Click here to contact Elizabeth and/or see her GoodTherapy.org Profile

Communication is central to a healthy marriage.  Communication was ranked as the number one problem among couples in therapy (Hecker &Wetchler, 2003). There are several obstacles that can contribute to poor communication between couples. Research findings with regard to communication between couples tends to focus on distressed versus non-distressed couples.  Research findings also stress and focus on the importance of positive communication between couples. The main goal of cognitive behavior therapy is to increase the desired behavior or cognition and decrease the undesirable cognitions and behaviors. There are basically three main phases of goals to help the therapist facilitate communication between couples which include; early-phase, middle-phase, and late-phase. During the early-phase the therapist assesses each partner and gains information about how the couple interacts and communicates. Complimenting and highlighting the couple’s effective communication begins the process of shaping. The therapist could ask the couple to define the problem behavior, as well as determine if there are any unacceptable forms of communication between the partners. Next, during the middle-phase the therapist should focus on decreasing inappropriate communication and increasing suitable communication between the couple. Implementing cognitive behavior psycho-education allows the couple to gain knowledge and information about communication skills and techniques. The late-phase goal of therapy is when the therapist draws attention to the eradication of the conflicting communication styles and patterns and investigates problem-solving competence. Cognitive behavior therapy uses thought patterns to change moods and behaviors. With cognitive-behavior therapy, the therapist should be aware that nonverbal communication is just as important as verbal communication with regards to communication. Self-report scales as well as several different techniques, activities, and homework assignments may be utilized to assess communication problems in a couple’s relationship. Furthermore, in facilitating communication between couples the therapist should demonstrate the importance of using “I” messages. Multicultural issues intermingled with a lack of communication can add a heavy burden on couples. Effective communication is facilitated by a healthy relationship built on mutual respect. Couples from diverse backgrounds are usually faced with greater communication obstacles.

Manual: Facilitating Communication between Couples With Cognitive Behavior Therapy

Introduction

Communication is central to a healthy marriage.  It is the main source of tranquility, love, and the continuity of a relationship. The absence of communication builds up to conflict, which could possibly end the relationship at hand.  Communication was ranked as the number one problems among couples in therapy (Hecker &Wetchler, 2003).  Communication is something we all know is necessary to keep any relationship strong and loving, and although we are aware of the importance of communication, we still seem to be clueless about what exactly good communication really is. This does not mean you are clueless as a person.  It means that more attention is required on your part, so that you can become more open and invite the many forms of communication that exist.  Hence, you will be able to understand yourself and your partner more adequately.

There is nothing that keeps a relationship healthy better than understanding.  Once you start becoming more familiar with your communicating styles, as well as your partners, you will be able to work better as a team in making the best of your relationship.  Effective communication cannot happen on its own or with the efforts of only one person. Both you and your partner have to be open and willing to work as a team on improving the way you communicate, so that you both can enhance your relationship skills and build a relationship where you both will have an understanding of who you are as individuals and what you both need and want. Just remember to stay real with yourself and avoid painting a foggy and falsified picture- so that you will never be caught off guard with nay-painful surprises or stressful misunderstandings (Ruigrok, 2005).

Couples are often adept at dealing with people outside the relationship, but few people enter an intimate relationship with the basic understandings or the technical skills that make a relationship blossom.  They frequently lack the know how to make joint decisions, to decipher their partners communication.  Because of the strength of feelings and expectations, the deep dependency, and the crucial, often arbitrary symbolic meanings that they attach to each other’s actions, partners are prone to misinterpret each other’s actions (Hecker & Wetchler, 2003).

Communication problems are one of the most damaging problems that a relationship can face.  Many couples often feel that their partner should know what they are thinking, but do not communicate their thoughts and wants to them.  Open communication sounds good, but in reality it is very difficult. The reason for this is that we do not want to be open, especially in the beginning of a relationship. Consciously or unconsciously, many people think that if we are real, other people are not going to like us.

Presenting Problems in Communication between Couples

There are several obstacles that can contribute to poor communication between couples.  Examples include, but are not limited to:

Contempt: insults or put-downs

One or more partners fails to listen to each other

Criticism: attacking or blaming the other partner

Men and women have different expectations for intimacy independence

Cross-complaining: spouses do not acknowledge each other’s concerns and desires

Fault-finding/Blaming the other partner

Defensiveness: warding off a perceived attack from a partner

Problem escalation: one spouse’s statement of a problem is followed by a negative response from the partner

Lack of clarity when sending/receiving messages while communicating

Debating the truth

Poor logic in a spouse’s statements

Stalemates: each person takes an unyielding position regarding the solution to the problem

Frequent topic shifts

Interruptions

Over-generalized statements: broad conclusions based on limited # of incidents

Dichotomous thinking: all or nothing thinking

Inconsistencies between verbal and nonverbal communication channels

Sidetracking: shifting from one topic to another

Vague statements that do not specify particular behaviors and emotions

Passive aggressiveness to coerce a partner

Selective abstraction: focusing one’s attention on only some aspects of a situation

Personalization: a partner concludes that events are related to them, when this is not the case

Magnification & Minimization: exaggerating or minimizing the significance of an event

Stonewalling/withdrawing

*Source: (Baucom & Epstein, 1990)

Differing communication styles between men and women can also serve as an obstacle to healthy communication.  Examples of male and female communication styles include: (1) men talk to give information or report, while women talk to collect information or gain rapport, (2) men focus on facts, reason, and logic, while women focus on feelings, senses, and meaning, and (3) men thrive on competing and achieving, while women thrive on harmony and relating (Simon & Pederson, 2005).  Cognitive behavior therapy is a theoretical approach that can be utilized to counteract the presenting problems mentioned earlier, as well as teach couples the skills necessary to identify and modify dysfunctional cognitions or behaviors in the future (Baucom & Epstein, 1990).  

Review of Literature

Research findings with regard to communication between couples tends to focus on distressed versus non-distressed couples.  For example, Baucom and Epstein (1990) note that, “distressed couples exhibit more negative nonverbal communication such as criticism and put-downs, and fewer forms of positive communication, such as acknowledgment, than non-distressed couples” (p. 39).  Research findings also stress and focus on the importance of positive communication between couples.  Epstein and Baucom (2002) point out that, “although the findings are not totally consistent, several studies have demonstrated that happy couples exhibit a higher rate of positive communication than distressed couples when the partners are having a conversation with each other” (p. 29).  These findings are significant because in cognitive-behavioral therapy, the therapist attempts to assess how distressed couples are while they interact with one another, so that the therapist can alter negative behaviors that may be maintaining the poor communication between the couple.  Researchers also study the way that couples send and receive each other’s messages when communicating, which is also referred to as encoding and decoding.  Baucom and Epstein (1990) state that, “research findings regarding the encoding and decoding of marital communication indicate that when attempting to understand a couple’s misunderstandings, it is important to investigate the degree to which it is a problem of unclear expressiveness by one party, or ineffective listening by the other party” (p.34).  Encoding and decoding between couples is important to cognitive-behavioral therapists because they assess the specificity and clarity of these actions while the couple is interacting with one another.  Then the therapist can help the couple alter the manner in which they send and receive each others messages.  As a result, partners will be more understanding of one another.

Goals and objectives of Cognitive Behavior Therapy

The main goal of cognitive behavior therapy is to increase the desired behavior or cognition and decrease the undesirable cognitions and behaviors. Another goal of cognitive behavioral couples therapy intervention techniques involves the use of cognitive restructuring. Restructuring is a process of evaluating cognitions and determining the accuracy of the cognition and changing those that are inaccurate or unrealistic. Attributions, assumptions, expectations, and standards that are unrealistic are worked on together by the therapist and partners to produce complementary explanations that are more accurate.  Hence, partners can direct more positive feelings towards one another.

There are basically three main phases of goals to help the therapist facilitate communication between couples which include; early-phase, middle-phase, and late-phase.

First, the early-phase goal is for the therapist to establish the therapeutic relationship with the couple by showing respect. The therapist can accomplish this task by modeling appropriate communication skills and positively reinforcing open progressive communication and interaction between the couple both during the session and out of the session. The therapist assesses each partner and gains information about how the couple interacts and communicates. The therapist should also be aware of any unresolved issues that may be contributing to the miscommunication. Complimenting and highlighting the couple’s effective communication begins the process of shaping. Shaping is a technique used by therapists that is based on operant conditioning and implies dividing the behavior into subsections, then rewards and punishments are implemented to produce the desired behavior. The therapist could ask the couple to define the problem behavior, as well as determine if there is any unacceptable communication between the partners.  The therapist may also ask the couple what their views of proficient communication mean to each of them. Homework consisting of charting inappropriate communication could be given to the couple. The use of functional analysis can be used to examine past experiences of communication patterns. Furthermore, a therapeutic contract should be developed during this phase to specify goals and objectives.

Next, during the middle-phase the therapist should focus on decreasing inappropriate communication and increasing suitable communication between the couple. There are several ways that communication can be facilitated during this phase. Implementing cognitive behavior psycho-education allows the couple to gain knowledge and information about communication skills and techniques. Two more major techniques that can be implemented in this phase are problem solving skills and communication enrichment. Challenging irrational beliefs facilitates the exploration of the couple’s inability to communicate. In addition, it is beneficial to investigate pessimistic assumptions and attributions that sustain the lack of communication among partners. It is also imperative that the therapist and couple discuss contracts and charts to observe changes or any need for renegotiation. The couple and the therapist must negotiate how the partners will treat each other and how they will communicate needs, wants, thoughts, and feelings. The therapist should recognize explicit constructive and unconstructive reinforcements for productive communication and let the couple know that it is crucial to maintain consistent reinforcement. The token system may be initiated. The token system is a technique that the therapist and partners develop. An inventory of preferred behaviors is listed with points associated with each item. The partners may earn points or have points deducted depending on the behaviors being displayed. When the points have accrued the couple may trade points for a variety of rewards. Time outs have been a popular disciplinary tool for parents to use with their children but time outs can be a useful instrument to help partners control situations that may escalate into an argument. It is a good idea for the therapist and couple to develop a plan for when the couple feels as though the situation is getting out-of-hand, it may be beneficial to take a time out so ensure that words or behaviors are not inappropriately exchanged.

Finally, the late-phase goal of therapy may be implemented which is when the therapist draws attention to the eradication of the conflicting communication styles and patterns and investigates problem-solving competence. In this phase the therapist and couple discuss any residual issues that may need to be explored and worked out. They also note any changes that have been made in the relationship, as well as changes in communication. Further psycho-education and communication guidance may be employed. It is important for the therapist to check-in with each partner and assess contracts and limitations to their communication. Any miscommunication that still exists should be worked through while maintaining rewarding patterns of communication. A contract may be put into place regarding how long the couple remains in therapy.  This may depend on the couple’s relationship satisfaction, or how well the couple communicates consistently with one another.  For example, the couple will terminate therapy if they appropriately and consistently communicate with one another for thirty consecutive days.  It is beneficial to renegotiate how the partners will treat each other and how they will communicate needs, wants, thoughts, and feelings. References and other support groups should be made available for the couple to explore. The couple and the therapist should make a list of warning signs of falling back into the same patterns of miscommunication and formulate a plan to deal with these issues. In addition, a list of appropriate and reinforcing behaviors and patterns of communication should be created to help the couple sustain improvements in their relationship.

Theoretical approach and Rationale

The rationale for using cognitive behavior therapy is that when couples experience difficulties in their relationship, especially communication, the problems are likely to include behavioral, cognitive, and affective components.  The assessment of these factors is crucial in preparation for therapeutic interventions with couple’s communication patterns (Baucom & Epstein, 1990).  Hence, cognitive behavior therapy can be utilized if cognitions, behaviors, or emotions are distorted and maintaining a couple’s communication problem.

Cognitive behavior therapy is an approach that originated as a result of the psychodynamic approach (with an added cognitive element). This approach includes behavioral techniques for families, couples, adolescents, children, and sexual dysfunctions. Cognitive behavior therapy uses thought patterns to change moods and behaviors. It is relatively short term. There are several positive aspects of this approach including: being empirically based, goal oriented, practical, active, and collaborative.  Despite these benefits, CBT can not be used for individuals in whom thinking or communicating is severely disturbed. If partners do not complete “homework” and keep accurate records, the therapeutic process can be greatly hindered. In addition, CBT focuses on a client’s present situation and does not attempt to dig up the past which can result in a lack of self compassion.  With cognitive-behavior therapy, the therapist should be aware that nonverbal communication is just as important as verbal communication with regards to communication.

The key theorists for cognitive behavior therapy include:

Albert Bandura

Aaron Beck

Albert Ellis

Joseph Wolpe

Richard Stuart

B.F. Skinner

Norman Epstein

Neil Jacobson

Gerald Jones

Gerald Patterson

Donald Meichenbaum

Arnold Lazarus

*Source: (Hecker & Wetchler, 2003)

Program Activities and Materials

The program activities and materials are based on Marriage enrichment and relationship enhancement philosophies and concepts.

1.Increasing and Identifying Rewarding Communication:

•One should reward their partner even if he or she is not showing rewarding communication and behavior in return. It may take a little while for one another to teach each other positive communication because the present communication and behavior has been used. It is important to follow the rule of reciprocity; if you communicate, usually, your spouse will reward you by communicating accordingly. Unfortunately, unrewarding actions are also reciprocated.

•It is important to know what each partner likes and dislikes about the other’s communication style and behavior. The partners are not mind readers and need each other to help teach one another and learn what they find rewarding. Many couples spend a lot of time dwelling on the negative and not enough time articulating what is positive and rewarding.

•Each partner should be very specific about the rewarding communication or behavior that they get pleasure from. For example, if a spouse told her partner that she enjoyed how nice he was to her last week, this taught her partner nothing. If a spouse were to say I really enjoyed how you called me Tuesday night to let me know that you would be home a little late, I really appreciate when you are thoughtful, this would give her partner insight and the ability to repeat the rewarding communication and behavior.

Homework assignment:

A.   List seven rewarding ways that your spouse communicated during the past week.

B.    Throughout the up coming week write down seven specific times your partner communicated and behaved in a rewarding manner. Do not show your spouse until the next therapy session.

C.    List seven specific rewarding things, which do not take up too much time, that you would like your spouse to do during the next week.

1.Taking Responsibility and Rewarding Communication-

·      Both partners in a relationship must take responsibility for change to occur. A general rule is actions that are rewarded will increase and actions that are punished will decrease.

·      Both partners must teach each other specific actions that they like and follow these rules;

A.   Articulate the specific action that pleased you,

B.    Genuinely reward your spouse immediately,

C.    Stay in the here and now.

Activity:

Ask yourself if you have ever heard or said any of these statements;

·      “You never talk about anything with me anymore” (thinking in a way that it is all or nothing).

·      “You told me how you felt today but you usually never tell me about anything” (using the zap method of treatment).

·      “Why can’t you be more open, caring, emotional” (using why as an accusation)?

·      Do you tend to withdraw, mope, or sulk?

Now think about how you would respond to these statements and what the outcome would be.

·      The all or nothing statement will promote feelings that your spouse can do nothing to make a difference so there is no need to try resulting in withdrawal or defensive interactions and behavior.

·      The zap method ends with punishment or accusation regarding the past so the spouse will more than likely remember the negative accusation and not the reward.

·      The “why” statement is the most common statements made by couples in distress and usually the outcome is an argument and then withdrawal. How is your spouse supposed to respond to this question? Withdrawal may decrease the chances of an argument but will annoy the other partner and furthermore, withdrawal does not teach each other what you do enjoy.

1.Build on the Positive-

·      The more the specific behavior is rewarded the better the chance of the behavior to increase. It is up to each partner to let the other know what he or she likes. The purpose of teaching each other what is enjoyable is to improve the relationship and facilitate better communication skills between each other.

Homework:

·      List seven specific times and examples of when you reward your spouse during the upcoming week.

4. Thoughts that are Automatic-

Automatic thoughts are ideas or notions that may or may not be accurate and are usually associated with negative viewpoints. It is beneficial to be aware and challenge automatic thoughts. The following is a list with examples of some automatic thoughts that are common among distraught couples.

Labeling- giving your spouse a name such as “aggressive” and believing that he or she will always be that way and is not capable of changing.

Shoulds- an irrational way of thinking about your relationship and standards that ought to be upheld. For example, “I should not have to ask my spouse to tell me what is on his or her mind”, “I should never be bored or discontented in my relationship”, “why should I have to change”?, “change should just happen and occur quickly”, If my spouse can not get the hint of what I want, than why should I stay in this marriage”?

Fortune-telling- predicting that your spouse will never change which results in telling yourself that you will never be happy.

Perfectionism- comparing your relationship to an impracticable idealistic view of how a relationship should be. For example, “it is not like we just met, we have been together for a while so he should know exactly what I want”.

Mind-reading- perceiving that your spouse is insinuating something with out sufficient evidence. For example, a spouse may think that her husband does not care about her because he did not open the door for her.

Discounting the positive- when a spouse ignores the rewarding behavior or styles of communication by believing that the actions are insignificant because that is what a husband or wife should do. Another illustration of discounting the positive when one believes that his or her success is trivial.

Catastrophic thinking- believing that the argument or issue that occurred means that your marriage is awful and doomed.

Emotional reasoning- you feel a certain way and relate the way you feel with how your marriage is going. For example, “I feel depressed which means that my marriage must be failing”.

Negative filter- when a partner only focuses on the negative and does not see the positive aspects of the relationship.

Externalizing- believing that you have no control over what happens.

Over-generalizing- taking a broad view of the situation and using statements such as “if I fail at me marriage, I will fail at everything”.

Homework:

Write a list each day of the automatic thoughts or comments and notice any patterns.

5. Ground Rules Regarding Having Differences of opinions and Arguing-   

·      Use “time out” if you and you spouse are prone to explosive actions and comments. (It is important to allow for your partner to ask for a time out and receive it without the other partner following Him or her in to the other room).

·      The issue should be solved by both of you and each person should be invited to discuss their opinion and offer ideas to the solution. Possible solutions should be prioritized from most acceptable to not suitable.

·      It is imperative that both partners compromise and come to a mutual agreement. Keep in mind that modifications may be needed if the first arrangement is not sufficient.

·      Stay on the present issue and do not bring up differences from the past or material that is irrelevant.

·      Accept responsibility for the role each person plays in the dilemma.

·      Remember not to label, use the why accusation (why do you always…?), withdrawal, mope, use sarcasm, use a loud tone of voice, or use threats or ultimatums.

·      Consider that rewarding each other for cooperating and compromising may increase more positive correspondence in the future.

6. Empathetically Listening to Your Partner-

Rephrasing is a good way for couples to show that they are truly listening to one another. When having a discussion briefly state the point of the conversation using only about three statements and then ask your partner to rephrase your statements. After your partner rephrases specify what was correct and clear up any misunderstandings. If there were any misunderstandings, explain your point once more and ask your partner to rephrase again. Next, ask for any disagreeing view points. If there are disagreements subsequently rephrase the differential statements. The rephrasing technique can be used to be certain that each partner is being heard clearly and may help decrease the severity of the altercation.

A number of other different techniques and activities may be employed in cognitive-behavioral therapy to help patients uncover and examine their thoughts, as well as change their behaviors.  They Include:

Cognitive rehearsal- The patient imagines a difficult situation and the therapist guides him through the step-by-step process of facing and successfully dealing with it.  The patient then works on practicing, or rehearsing, these steps mentally.  Ideally, when situation arises in real life, the patient will draw on the rehearsed behavior to address it.

Journal- Patients are asked to keep a detailed diary recounting their thoughts, feelings and actions when specific situations arise.  The journal helps to make the patient aware of his or her maladaptive thoughts and to show their consequences on behavior.  In late stages of therapy, it may serve to demonstrate and reinforce positive behaviors. 

Modeling- The therapist and patient engage in role-playing exercises in which the therapist acts out appropriate behaviors or responses to situations.

Conditioning- The therapist uses reinforcement to encourage a particular behavior.  For example, a child with ADHD gets a gold star every time he stays focused on tasks and accomplishes certain daily chores.  The gold star reinforces and increases the desired behavior by identifying it with something positive.  Reinforcement can also be used to extinguish unwanted behaviors by imposing negative consequences.

Systematic Desensitization- Patients imagine a situation they fear, while the therapist employs techniques to help the patient relax, helping the person cope with their fear reaction and eventually eliminate the anxiety altogether.  The imagery of the anxiety producing situations gets progressively more intense until, eventually, the therapist and patient approach the anxiety causing situation in real life.  Exposure may be increases to the point of “flooding”, providing maximum exposure to the real situation.  By repeatedly pairing a desired response (relaxation) with a fear producing situation, the patient gradually becomes desensitized to the old response of fear and learns to react with feelings of relaxation.

Validity testing- Patients are asked to test the validity of the automatic thoughts and schemas they encounter.  The therapist may ask the patient to defend or produce evidence that schema is true.  If the patient is unable to meet the challenge, the faulty nature of the schema is exposed.  

Self-report scales- May be utilized to assess communication problems in the couple’s relationship.  Some examples include: the Marital Communication Inventory, the Primary Communication Inventory, the self-report form of the Verbal Problems Checklist, and the Problem-Solving Communication and Affective Communication scales from the Marital Satisfaction Inventory (Baucom & Epstein, 1990).  These inventories are effective tools for gathering information about the couple’s patterns of communication, and they help with determining what areas the couple needs to work on during the treatment process.

“I” Messages- In facilitating communication between couples the therapist should demonstrate the importance of using “I” messages. “I” type messages place focus on the speaker’s feelings with regard to their partner’s behavior. By using “I” statements the listeners can gain a better understanding of the effects their actions have on their partner.  The therapist should understand what type of communicator each client is. Expressive communicators tend to share emotions and feelings. These individuals usually need responsive feedback. Problem-solving communicators may seldom talk about their feelings. These types of communicators may place facts in place of their feelings when giving a statement (Baucom & Epstein, 1990).

Diversity Issues

Diversity issues can sometimes create severe conflict within a relationship.  Couples who are combated with diversity and communication issues are dealt a dueling dilemma when trying to coexist in harmony.  Gender differences are the first issue couples must deal with. Men and women can be on opposite ends of the communication spectrum. Communication between members of the opposite sex can be difficult when neither party understands the issues being brought forth by each other. When gender roles (with regard to responsibility) are strongly defined within a relationship, a couple’s communication may suffer. When gender issues are combated with communication issues, the role of the therapist becomes more difficult. The therapist must be sensitive to both sides and respect the argument given by both parties involved.

Multicultural issues intermingled with a lack of communication can add a heavy burden on couples. Effective communication is facilitated by a healthy relationship built on mutual respect. It is imperative that couples understand each others culture, beliefs, and values. Multicultural frameworks are important in therapy. With the U.S. being a collection of diverse individuals, effective couples therapy is of grave importance (Hecker & Wetchler, 42). Couples from diverse backgrounds are usually faced with greater communication obstacles. Learning and understanding the cultural norms of a partner is important. Not being culturally aware can cause a breakdown in communication. Some groups, such as Native Americans feel that problems should be dealt with on a personal level. If in a relationship with an individual of strong Western ideology, communication can become compromised. Hanna & Brown (1995) present questions for assessing racial and cultural factors in therapy:

How does your racial/cultural/religious heritage make your family different from other families you know?

Compared to other families in your cultural group, how is your family different?

What are the values your family identifies as being important parts of your heritage?

At this particular time in you family’s development, are there issues related to your cultural heritage that are being questioned by anyone?

What might an outsider not understand about your racial/cultural/religious background? (Hecker & Wetchler, 429)

Not only could the answers to these questions aid in facilitating communication between a diverse couple but it could also aid the therapist in gaining an understanding of that culture. Exploration into the importance of culture can assist in understanding and overcoming communication obstacles (Hecker & Wetchler).

Program Evaluation

Assess diagnostic workup of patients at the start of therapy placing emphasis on problems, needs, and issues brought to the table.

Review treatment plans including the goals and the couples needs for therapy.  Assess their level of communication, anxiety and stress from the start of therapy.

After reviewing information and history from the beginning of therapy, therapists can evaluate the progress made by clients by means of discussing with clients the progress they have made, observation of new and beneficial communication skills, charting/journaling, evaluation of goals met and satisfaction of relationship between the couple. 

Assess if the desired behavior or cognition has been increased and the undesirable cognitions and behaviors have been decreased or eliminated.

Measure whether restructuring has taken place-determining the accuracy of a cognition and changing those that are inaccurate or unrealistic

References

Baucom, D. H., & Epstein, N. B. (1990). Cognitive–Behavioral Marital Therapy.  New York: Brunner/Mazel.

Becvar, D. S., & Becvar, R. J. (2003).  Family Therapy: A System Integration fifth edition.

Brown, J., & Brown, C.  (2002).  Marital therapy:  concepts and skills for effective practice.

California: Brooks/Cole. 

Bauserman, R. (2002). The Journal of Family Psychology 2002, Vol. 16, NO. 1, 91-102.           

Corey, G.  (2001).  Theories and Practice of Counseling and Psychotherapy (6th ed). Wadsworth.

Corey, G., Corey, M., & Callahan, P.  (2003). Issues & Ethics in the Helping Professions(6th ed).  Brooks/Cole- Thompson Learning.

Corliss, R. and Steptoe, S. (2004, January 19). The Marriage Savers. Time, 88-96.

Dattilio, M. F. (2001).  Cognitive-Behavior Family Therapy:  contemporary myths and misconceptions.  Contemporary Family Therapy, (23), 1.

Doss, B. D., Thum, Y. M., Atkins, D. C., Sevier, M., & Christensen, A. (2005). Improving

relationships: mechanisms of change in couple therapy. American Psychological Association, 73(4), 624-633.

Epstein, N. B., & Baucom, D. H.  (2002).  Enhanced Cognitive-Behavioral Therapy for Couples. Washington, DC: American Psychological Association.  

Gehart, D. R., & Tuttle, A. R.  (2003).  Theory based treatment planning for marriage and family therapists: integrating theory and practice. Brooks/Cole.

Hecker, L. L., Wetchler, J. L., (2003).  An introduction to marriage and family therapy.  New York:  The Haworth Clinical Practice Press.

Hunt, R.A., Hof, L. and DeMaria, R. (1998). Marriage Enrichment; Preparing, Mentoring, and  Outreach. PA: Brunner/Mazel.

Simon, V., & Pederson, H.  (2005, March).  Communication with men at work: bridging the gap with male coworkers and employees. Retrieved February 18, 2006, from

http://www.itstime.com/mar2005.htm

©Copyright 2008 by Elizabeth Mahaney, M.A., MHC, MFT All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Elizabeth and/or see her GoodTherapy.org Profile

Despite the common misconception among many single people, marriage is not easy. It takes a lot of work because life takes a lot of work. Life can be difficult and complicated enough for a single person, so when another person is involved it can become more complicated. Money is one of the many reasons that a marriage can break up, especially if times of financial distress has continued over a lengthy period of time. In fact, financial stress appears to be the cause of about 80 percent of all divorces. This goes to show just how stressful financial trouble can be for a couple who are both affected by it.

The vows taken today are often recited more because they are what couples are supposed to recite when going through the process of getting married. Very few actually take the time to review the vows and take their meaning to heart. This is why many difficulties that arise at a later time may be enough for the husband, wife or both to call it quits and to start living their separate lives. Money is what allows people to get their necessities, so a lack of money to the point of poverty and the inability to acquire the necessities and comforts of life can often make a married couple stressed and very unhappy with each other. Of course, it is not just simply the lack of money, it is how there came to be the lack of money. There are couples where one or both of them will spend more than they are earning each month. Poor management of the income is often the biggest reason for the financial trouble a couple is experiencing.

As is the case for any couple who are suffering overwhelming stress that is making the couple seriously think about divorce, contacting a family therapist or a couple’s counselor might not be a bad idea. The therapist or counselor can talk with the couple and help them work out what exactly is causing their want for separation. If it appears that financial stress is possibly the biggest reason, the counselor or therapist can put the couple in touch with someone who can help them right their troubles. Then, the couple’s therapist can speak with the couple and help them reconcile and maybe even calm the couple down enough to think more clearly about what a divorce would really mean for them and any children that are involved.

Divorce is not something that should never be entered into lightly. It means an end to that relationship and the breakup of a family, which can be greatly traumatizing to the children of that marriage. When a couple believe that the only way out of their troubles is to get a divorce, consulting a marriage therapist to get some impartial advice might help save the marriage as well as find a way to deal with the issues causing the stress. If divorce is still what the parents choose to do, then family counseling for both the parents and the children might be a good idea so that everyone can get through the divorce without unnecessary stress.

©Copyright 2008 by Jennifer B Baxt, LMFT, LMHC All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Stefanie and/or see her GoodTherapy.org Profile

When it comes to the holidays are you thinking “I’ll just be glad when it’s all over with”? You’re not alone. Many people believe that we’ve gotten away from the true meaning of the season, with consumerism and unrealistic expectations taking all the fun out of things. But that’s not at all why you’re dreading the holidays this year, is it? Have the holidays become “hollow days” because you don’t have children yet?

The holiday season means different things to us over the years. As a child it is a time of wonder and excitement. Everything seems to have a special sparkle about it. As a college student it is that welcome break that follows all night study sessions, term papers and final exams. Oh yeah, and a time to eat mom’s home cooking. It is a time of spiritual preparation and reflection and a time to realign priorities. And as adults we get the opportunity to rediscover magic through our children. But, when you long to be a parent, the holidays can become a painful reminder of what’s missing in your life. Holiday traditions can seem hollow and empty without a child to share them with.

It’s no wonder those struggling to build a family find themselves feeling increasingly stressed and sad as the holidays approach. Here are some tips to help you get through the next month and maybe even experience some joy along the way.

* Bow out with…with a plan: You certainly don’t have to go to every party or gathering you’re invited to, especially if seeing pregnant friends or new babies leave you bawling in the bathroom instead of enjoying the party. It may be helpful to plan something else special for that evening so you won’t be focused on what you’re missing.
* Keep it brief: If you decide to attend an event, have a plan to hit the road early if you find yourself becoming upset.
* Give it a rest: Take a vacation from the holidays this year. And while you’re at it, how about a vacation from infertility? Get away to one of your favorite spots and spend some quality time with your honey.
* Breathe: It’s amazing how often we stop breathing when we become stressed. Make it a habit to be aware of your breath. Take several deep, cleansing breaths throughout the day. These mini-energizers can be real lifesavers.
* Move:Exercise is a fabulous stress reducer and can even help you sleep better at night. Here’s some ideas: take your dog for a brisk walk for 20 minutes a day, use that gym membership you keep threatening to cancel, call your best friend to go for a bike ride, take the stairs, go bowling… oh, and don’ t you have inline skates somewhere in your garage?
* Tickle your funny bone: How long has it been since you’ve had a good belly laugh? Look for opportunities to experience joy. Rent one of your all time favorite funny movies or make plans to go with some friends to a comedy club. Talk about stress reduction… there’s nothing like a good laugh.
* Have vs. have nots: Start and end each and every day by focusing on all the wonderful things that are going well in your life. Fertility problems can totally eclipse your life and get you thinking about all that’s missing, wrong or unfair. It’s important to lend our energy to what’s going right in your life.
* Bend an Ear: Talk with your partner, a trusted friend or family member about what you’re feeling. Be prepared to ask for the type of support you find most helpful, as those closest to you may not know how best to help. And don’t be afraid to reach out for professional guidance and support when you need to. We all need a helping hand from time to time.

©Copyright 2008 by Stefanie Luna, LMFT All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Stefanie and/or see her GoodTherapy.org Profile

Click here to contact Noah and/or see his GoodTherapy.org Profile

Being highly effective in a relationship requires certain qualities in a person.

Scripture instructs, as in 1 Peter 4:8 to “love each other deeply, because love covers over a multitude of sins”. The Bible is replete with descriptions and lessons of love but, why do people continue to fail?

Dr. Norman Vincent Peale once said that relationships fail because of “selfishness” and “immaturity”, explaining why so many marriages end in divorce.

Couples tend to marry young, and before they have a chance to know themselves and to learn many of life’s lessons about self-esteem, love and relationships.

Over a twenty-seven year period of therapeutic work with individuals and couples, watching some fail and others succeed, a factor analysis was calculated, attempting to understand what were the characteristics and behaviors, or “habits” of people who were highly effective in their relationships.

These habits are learned patterns of behaviors from parents, or primary care givers, as children grow up. Most individuals perform an unconscious “re-enactment” of what is observed from others to replicate them as adults in their current relationships.

There are four basic habits a person must demonstrate to be successful in relationships.

The first habit is Generosity.

Generous individuals learn and demonstrate kindness, consideration, thoughtfulness, and courtesy for others. They also know love as an attitude, thinking about the welfare of others as Christ taught us in Matthews 19:19 “to love your neighbor as yourself”. Love is also a behavior; it is what we do.

Generous people understand that love requires making sacrifices for others. The greatest example of this is indicated in John 3:16, when God sacrificed His son, so that we may know eternal life.

Those who possess the habit of generosity also know how to forgive. They understand that to let go of hatred, resentment and anger is to be free from evil.

The second habit is Maturity.

As individuals develop over time, they acquire greater maturity when they learn to be self-aware. Lacking this characteristic prevents a person from knowing how they are affecting others.

Self-discipline is another component of maturity. An adult should be able to meet the demands of reality in order to function at his or her highest level, as well as to meet the expectations of those who depend on them.

In a healthy relationship, a mature person will also will take responsibility for their own actions. The initial response a person makes in any given situation is to ask themselves “what did I do to contribute to this problem?”.

Mature people are patient people. They understand that the ability to suffer delayed gratification is to know the true purpose of time, and that is, so that every thing does not have to happen all at once.

The third habit is Trust.

Having faith in others and being trustworthy is an essential element of a healthy relationship.

A person should not only trust themselves but be discerning in knowing how to trust others. Most importantly, having faith in God allows us to be comfortable living in this world. Psalms 28:7-8 suggests that trusting in the Lord brings peace to the heart.

Trust not only requires communicating, but it requires a specific type of communication. It should be regular in frequency, effective in its clarity and conciseness, as well as honest. Do not leave out information another person would want to know and do not bear false witness.

Additionally, trust necessitates reliability. People need to know they can depend on you. Be consistent. Do what you say you’re going to do and be where you say you’re going to be.

The fourth habit is Empathy.

There are two types of empathy. Cognitive empathy allows you to visualize what someone is saying or experiencing, and leads to a greater understanding of another person. Emotional empathy allows you to feel what someone is feeling.

What occurs in a relationship should be guided by understanding and feeling what others experience, helping you to connect in such a way that you would not hurt the other person.

The key to being highly effective in relationships is to develop healthy habits of being generous and mature in your approach to others as well as being trusting and trustworthy. Your connection with others will be stronger by being able to empathize with another person’s feelings and understanding their point of view.

When these habits are formed, and they consistently become a part of your character, you will, without a doubt, be highly effective in all your relationships whether at home, work, or in your church.

Dr. Kersey is a licensed psychologist and has been practicing in Indiana since 1987. You may email him at DocNoah7@aol.com or visit his website at www.LifeCareCounselingServices.com

©Copyright 2008 by Dr. Noah H. Kersey, Ph.D. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Noah and/or see his GoodTherapy.org Profile

Click here to contact Astar and/or see his GoodTherapy.org Profile

What is The Voice of Light Treatment?
The treatment is based on the utilization of the therapist and the patient’s vocal energies in order to disperse energy blockages, release painful and aching body parts and fill them with energy.
The therapist uses the different frequencies of his voice in order to create energetic fluctuation inside the body so that the body can take care of itself.

The Vocal frequencies are being passed through a special cone made of wood, which is called a “Kondola”.

Each and every body part has it’s own sound or frequency and by giving it the proper attention, the healer can identify the right frequency for any specific organ.

The sound waves, which are penetrating the aching body parts, scatter the tension and cause an immediate relief and ease of pain.

We ourselves are energy; Everything around us is energy.
The vocal treatment is meant to create freedom in your body and consciousness thus promoting the healing process.

During the treatment, the person becomes relaxed and then a connection with the natural force and healing powers is made possible.

The treatment is not of an invasive nature and does not hurt.
The sound waves enter deep into the body and echo through the parts in need of stabilization and strengthening.

This balancing treatment is highly recommended for Self Awareness, Mental development and releasing pains such as: Back aches, Neck, Joints, Stomach, Menstrual aches, Stress, Emotional pains.

©Copyright 2008 by Astar Shamir. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Astar and/or see his GoodTherapy.org Profile

Pittsburgh Therapy

If you are a counselor who finds that “nothing works”
to manage some students, this article may help. It’s also
the perfect article to pass to teachers and parents to help
them better grasp the key ideas behind a diagnosis of ODD,
Oppositional Defiant Disorder.

This article is just the start. Be aware that this
primer gives you just part of what you will
need to know to maintain control and best assist
ODD-challenged youngsters.

WHAT DOES “OPPOSITIONAL-DEFIANT” MEAN?
“Oppositional-Defiant” is a mental health diagnosis that
describes kids that have consciences but sometimes act
like they don’t. This diagnosis can only be applied by
a mental health professional but will be very important
for any youth worker to know and understand. This
diagnosis is far more hopeful than “conduct disorder,”
which means the child lacks a conscience and a real
capacity for relationships. While the oppositional-
defiant child (ODD) may also appear to have little
conscience or relationship capacity, you may be able to
improve that with the right approach and methods. With
conduct disordered youth, such improvement may not
be possible.

** WHAT DOES “OPPOSITIONAL-DEFIANCE” LOOK LIKE?
Oppositional-defiant kids are often some of your most
misbehaved students. They may disrupt your class,
hurt others, defy authority and engage in illegal
or problematic conduct. Though they may look similar
to conduct disorders, their bad behavior is usually
less severe, less frequent, and of shorter duration.
The ODD label is often inaccurately applied as this
dynamic can be a difficult concept to grasp and apply.
Many ADD youth are also ODD, and boys dominate
this category.

**THE 3 AREAS OF HELP FOR ODD YOUTH
The thrust of helping the ODD child must focus on
1) Skill building, plus 2)”Pulling up” that
conscience and 3)Improving their relationship skills.
For skill building, teaching them how to regulate their
anger, actions, peer skills, verbal output, etc. will
be critical. But equally important, this child must
be aided to care about others and to be guided more
by conscience. These are areas we cover extensively in
our live and taped workshops, but here are a few of the
most effective interventions we give especially for ODD
children and teens. These interventions will only focus
on stimulating that conscience or “compensating” for it.
If you want more than the handful of ideas given here,
or, you want to see how to build skills or
relationship capacity, the other two crucial aspects
to concentrate on with ODD kids, then consider coming
to our class or getting some of our books that will
deliver hundreds of the solutions you need.

**STRATEGIES TO STIMULATE THE CONSCIENCE OF ODD KIDS

*** To help “pull up” the child’s conscience, use
this intervention. It can be used pro-actively or
reactively (before or after the child has engaged in
misbehavior.) For example, let’s say the child has
stolen the teacher’s pen, you can say “I want you to
imagine that we’re making a video about your life.
Are you impressed?” That “uncomfortable sensation that
the child may have in reaction to this intervention may
be the conscience stirring.

*** Another intervention to stimulate the conscience:
after the child has engaged in a problem behavior, such
as stealing a pen, as in the example above, ask the
child, “So what’s your integrity worth to you?”

*** To adapt the intervention shown above for young
children, simply rephrase the question to “So what’s
people believing in you, worth to you?” Or, rephrase
it to “So what’s people trusting you, worth to you?”

*** Before a child undertakes a problem behavior, ask
the youth to imagine that s/he will read about that
act on the cover of the local newspaper in the morning.
Ask the child their reaction. If they say that they
wouldn’t want to read about it in the newspaper, the next
morning, then you can say “Then don’t do it!” This
image makes a fast and easy guide for kids to
follow to evaluate whether or not to do questionable
behaviors. This intervention is a good choice to use
with children whose conscience provides little guidance.

Remember: you’ve just gotten a tiny portion of the
information you need on ODD students. Please be sure to
read more, go to a training, or otherwise update your
skills. There is no substitute for getting the tools
you need for your office. Read more details on ODD
and be sure you know about CD (Conduct Disorder)
at our site: http://www.youthchg.com/hottopic.html.

©Copyright 2008 by Ruth Herman Wells. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Phoenix Therapy

As Shakespeare aptly proclaimed eons ago, the world is but a stage, and our lives are compelled to be played out on it. For me, life has become a grand theater of the Self, a fascinating arena for encountering the mystifying fact of our existence, and uncovering our true natures. It is a continually surprising encounter with psyche and the complex of “inner selves” or sub-personalities that comprise it. In short, experiencing life as a stage in the play of my soul’s evolution has given me a viable context in which to meet my destiny.

When I remember to do so. Given “free choice,” you and I can relate to this cosmic-yet-practical self discovery theater context in a number of ways. We can forget about or ignore it altogether, deny its importance or relevance, feign competence or incompetence, or embrace the challenge of being its director, writer or actors more or less as a full-time assignment. With varying results. We may turn in our resignations, time and time again, or enjoy the ride - particularly when the production and we are faring well. But one thing is certain: we cannot escape the play of our lives, nor the effects of how we participate in its unfolding.

The concept of “Theatre of the Self” per se took me by force last summer. It was as though all of the varied ways I have consciously or not-so-consciously explored self discovery intersected at once, creating a blazing point of awareness in my craw. There were all those lyrics and poems and comic and improvised characters from my show business days, revealing facets of my persona. There were a few scripts, and scores of routines and sketches telling stories that reflected my greater Story, and three book manuscripts detailing stages of the plot to gain soulful redemption.

Recontexting from hindsight, I see the plotlines from my life “pre show business.” For example, I recall working for the Wichita Kansas Welfare department fresh out of college, B.A. clutched in my novice hands. There I encountered characters from an unreal, previously invisible world to my own, characters playing out my own pain through their particular struggles. I undertook to assimilate them into my own “reality.”

In the last dozen years of my “post show biz” period, the heroine, me, acquired and amalgamated a tool for exploring consciousness developed by the Jungian analyst married team, Hal and Sidra Stone. I was thrilled with Voice Dialogue and the enormous access it gave me immediately to my inner cast of characters and their plots to run my life. Most of them were running my show behind the scenes of my official awareness. Over the years, developing my skills and creatively weaving into the Stone’s early work other factors (my prolific show business background and penchant for drama, my writing and drawing skills, my love of animating everything from dreams to body parts and ‘conditions,’), my own “character voice dialog” emerged.

Last summer, the Dialog process joined with my fervor for improvisational play and produced a format for teaching, playing, doing theatrical styled “recovery” work and developing “creative I.Q.” - another term I coined to fill a previous void in our language. Just when I thought I saw how the next act was going to look in my career and financial subplots, I got another full on surprise, this time from a Master Trickster: Coyote.

I should explain that a shamanic medicine path called me in 1990, and I reluctantly succombed. Or, to describe it another way, I was Told I would be asked to take on the production, direction, play-writing and acting of my own Show of Life full time, no matter what. And to assist others. Mostly others not necessarily wanting assistance, either - at least not consciously. This was a blow to a woman driven somewhat to be a Star, rather than a shining light. A woman desperately seeking recognition, rather than giving it with heart.

I became a self-styled shaman, a shapeshifter, donning many disguises, playing many roles as I moved closer to defining my Heroine’s role, her quest, her grail, her raison d’etre. Coyote moved in to whisper audibly in my ear last summer that S/He was now a primary script consultant -for the rest of my life. And that I could think of myself as a “shiftshaper” now: someone taking on the role of consciously dedicating herself to a “higher” form of the Calling to assist: by willing to be a lowly, underpaid, under-recognized “teacher and mentor.

-For the time being, and depending upon which of my burgeoning cast of inner selves was at the helm of my actor’s ship. And, far more importantly, to assume the role of humble servant for my own, behind the scenes, not so visible awakening process.

Coyote suggested strongly that I rename my Theater of the Self, “Coyote Players,” since my playshoppery (“Tao of Play” officially) is Trickster turf. What I didn’t know at first was that I would be the one tricked, time and time again, as I tried to create “perfect” workshops. Or relationships. Or wisdom circles. Or housekeeping. Or garden. Or -anything. And that I would find that the best part of everything I undertake comes in through the cracks, the unexpected factors. That blessings, that wisdom, that love -can’t ever be dictated or otherwise controlled…

There has been nothing left to hold onto of my treasured safety mechanisms. Time to accept what philosopher Alan Watts called, “the wisdom of insecurity.” I like best to call it “trust” for the “play of the moment.” Seizing the fullness of the moment in the grand theater of my life, the very play of Life itSelf. Great “medicine,” great challenge for my vascillating consciousness. And the best Role I have ever been offered, ever accepted.

I am left to construct the unfolding, the writing, the directing and performing of my continually evolving story within the Story with as much care and daring as I may. And to be caught off guard, surprised, again and again at the unexpected Blessings contained within the enterprise.

In the Theater of the Self, of my wondrous, your wondrous, our collective wondrousness of Self. All the world’s a stage -and a just a stage of Life and Its mystery. May you accept the task, and enjoy all it has to offer.

Let me know where you are Playing: I want to be there.

©Copyright 2008 by Marcia Singer. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Philadelphia Therapy

Click here to contact Cory and/or see her GoodTherapy.org Profile

Love Economics is a new terminology for analyzing the benefits of love and relationships. For example, the benefits of a relationship include emotional, physical, social and materialistic needs. Using the theory of Love Economics, dating and relationship problems can be analyzed and solved by using a more pragmatic approach. The advantage is that decisions will be based more on logic rather than on emotion. Before committing to a new relationship, a Love Economist will make it perfectly clear that he/she won’t neglect their social portfolio of personal friends. This decision could save a lot of embarrassment should they break up with their love interest. A Love Economics major will limit their emotional cost at all times to protect their own expenditure. This philosophy doesn’t work for everyone, especially when going through something as dramatic as a breakup. Whether you are breaking up from a relationship or going through a divorce it’s inevitable that you will feel emotional pain. No amount of Love Economics or pragmatism is going to protect you from experiencing the lows that only humans can relate to. After all experiencing love can make you feel the most jubilant and satisfying emotions while losing love can make you feel the most devastating feelings of sadness and pain.

The following 12 steps are the most effective way to handle, heal, recover and raise your self-esteem so that you can move on with your life in a positive and productive manner after a breakup.

1.First write down how it would make you feel to never see that person again.

2.Then make two columns and write down the pros and cons of your relationship. See which list is the longest.

3.If the relationship has been a long one, a mostly good one and you care about the other person’s feelings, begin to taper the amount of time you spend with each other.

4.Connect or reconnect with people who make you feel good when you are with them.

5.Take up activities that will take your mind off your declining relationship and increase your self-worth and confidence.

6.Learn valuable lessons from your past experiences. Write down what you have you learned about yourself and what you would do differently? This is important because you don’t want to repeat negative patterns. Relationships end when they are supposed to. There are no mistakes in life, only lessons.

7.Do not mourn your break-up, blame or punish yourself. Do not drive your family and friends crazy by constantly talking about your woes. Instead, recognize and list all the wonderful qualities that you have to offer someone, acknowledge all your accomplishments, big and small.

8.Take a gratitude moment every day for all the good things in your life and thank the Universe for all that you have.

9.The best revenge is “Happiness” so make a commitment to do at least three things that make you happy every day.

10.Imagine that you are “Ten Times Bolder” than you were before, take fun risks and don’t miss out on opportunities. Have no regrets.

11.Celebrate the beginning of a new phase in your life with a positive attitude and buy yourself a gift or go out to dinner with friends to signify a celebration. Reward yourself! You are valuable and if you treat yourself as a valuable person, so will others.

12.Don’t shut love out by saying “It’s impossible to find. Open up your heart to new possibilities. The quickest way to receive love is to give it.

©Copyright 2008 by Cory B Honickman. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Cory and/or see her GoodTherapy.org Profile

Palo Alto Therapy

Click here to contact Christine and/or see her GoodTherapy.org Profile

“The past is the past. Put it behind you. Get over it already.”

We all have parts of ourselves whose job it is to know how and when to feed us these lines. It is usually after more tender parts of us get triggered and we are feeling hurt or isolated or helpless. These tender parts haunt us with a very different set of lines that they have learned, “You’re not good enough. You’re unlovable. You don’t matter. It’s hopeless.”

These learned beliefs are so painful. Few of us welcome them with open arms. Just the opposite. We lock them away in the basements of our being and put sentries at the door. The “get over it” sentries then run the day-to-day show and keep us consoled, soothed. These sentries protect us from the pain we have locked away in the basement. If life events come close to triggering the pain in the basement, they step in and feed us their lines. Once we are feeling soothed we can once again turn our backs on the basement door. We need these sentries.

But what happens when the tender parts are more triggered than the protective sentries can handle? What happens when they are banging on the basement door, or have gotten out and are running the place? Enter a third kind of part: the Major Distracters. They are the ones that know how to really keep our minds off our pain. They get the job done when the sentries cannot. Major Distracters are the parts in us that use various kinds of addictive strategies like over-drinking, over-spending, over-sexing, over- or under-eating, cutting, raging or any other kind of impulsive behavior. However, when these parts take over we often feel out of control and we cause great suffering. But at least our inner pain was avoided. Mission accomplished.

Sound a bit chaotic? Overwhelming? There is hope. There is a way to help unburden all of these parts from the jobs they have been stuck with for so long. Each part probably already has some idea of what they would really rather be doing anyway – some gift or talent that they had to give up when they got their current job assignment. There is a therapeutic process that mediates a compassionate dialogue with all of these parts and helps you to heal them.

Once the exiled basement residents having been safely healed of their pain, the sentries can be honorably discharged and the Major Distractors can channel their abundant strength and energy toward deeply satisfying endeavors. All of the parts can go about living the life they were born to live – celebrating their unique abilities.

People who have used this therapeutic process report profound shifts in the feelings and beliefs that previously tormented them, noting that as they became more confident and compassionate, they were able to find increased harmony not only within themselves but also with family, community, and the planet.

The past is the past. We cannot change the painful things that we have endured. But we can rescue the parts of us that have been stuck living in the past. We can help them out. We can heal them. Only then can we truly and beautifully get on with it. Whatever “it” is.

©Copyright 2008 by Christine Horn. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Christine and/or see her GoodTherapy.org Profile

Omaha Therapy

Click here to contact Lana and/or see her GoodTherapy.org Profile

The well-written article by Daphne Merkin entitled “Darkness Invisible” in the September 16, 2007 edition of The New York Times was disturbing. It wasn’t disturbing due to its darkness. It was disappointing due to the misconceptions and insensitive comments regarding drug use/misuse. Drugs, to include alcohol misused—not only mask a depression—it can MAKE for depression and illuminate MELANCHOLY. Its use/dependency/misuse/alcoholism can, through psyche, soma, and behavior create, as Merkin quotes Chekhov: “I am in mourning for my life.” Addiction is a way to mourn for being alive—for actually living to full potential — via a never-ending depression. Alergy to alcohol—eventually produces (for some, earlier; for some, later) non-feeling states, inappropriate thinking and behavior, desperate acts, suicide—real—not imagined. Alcohol use/dependency/misuse/alcoholism/drug abuse is rampant—not only among the creative folk in film—in every walk of life—and with every socioeconomic class. It spares no one who suffers.

I treated Jan after her alcoholism relapse. She was 50 and sober 16 years when she relapsed. She “nibbled” (Merkin’s language) on alcohol for about three years before coming to see me. Although intellectually having known better, Jan believed she could drink again. She was looking to keep drinking—even though she felt numb, dead, suicidal, empty and terrorized. She came to see me after a number of interviews with “harm reduction” psychotherapists (counselors who do not hold ‘abstinence’ as a priority to treatment.) She had lost her life and some of her work when she relapsed. She was unable to get close to anyone. Feelings of intimacy with her husband and children were long gone. Jan began with binge/periodic drinking—drinking small amounts on holidays, birthdays and other social functions. Over a handful of years, and life having made its usual twists and turns, e.g., she couldn’t get a “showing” at a gallery, “ a few mishaps with her car were “scary,” an unexpected death in the family was “disburbing” to her, etc. Jan progressed into weekend nibbles which turned into a few ‘bottles’ a week and nightly trials.

Jan shared a DSM IV with Owen Wilson, Robin Williams and Richard Pryor. As an artist and sculptor, Jan created while she lived and worked. Still alive through her several year relapse that produced and avoided feelings of emptiness, darkness, solitude, sadness, depression and suicide (ideation and thoughts of killing or drinking herself to death, Jan was downtrodden. She was not hospitalized. She did not enter detox or rehab. Jan had many moods: She was depressed, melancholy, high, sometimes drunk, sometimes slightly drunk. Jan was hung over on most days — not having enough substance through controls—or illusion of controls — two/three drinks a night. She was never a real depressive—she experienced bouts of depression. Jan ‘nibbled’ on her choice of drug: alcohol. If she could have her mind, body, soul, emotions, and spirit, she would still be nibbling. This is not possible. Jan learned the hard way—through her relapse. Notwithstanding years in 12-Step programs that enabled her to have a career, a marriage, a decent enough personal analysis, Jan was surprised that she “couldn’t stop drinking.” She had long exited from any self-help group involvement. Jan would not emotionally understand this until a year into her second sobriety. At a certain point in the drinking of every alcoholic, he/she passes into a state where the most powerful desire to stop drinking is of absolutely no avail. This tragic situation has already arrived in practically every case long before it is suspected.

Jan’s older sister died of alcoholism. Her death was classified as “suicide.” Jan at that time was in mid-stages of active alcoholism. Jan commented, “I couldn’t help her or myself.” Untreated alcoholism is suicide.

This writer also relapsed after many sober years for a period of time where it was the “first” drink—not the “fourth” vodka. It was always the “first” drink—I am addicted to alcohol. I was suicidal and didn’t appreciate the extent of my alcoholic despair—notwithstanding my then analyst suggesting “medication,” having missed the alcohol relapse in its entirety. He tried. His interpretation of “you’re playing with fire,” did not cut it! I had to melt down, black out, space out and begin to put miniatures in my office freezer… and not tell anyone. And, I was not drinking much. That was the problem. I was not having ENOUGH alcohol to reduce craving or satisfy the perpetual cycle of tolerance and withdrawal and the suicidal thoughts. My body was screaming, “Vodka” and my mind was saying, “You’re nibbling and in control of your drinking, you’re OK.” “You’re not a Bowery person—the neutered man with the dirty raincoat with a flask in his pocket.” Absurdity. I do not suffer from depression – a smatter of anxiety, but not depression. I can get dark, but stay with the darkness/my feelings and not entertain them with a full orchestra…so long as I remain abstinent—as I have again for several years. (As an aside, one of my patients who hates her feelings states, “I will not entertain them—no orchestras for me — only through a string quartet!”)

So, what happened? Jan showed up and I could not treat her as her “nibbling” was too close to my own. She didn’t stay in my practice long. As I got honest and began to treat her drug abuse, I faced my own relapse.

The physiological vulnerability that Merkin states is a “self-annihilating impulse” is not accurate for addicts. Addicts’ behavior mimics a “self-annihilating impulse.” Impulse issues or massive anxiety ran out with the borderline escalation of diagnoses for addiction many many years ago. The heart of addiction, of course, resonates with human psychological suffering. Human issues of experiencing emotion are in the extreme: feelings are overwhelming and unbearable, or they are absent and confusing. Addiction resonates in an inability to control one’s life. Addicts alternate between losing control of their behavior and substances and then, often at the same time, they exert multiple and varied attempts to gain and maintain control. Drugs (including alcohol) are compelling because they initially work but ultimately due to physical tolerance and evolving diminished psychological capacities, the attempts at self-correction fail. Suicide often becomes a fatal alternative.

Relationships for the active addict are not possible—clear thinking is not possible—judgment is not possible—self-care is not possible. Living is not possible for an addict. It’s not easy living without drugs after any amount of years of abstinence. With some, life on life’s terms, feels harder as one becomes more aware and open. It can be uncomfortable for some with a “smatter of anxiety.” Addiction/recovery ”sagas” as Merkin gleefully comments as “boring” are attempts to master affects – to tolerate the darkness and the lightness with “props” (alcohol, other drugs, heavy prescription medication). Merkin’s article attempts to dissuade her own “darkness,” quite unsuccessfully. In this writer’s opinion her being “flip” only highlights other possible issues/conflicts. Her references to talents mentioned, i.e., Robin Williams and Richard Pryor are appalling.

Merkin’s reference to a “guy with everything” (Wilson) is judgmental. Suicide—while an act of hostility, which says, “I’ll show you…” (whomever he/she wants to blame for his/her lot in life) is an attempt to evade any sense of real responsibility for self-care. So what’s new here?

Depression, as Merkin comments, is not “chic.” It may well sell in memoir. Merkin may need to write her own memoir. Addiction does not sell. Many do not stop drinking. Many relapse. Many wind up dead. My assessments, consults, chemical dependency Interventions, new potential prospects in colleagues’ treatment rooms—is the ‘real hard stuff’— at least as hard as depression. Addiction kills. I know of a rather ‘known’ analyst (not personally) at a recognized NYC Institute who lost two families, two homes, two children, his self-dignity, let alone not giving his patients/clients/students his help—he can’t help himself, who yet after quarter of a century trying to control alcohol. How sad! I know a colleague whose ex-husband sits in an Institution with wet-brain—he couldn’t control his drinking. How sad! Jan’s sister—a talented surgical nurse—is dead! How sad! Addiction is denial for many. I too, almost died…again.

I’m glad to be alive. I can be caring, empathic, knowledgeable and loving. I am grateful for my life, some of my more important relationships, my profession, my depth of character, and an emotional and physical sobriety—which protects me from alcohol. It—so far—stays in remission. I never liked my family of origin. Addiction figures here as well!

©Copyright 2008 by Lana M. Ackaway. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.

Click here to contact Lana and/or see her GoodTherapy.org Profile

Cambridge Therapy