This is a time of exploration and fun. Sometimes it is also a time of anxiety of being with someone new. These emotions make us feel fresh and somewhat alive.

Two becomes One

Passions fade with newness. How come?

As the relationship progresses, two very different people become more and more alike. This seems to be a “natural” process in most intimate relationships. “Successfully” married  (especially elderly) couples, often look and act like each other, oftentimes even being able to read each other’s minds and/or finish each other’s sentences.  For that reason perhaps, we’d think that “two becoming one” is the path to take in relationships.It , after all  recited in most marriage vows.

…then there is none

Resnick argues, however, that when two become one, there’d be none.  The passion arising from the meeting and the curious exploration of two different people is doesn’t exist anymore, when these two different people become the “same person”.

It would then seem like an ideal if both persons in a romantic relationship can stay together as unique individuals, different from each other.

Changing the Other or Changing for the Other

With attachment comes reliance.  There is mutual responsibility attached to serious relationships. We need this kind of mutual responsibility.  Caring mutual responsibility is healthy.

What unfortunately gets mixed up with caring responsibility,  is the idea that we have to give up our needs altogether, or that the other person is expected to give up his/her needs likewise.

With personal needs unmet, both parties begin to make silent demands on the other.  This circle of needs and demands go unnoticed in the undercurrent of the relationship.  There is dissatisfaction as one tries to change him/herself to fit into a relationship role, and there is conflict when one tries to change the other person in to his/her role.

Maintaining a Mutually Nourishing Relationship

To be ourselves and to be with the other. To be for ourselves and to be for the other. To be taken care of by the other and to be take care of the other.   Movement between being for ourselves and being with the other is the premise of a mutually nourishing relationship.

Oftentimes, though, we are not moving, we are really stuck.

We can only “be ourselves” if we are aware of who we are. We can only be well taken care off, when we are fully aware of our own needs. We can be for the other only if we are able to listen to what the other person is saying.  Without  awareness, both parties can only rely on guesses, expectations, silent resentment, and conflict.

Couples Therapy Approach

When couples come to the practice, the “client” is the relationship. Relationship functions through communication. Couples therapy will then be centered around communication between two persons in the relationship.

Questions to ask are: How do we perceive our needs? How do we express what we want?  How do we hear the other? How do we react to the other person’s needs? How do we compromise? What do we want the other person to know? How important is the relationship to us? Who are we? …

During therapy, an assortment of themes arise. The focus is on how the couple deals with these themes.  How do they communicate with each other in situations.  The focus is on dialogue.

Each person gets his/her space and voice. The background of each person in the relationship is considered, validated and heard. What has he/she been through? What is he/she going through now? What do both persons want for the future?

Contact me if you have questions regarding Couples Therapy

Reference

Two Become One and Then There Are None: Moving from a Fusion Model to a Connection Model in Couples Therapy from Clinton Power on Vimeo.

 

 

Scapegoating in Groups and Families

Scapegoating is a phenomenon that happens in almost all human groups. A. Colman (video below), begins the above talk by saying that it is the root of evil in humanity. Is he exaggerating this? Or are there truths in his remark?

bullying

What makes a group?

A group is made up of a bunch of individuals (and we are referring to human individuals here), who have to be together because of a certain task or function. A company of workers is a group. There are social groups, church groups, political groups, hobby groups, support groups and the like. Families are also groups.

In my article Bion: The Function of Myths in Groups, I explain that a group is a body that has a mental state and creates a phantasy. The group becomes more than the sum of people that come together to form it. The group has its own dynamics and it is its own organism.

Groups are like organisms, and they strive to keep themselves intact

The group connects the inner worlds of people. Narcissistic tendencies and psychological traumas get played out in groups. Like a living organism, the group strives to keep itself intact.

In order to do so, any form of aggression that naturally and unconsciously arises from the group becomes a threat to the status quo of the group. There is a tendency then for the group to move towards “doing something” to maintain harmony and equilibrium. The individuals then strive to retain their own idea of their “good self” and deny their part in the aggression that threatens the group.

Groups need scapegoats so that the members can disown their responsibility for the group’s destruction

The aggression that is latent in the group becomes disowned by the individuals (who do not want to be blamed for their group’s destruction), and transferred on to an external object of blame. This object of blame is the scapegoat.

Oftentimes the scapegoat is a member of the group. Sometimes it appears in the form of someone from outside the group– people from another culture, immigrants, women, etc.

Scapegoating in Groups

Scapegoating is the most ancient human rituals. It used to come in the form of practices such as child & animal sacrifice, adult sacrifice, witch hunting. Large groups of people can also become scapegoats, as we have witnessed during the Holocaust, Apartheid, and other genocides.

A Scapegoat is a person, subgroup, collective idea … who is made to take the anxious blame for the other people in their place.

The process of scapegoating is done in order for the rest to feel more comfortable, or to be more efficient, and whole.

The scapegoat embodies the transformational, creative and/or destructive potential within the group.

The scapegoat has often creative potential, and is often different from the others in the group. Sometimes this person has the potential to make changes in society.

Scapegoating is victimization of the other

Many who have been young victims of bullying in school or in the family have experienced from a young age, what it is like to be in the position of the scapegoat.

The scapegoat is usually the different / outsider. Not being able to bear the difference. Potential scapegoats are usually people who are racially different.

Scapegoat’s Adjustment

In order to survive being scapegoated, the person either turns into the

  • victim /patient (as in children who develop illnesses or develop behavioral problems in school).
  • avenger (someone who takes revenge)
  • the messiah / prophet (someone who saves the group)

09:10 Colman, in the video above provides us with literary examples of some of these scapegoat transformations.

In Families, the child who becomes the Scapegoat is also the Symptom Bearer

Scapegoating happen in almost all families. Most of the time a child in the families bears the brunt of the scapegoating. If the family is relatively harmonious, the scapegoat feels simply like a “black sheep”, and grows up to be an adult who can function well.

In families that are dysfunctional, or in families where mental disorders and/or addictions or illnesses exist, the scapegoat child develops symptoms or syndromes that affect his/her ability to function emotionally as an adult. Some of these scapegoated children develop psychological issues like depression, anxiety, eating disorders. Some also develop the tendency to self harm.

This is usually seen (which I witness in practice) in a families where parents strive to stay together, despite the fact that one or both parents are abusive or psychologically unstable. What would have been a natural course of action, a break up, is avoided by members of the family at all costs. A superficial picture of stability is often seen in these families.

The “only” problem this family seem to have is a problem child — a child who is doing poorly at school, has behavioral problems, has eating disorder, self harms or has other emotional difficulties. When as therapists we see such children, we understand them to be symptom-bearers.

The experience of being a child scapegoat is one of Childhood trauma. There is immense feeling of loneliness because his/her feelings towards the family are negated by their own parents and siblings. These are the children who’d take the blame for their parents’ worries. Many grow up believing that they are flawed. Many introject the blame. Self blame lead to self hatred, self harm and sometimes suicide.

Psychotherapy for Child Symptom Bearers

Usually families bring themselves into therapy because of a “problem” or “sick” child. In successful family therapies, the therapeutic work centers around the relational dynamics between the family members, and not focussed on the “problem child”. Helping the parents and other members become aware of their roles in the family system releases the afflicted child of having to bear the intrinsic problems that exist in the family.

Psychotherapy for Adult sufferers of Scapegoating

One does not always know that one is being made a scapegoat. In the working environment, the scapegoat may simply find work in the office stressful with conflicts.

Sometimes, of course, in the course of therapy the client realizes that he/she was his/her family’s symptom bearer, or that he/she was a scapegoat in a group.

Being a scapegoat brings with it feelings of loneliness. You are being targeted as the cause of problems. Because of this, there’ll also be feelings of having done something wrong, or being flawed. This progresses to self blame. Psychotherapy involves

  • addressing these feelings of loneliness, shame, fear and betrayal
  • re-aligning oneself by being awareness of the group reality,
  • finding oneself again being independent of the group,
  • finding resources outside the group
  • getting support from others

Contact me freely for more information on this topic, or for therapy.

Psychotherapy in Vienna & on Skype

Find out more about:

Therapy in Vienna …. Therapy over Internet

Anorexia & Eating Disorders in Children: What Parents and Family can do

When a child in the family develops symptoms of eating disorder (like anorexia nervosa, anorexia bulimia or binge eating disorders), other members in his/her family, in particular the parents may feel overwhelmed by the situation and even helpless.

The ways in which different families deal with the illness vary individually.

As parents or guardians the most immediate thing to do is to get for themselves support from a professional in treating eating disorders, be they doctors /psychiatrists  and/or psychotherapists.

What parents can do

The actual diagnosis and treatment of the physical and psychological aspects of the eating disorder is conducted by doctors. Usually these are done by specialists.

Parents can help the professionals by offering information on the family situation when these questions are posed to them by the diagnostician.  If there is such an interview given, it is best to provide the information as openly and honestly as possible.  This would facilitate un-hindered support for the children.

Once in the care of professionals, it is best for parents to allow the process to take place. 

It is a common reaction for worried parents to want to “take things into their own hands” when they perceive that help is not achieved adequately or quickly enough. Reacting to the child’s treatment in any way, so as to affect the relationship between the child and the professionals treating him/her, or to affect the child’s emotional state can be counter-productive.

If you are a parent of a child who is being treated for eating disorder, and feel uncertain or unpleasantness about the progress of the child’s treatment, do seek a conversation with the professionals in charge, before taking other action to change the treatment process.

Eating disorders arise and develop out of different situations. Sometimes the causes are linked to family dynamics, and other times it is not the case. Regardless of this, there is a tendency for parents and other family members to hold feelings of sadness, anger and guilt, as the result of realizing that a child is suffering from the disorder.

Difficult emotions being felt by parents, when ignored, can make problems worse, rather than better. This is because, when the emotions are pushed aside, they become stress factors that result in actions or behaviors that cause more stress in the family environment. In turn this may snowball into more problems for the child, and his/her other siblings.

It is hence recommended that parents themselves seek some kind of counseling from a psychotherapist, or a self-help group (if such is available).

Having counseling for parents, does not mean that the parents are in any way at fault, or have problems themselves. When parents go for counseling they are supporting the child by helping to provide a stable environment at home for him/her to get better.  

This short article is written with the wish that parents of children suffering from eating disorders take to heart that in order to support the healing of their children, they can do well by taking care of their own emotional state. Having a child diagnosed with eating disorder is, after all, stressful and riddled with questions and judgements of and from the self and others.

It is good to consider this metaphor taken from the aircraft emergency procedures:

“In the event of emergency, put your oxygen mask on first.”

The consequence of not following this aircraft safety advise is the loss of emotional bearings due to hypoxia (lack of oxygen in blood), rendering the person unable to help others, and worse…

In the case of supporting the child with eating disorder, counseling  for the self is the oxygen mask. It helps provide emotional stability in times of stress in the family.

Other Readings

Cottee‐Lane, D., Pistrang, N., & Bryant‐Waugh, R. (2004). Childhood onset anorexia nervosa: The experience of parents. European eating disorders review12(3), 169-177.

Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz (2018). Essstörungen: Was Angehörige tun können. Web source from URL:https://www.gesundheit.gv.at/krankheiten/psyche/essstoerungen/was-angehoerige-tun-koennen. Retrieved on 06.2018.

Honey, A., Boughtwood, D., Clarke, S., Halse, C., Kohn, M., & Madden, S. (2007). Support for parents of children with anorexia: what parents want. Eating disorders16(1), 40-51.

Lask, B., & Bryant-Waugh, R. (Eds.). (2000). Anorexia nervosa and related eating disorders in childhood and adolescence. Taylor & Francis.

Crisp, A. H., Harding, B., & McGuinness, B. (1974). Anorexia nervosa. Psychoneurotic characteristics of parents: Relationship to prognosis: A quantitative study. Journal of Psychosomatic Research18(3), 167-173.

Brief Therapy Interview Strategies

Icebreaker Compliment or Positive Statement (Examples)

I’d like to thank you for getting here so promptly today.
I do appreciate that very much.
I’d like to thank you for taking the time to come in today.
I’d like to thank you for filling out all those forms.
I’d like to thank you for answering all those questions on the forms you filled out.
I’d like to thank you for coming in and giving me the time to go over some things with you.

Basic approach to changing the mindset of clients from involuntary to voluntary status:

Our work with them follows this schema:

Whose idea is it that you come here?  What makes ___ think you should come here?  What does ____want you to be doing differently? Is this something you want? (Goal frame)
If yes, proceed as with a voluntary client.
If no, ask: Is there something you would like out of coming here? (Goal frame)

If yes, proceed as with a voluntary client.
If no, explore the consequences of not coming to sessions.

Source: Walter, J. L., and Peller, J. E. (1992). Becoming solution-focused in brief therapy, 247. New York: Routledge.

Utilization strategy

It involves the therapist learning from the outset as many of the specific strengths and resources the client possesses.
Asking questions that will evoke positive data.

e.g. Work history in a particularly interesting or difficult job • Interesting profession • Challenging work experiences • Hobbies • Talents • Interests • Sense of humor • Desire for change • Positive attitudes • Use of language • Beliefs • Intentions • Narrative abilities • General experiences

Conversational Questions

Conversational questions maintain effectiveness not only because of the engaging attitude of the therapist, but also because of the quality and substance of well-chosen questions. Clients might be asked about what kinds of questions they felt the therapist should have or could have previously asked in the session (but didn’t); or about what kinds of things prior therapists did that could have been done differently or better; or what they did that was totally useless and ineffectual. In all, this strategy constitutes an elemental therapeutic process of entering and expanding the areas of the unsaid or the not-yet-said (Anderson & Goolishian, 1988, p. 381).

“You have seen many therapists. What do you suppose they overlooked or missed with you?”
If I were to work with another family just like you, what advice would you give me to help that family out?
Who had the idea in the family to go for therapy?
If there were one question you were hoping I would ask, what would that be?
If there were one issue in this family that has not been talked about yet, what would that be?
Who in the family will have the most difficult time taking about this issue? (Selekman,
Who probably had the most difficult time coming here today?
What is one major thing holding everyone back?
What is one major reason for not talking together as a family?
What are some things I should be asking about you?
If you’ve been to other therapists, what are some of the things you didn’t like about the questions they asked or how they asked the questions?
What do you think are some needs that we should discuss first, before moving forward?
What did you like or dislike about your prior therapists?
What people in the family could change things if they had the power?
What people do you trust the most? Why is that so?
What is one small thing that could be changed to help get us started today?

 Dyadic questioning and triadic questioning#

The client’s voicing of what others might believe and what others might be saying or thinking paradoxically allows the therapist access into the client’s world.

Scaling questions and percentage questions

“On a scale from one to ten, how painful was it for you to come here at the beginning of this session? Ten being no pain, and one being very painful.”

“If the number one stands for a low level of confidence to lose five pounds and ten stands for a high level of confidence to lose five pounds, what was your level of confidence at the beginning of this session?”
“What would it take to bring your level of confidence up to a four? What needs to happen?”
Percentage questions are slightly different…

Normalization

Therapist use of statements to imply client problems not necessarily viewed “as pathological manifestations but as ordinary difficulties of life”
(O’Hanlon & Weiner-Davis, 1989, p. 93).

The goal of this strategy is to pre-emptively depathologize client problems and the client’s view of the problems.

The normalization statement also contains the counselor’s implicit acceptance of the client.

Deframing

Deframing is defined as a strategy that introduces uncertainty into the client’s present and past view of things which have not been shown to be useful (O’Hanlon & Beadle, 1997 p. 35).
Deframing is achieved by calling into doubt the client’s beliefs or belief system.

Examples of Deframing Questions:

How do you know that to be so? What makes you say that? How is that so? Where did you get that idea? On what basis have you reached that conclusion? What do you think is the origin of that belief? What is the foundation on which you rest your case? Did you ever have any doubts about those thoughts? Are you sure that’s accurate? What makes you so sure? What are the benefits in believing that? What influenced you to think along those lines? Why would you want to stick with that belief?

Positive connotation

whereby the therapist—after examining the family interactional patterns—ascribes worthy motives and noble intentions to what otherwise might be considered only symptomatic behavior

Coping questions

With families that . . . do not respond well . . . I shift gears and mirror their pessimistic stance by asking them:

“How come things aren’t worse?”;

“What are you and others doing to keep this situation from getting worse?”

Once the parents respond with some specific exceptions, I shift gears again and amplify these problem-solving strategies and ask:

“How did you come up with that idea!?”;

“How did you do that!?”; “What will you have to continue to do to get that to happen more often?” (Selekman, 1993, pp. 65–66)

“I’m just very curious as to how come things haven’t gotten any worse?”

“So what else is there that has prevented things from getting any worse?”
“So, it seems like something positive has already begun. How did you get that to happen?”

“So what other changes do you think you might have started and not have realized until our conversation today?”

 Pessimistic questions

In effect, the therapist’s act of joining clients in their worsening situation helps to create a reverse psychology scenario where the therapist—now being one of them, so to speak—is suggesting pre-emptively a kind of hopelessness that, ironically, the client might best handle with some kind of positive activity.
Often this line of questioning will enable family members to generate some useful problemsolving and coping strategies to better manage their difficult situation. Typical examples of pessimistic questions are as follows:

“What do you think will happen if things don’t get better?”;

“And then what?”; “Who will suffer the most?”;

“Who will feel the worst?”; “What do you suppose is the smallest thing you could do that might make a slight difference?”; “And what could other family members do?”; “How could you get that to happen a little bit now?” (Selekman, 1993, p. 72)

Problem tracking

involves tracing past behavioral transactions for the express purpose of noting problem-interaction sequences;
use this when strategies don’t seem to be working effectively…

“If you were to show me a videotape of how things look when your brother comes home drunk, who confronts him first [asking a sibling of the identified client], your mother or your father?”;
“After your mother confronts him, what does your brother do?”; “How does your brother respond?”; “Then what happens?”; “What happens after that?” Ideally the brief therapist will secure a detailed picture from the family members regarding the specific family patterns that have maintained the presenting problem. (Selekman, 1993, pp. 76–77)

Therapists may also employ other prominent strategies such as those listed below.
• Exception-oriented questions
• Miracle question sequence
• Problem dissolution.

Problem dissolution

Integrative therapists O’Hanlon and WeinerDavis begin

“with the assumption that it is possible to negotiate a therapeutic reality that dissolves the idea that there is a ‘problem’ ”

(1989, p. 57).
This involves introducing uncertainties that challenge the client’s dysfunctional beliefs and past dysfunctional behaviors, and debunks and demystifies them.
problem tracking (leading to)
—> exception orientated questions
—> miracle questions
—> problem dissolution

Exception-oriented questions
————————

There are always times when the identified problem is less severe or absent for clients. The counselor seeks to encourage the client to identify these occurrences and maximize their frequency. What happened that was different? What did you do that was different?
wikipedia

The miracle question

The miracle question or “problem is gone” question is a method of questioning that a coach, therapist, can utilize to invite the client to envision and describe in detail how the future will be different when the problem is no longer present.
“If you woke up tomorrow, and a miracle happened so that you no longer easily lost your temper, what would you see differently?” “What would the first signs be that the miracle occurred?”

Use of silence

The pause serves to give the client time and psychological space to think especially if the therapist’s question involves something painful
“So far we’ve spent about 15 minutes together, and you’ve said very little. We’ve already discussed the consequences of your not coming to future sessions. Your parents may decide to take action that may not please you. I’ll remain silent for a while, and whenever you feel like saying something to get things moving along, I’ll welcome your remarks.”

Source

Interviewing and Brief Therapy Strategies: An Integrative Approach

George Carpetto ISBN-13: 9780205490783

Chapter 7: Excerpt http://www.pearsonhighered.com/samplechapter/0205490786.pdf

Kabat-Zinn Quote on Responsibility of Parents

This is a excerpt from an article, Can attachment theory explain our relationships?

Kabat-Zinn: The meaning of being a parent is that you take responsibility for your child’s life until they can take responsibility for their own life. That’s it!

Me: That’s a lot.

Kabat-Zinn: True, and it doesn’t mean you can’t get help. Turns out how you are as a parent makes a huge difference in the neural development of your child for the first four or five years.

Me: That is so frightening.

Kabat-Zinn: All that’s required, though, is connection. That’s all.

Me: But I want to be separate from my child; I don’t want to be connected all the time.

Kabat-Zinn: I see. Well, everything has consequences. How old is your child?

Me: Four and a half.

Kabat-Zinn: Well, I gotta say, I have very strong feelings about that kind of thing. She didn’t ask to be born.