Category: Approach

The Family Research Project: A Summary

Posted on by rezendevknowfully.com
Sometimes a new idea offers such a radically different lens that it challenges conventional wisdom and even turns standard theory and practice upside down. Children of alcoholics (COA's) and adult children of alcoholics (ACOA's) were new ideas of this kind. We believe that our Family Recovery Research extends this revolutionary perspective. Since 1989, we (Stephanie Brown and Virginia Lewis) have been asking the question: Is there a "normal" developmental process of recovery for the family, similar to the long-term process of change that has been identified for the alcoholic and for children of alcoholics? What happens over time when one or both parents stop drinking? Are there predictable, defined stages? What is the impact of abstinence on the family and on the individuals within?

I have often asked over the years, "Why do people resist looking at recovery? Why does the focus of research and treatment remain fixed on the drinking alcoholic?" While so much effort has been targeted toward a "goal" of abstinence, the focus has always stopped at that point, as if everything is expected to turn out well once the drinking stops. It is not so simple. Abstinence marks a positive beginning rather than an end. Recovery is a difficult, painful process of radical change that is never easy and rarely smooth for anyone involved. Without knowledge about what to expect, including the paradox that what is normal and necessary to long-term positive change is also disruptive and even traumatic in the short run, the impact of such turmoil can cause further damage. Over the last six years, we have interviewed and tested 52 couples and families (those who were together for a least five years during drinking and who are still together in recovery), with sobriety ranging from a few months to over 18 years, in order to discover what recovery is like. We have examined the process of change according to length of sobriety within three domains: the environment, the system, and the individuals within.

Research Findings

  • The four stages of recovery already defined for the individual hold true for the family: Drinking; Transition, the move from drinking to abstinence; Early Recovery, the stabilization of abstinence with new learning, much uncertainty and constant change; and Ongoing Recovery, when massive change has been consolidated and the family is guided by the organizing behaviors, values and beliefs of recovery.
  • The environment, or context, of the drinking family is traumatic and harmful to children and adults. It remains unsafe and potentially out of control into Early Recovery, which may last as long as three to five years. In Ongoing Recovery, the environment is safe and not thrown off track by the difficulties and crises of "normal" life. One family looks back:
In the first year, we lived on pins and needles. There was more tension than there was during the drinking because no one knew what to expect. Before, the drinking was known; it was predictable. Now, our nerves were raw and ragged. We all feared an explosion. It took years before we felt calm and secure.
  • The unhealthy drinking family system must collapse as the family enters recovery, permitting attention to shift from the system to the individuals. Many families do not accomplish this collapse or they do not survive it. Because there is so much disruption with abstinence, and so much turmoil caused by the collapse of the system, many families break up, seeing that things have gotten worse, not better. Our data explain how outside support networks (12-step programs, treatment centers, therapists) provide a "holding environment" for all members of the family, a cushion and substitute for the drinking family system that has collapsed. Families utilize these outside supports to weather the difficult changes of the first three to five years. It may be five to ten years before a stable, strong sense of healthy family is secure. Change like this does not occur from inside the family in the vacuum created by abstinence. It requires external guidance and supports. Yet conventional treatment wisdom often leans in the opposite direction: much of family therapy is aimed at bringing individuals together, to focus on a "we." Our work demonstrates the importance of an individual focus during the early period. Another family remembers:
In early recovery we could begin to talk about an "I" and a "you." We didn't dare try to communicate as a "we." For the first two years, we didn't talk to each other without first calling our sponsors and we didn't talk about important things for at least five years. We led parallel lives and slowly got to know each other again.
  • The process of individual recovery takes years, not days or months, and can enable lasting, in-depth changes in the family. Unfortunately, there is sometimes an unrecognized dark side: children may be neglected as parents focus exclusively on their individual recoveries and abdicate parenting responsibilities. One parent told us:
Early recovery was a self-obsessed time for us. Our children had a "recovering Dad" and a "recovering Mom," but who was taking care of them? No one. I will be forever grateful for sobriety, but I have a profound regret that we abandoned our children in the service of our own recoveries.

The Trauma of Recovery

Data on the process of family recovery shocks us with mixed news: Yes, recovery is positive; the end of the drinking is extremely important and lays the necessary foundation for in-depth change. But that process of change, which we have called the "trauma of recovery," is difficult. Families may not survive it, and without sufficient knowledge or supports, children may suffer unknown and unintended consequences of this time of uncertainty, instability and radical change.

No wonder there is resistance to focusing on recovery.

It is hard to see what's really there and what is normal. In our culture we idealize short-term cures, "symptom reduction" and magic answers, refusing to understand or accept that solutions to massive problems require difficult, painful choices and a long time in the process of change.
 
We think it will be surprising to many that children experience a "trauma of recovery" in addition to the horrors of drinking. It is grim news to learn that children may feel worse, not better, just like their parents, and they may experience physical abandonment as well as continuing psychological isolation due to their parents' recovery.
 
There is great danger that news like this will be rejected, or denied. Or, we will rush to the obvious, but wrong, conclusion that parents should not follow individual recovery programs. We must face the fact that what is essential for parents may be inadvertently damaging for their children, but only if we deny it. Once we acknowledge this reality, we can address the holes in our treatment programs so we may better protect children AND support parents in their recoveries. We can also focus on the absolute need for support structures outside the family, which we are calling "community systems," and on the need to expand our ideas of prevention to include recovery. Our current theories and practice for the professional treatment of alcoholism and the family leave people hanging without necessary knowledge and support.

Helpful Interventions

What kinds of interventions can be helpful at what stage of recovery? Couple and family therapy in the early period of abstinence can provide education about the normal process of recovery, i.e., the turmoil and disruption to be expected, the need for parents to focus on themselves as individuals, and the importance of maintaining or learning parenting responsibilities, both concretely and emotionally. Parents need guidance in focusing on themselves without further neglecting or abandoning their children. Supportive couples therapy that does not shift the focus off of individual recoveries can provide necessary structure, concrete advice and education and a watchful eye on children's reactions and needs in early recovery.
 
As part of our research we have developed a curriculum for families with longer recovery—a minimum of six months and ideally at least a year. Called MAPS (Maintaining Abstinence Program), the classes provide a "map" of what families can expect individually, and as a system. During one meeting, a couple or family with many years of recovery (the "mentor family") shares the story of their drinking and recovery. We believe that this adaptation of the A.A. and Al-Anon sponsor can offer tremendous support and fill some of the holes which we know exist.
 
We also recommend adding an educational component to treatment programs that emphasizes the importance of family and the need to attend to family during the early days and months of abstinence. How to do this without sacrificing anyone's individual needs will require careful planning.
 
Finally, we see that couples and families with stable recovery can benefit from more intensive therapy, depending of course on their particular needs and circumstances. When individual recoveries are stabilized and secure, family members can turn their attention to relationships within the family without threatening their own progress, or forcing a return to old, unhealthy family interaction patterns.
 
We expect an outcry against our research because we recommend additional "treatment" and unlimited "continuing care" rather than less treatment, or even none. We believe that much of this care can be provided by volunteers who offer education, support, and the sharing of their experience as "mentor families" through an extension of the "apprentice model" of the 12-step programs. We see this need as an opportunity to strengthen an already existing bridge between the recovering communities and professional treatment. With an ongoing "holding environment" outside the family, individuals within can attend to their own healthier development. Later, they can shift their attention back to the family.
 
The now-grown-up child of two recovering parents listened to them tell the story of their recovery and then reflected on what recovery had been like for her:
 
From the time I was six until I was ten, my mother was in and out of treatment for her alcoholism. I went to Alateen because my parents needed me to go. I told myself that what was happening wouldn't be important to my whole life, that all of this was not traumatic. Now I know I was living in a vacuum, that I had nothing to hold onto. I was tuned out for most of this time. As I listen to them talk today, I know why. They weren't there for a long, long time.
 
This family talked about the process of coming back together. As their individual recoveries progressed, the environment became safer, and a new, healthy family system could develop. Father reflects:
 
By the time things finally started to work in the family, our two oldest kids were on their way out, so there was not time for bonding. They needed to push away, but there was nothing to push against.
 
The children, having grown up with drinking and the turmoil of early recovery, are now coming home—emotionally—to join this healthier system and repair the bonds of attachment with their parents. Much of the developmental work that should have occurred during childhood and adolescence can now take place…and does.

Edna Foa on Prolonged Exposure Therapy

Posted on by rezendevknowfully.com

Exposure Therapy Explained

Keith Sutton: Welcome, Dr. Foa. To get started, why don’t you tell us a little bit about what exposure therapy is. Many of our readers may be unfamiliar with, or may not remember much about, this type of therapy.
Edna Foa: Exposure therapy is used mostly with anxiety disorder. The idea is that people who suffer from anxiety disorders—who get anxious when they confront safe situations or objects—are taught through exposure therapy to become less afraid, or not afraid at all, of the things they’re fearful of. So if the fear is a normal fear—like the fear of driving on the track when you see the train whipping by very fast—you don’t want to teach people to get over it. You don’t want to change people’s fear of driving over the track just in front of the train, because normal fears protect people from doing things that will harm them. The idea behind exposure therapy is that the therapist helps patients to confront or approach what they’re afraid of, because the things they’re afraid of are intrinsically not dangerous. Through exposure to these situations, they learn that there is no reason to be afraid of these situations. The disaster they expected does not occur. Originally, exposure therapy was derived from animal studies. In these experiments, scientists condition a mouse to become afraid of a red light by pairing the light with electrical shock. And after a certain numbers of pairings, the mouse will start showing fear responses when the red light is presented, even when it’s not paired anymore with shock. We call this response a conditioned fear. Then if we want to eliminate the mouse’s fear of red light, we present it with a red light without the shock. After repeated presentation of the light without shock, the animal stops showing the fear reaction to the light. That’s called extinction. In the ’60s and the ’70s, several experts, in England and the United States, translated the animal results to human beings and said, "Let’s suppose that the anxiety disorders—such as claustrophobia or fear of heights—are like a response that was conditioned. The person was conditioned to be afraid of elevators even though being in an elevator is not dangerous. So how do we eliminate the fear of elevators? We instruct the person to ride on an elevator many times until the fear is extinguished."

KS: Is that what’s called the flooding of the anxiety?
EF: Well, it’s called flooding if the therapist conducts the exposure very abruptly. And it’s called systematic desensitization if the therapist is doing the exposure very slowly in small increments, and if he pairs the exposure with relaxation. There were big debates in the '60s and the '70s about what works better, and whether flooding is dangerous. Some experts, like Wolpe, thought it was dangerous to do flooding because the person will actually become more rather than less fearful.
KS: Yeah, common sense would make you think that, wouldn’t it?
EF: No, not really. According to some theories, flooding should make the patient feel worse. But according to other theories, abrupt exposure should extinguish the patient’s fear more quickly, so it is actually more efficient.
KS: One of the central ideas around the exposure is that the anxiety peaks within a reasonable amount of time and decreases. Is that right?
EF: Well, it depends. Not necessarily. Let’s say that somebody is afraid of going to the supermarket. People with panic disorder, you know, are afraid of going to places where they cannot escape quickly, like sitting in the first row at the movies. It takes longer to get out from the first row than from last row. Experts did abrupt exposure, getting patients to sit in the front seat from the start of the therapy, and other experts said, "Let’s do it incrementally—let them sit in the last row first, and then in the row before the last, and then two rows before the last, and then five rows before the last."
KS: Is that the exposure hierarchy?
EF: Exactly. Gradual exposure gets patients used to each one of those stages, and eventually the patient will sit in the first row. Now, studies have found that doing abrupt exposure is as effective as doing gradual exposure, except that the patients in the gradual exposure suffer less. But flooding doesn’t really make them worse, as Wolpe thought. So we know now that we can do flooding, or we can do systematic desensitization. Both work. Today, experts don’t quarrel about this issue anymore; all therapists use more or less a gradual exposure, but not as gradual as systematic desensitization, because that takes too long and is unnecessary.So that’s what exposure is. Now, how does exposure work? It works because of a mechanism that we call extinction. Extinction is not unlearning what you learned, but rather it’s learning something new—it’s learning that what you were afraid of is not dangerous. Some experts say that the mechanism is the reduction of the anxiety—that gradually you’re less and less fearful. This is called habituation. But habituation is not an explanation for why patients get less fearful with exposure therapy.My theory is that exposure reduces fear and anxiety because the patient learns that the bad thing he thought would happen to him does not happen. Therefore, it’s very important to plan in a way which will ensure that the thing the patient is afraid of will not happen during the exposure. Let’s say after being raped a woman starts to be afraid of going anywhere by herself after dark. The therapist then plans exposures to places that are not safe after dark, and she is attacked again. That’s not a good exposure, because it doesn’t teach the patient that what she was afraid of does not happen.I always give the example of a person that is afraid of big dogs, but not of small dogs. The therapist decides to treat him by exposure to dogs, and brings to the session a small dog. Well, because the patient is not afraid of small dogs, this exposure will not work. Exposure needs to include the things that the patient is afraid of. The therapist then brings a big dog to the therapy session to do exposure. The patient enters the room, sees the dog, and gets very fearful. With the encouragement of the therapist, the patient slowly approaches the dog, which the therapist holds on a leash. When the patient gets close to the dog, the dog jumps on him and bites him. This is again not a successful exposure, because what does the person learn from it? He learns that he was right all along, that big dogs are dangerous.
KS: It reinforces that belief.
EF: Exactly, it reinforces rather than extinguishes the fear. So that’s the way exposure works. In order to implement therapeutic exposure, the therapist has to find out what the person is afraid of, then make a list of these things and organize this list from the not-so-fearful situation to most fearful situation, in a kind of hierarchy. In order to create a good hierarchy, the therapist teaches the patient to assign a number, on a zero-to-one-hundred scale, to each situation. This number signifies how much fear the patient would have if he would be confronted with this situation. It is important that the therapist makes sure that the situations on the list are not really dangerous.The therapist chooses a situation by saying to the patient, "Let’s choose a situation that is about forty on the scale. Which of these situations do you think you are able to do for homework next week or in the session with me?" The patient selects a situation and begins to practice approaching it, staying in the situation until he feels that the anxiety goes down and realizes that the fear is not realistic.So exposure works through two mechanisms. The first is that the situation elicits the patient’s fear—there is a match between the situation that the therapist is presenting to the patient and the patient’s own internal fear. The second mechanism is that the exposure situation contains information that is incompatible with the information that the patient has in his mind. In the example I gave you about the dog-phobic, if the patient is afraid that large dogs will bite him and the therapist presents him with a large dog that, over several instances, does not bite, the patient will cease to be afraid of big dogs. Patients don’t really need to be in the situation a long time—they don’t need to wait until the anxiety dissipates completely. They just need to be in the situation long enough to realize that what they feared would happen does not happen.

Transforming the Wounds of Racism: An Autoethnographic Exploration and Implications for Psychotherapy

Posted on by rezendevknowfully.com

A young boy splatters my painstakingly finished painting, taunting me to go back to where I had come from. I accuse his ancestors of plundering my nation: "Look what your people have done to my people." (Saira, eight years old)

The stories of colonialism that my father had told me suddenly came to life and I felt bold and proud as I looked to my teacher for further confirmation. She remained silent as the other children laughed at me. I found myself shrinking away in that moment of humiliation. I think about that experience quite often and I imagine what might have happened if my teacher had affirmed my words. Especially, now that the cultural landscape has changed and I see white women with henna tattoos, and Indian fashions, designs and music everywhere I look. It is curious that what was once denigrated is now accepted and desired. This is both inexplicable and inspiring to me.

My brother and I are in the garden gathering brittle autumn leaves for the fire, savouring the sweet evening air in our lungs. Two white teenage boys peer over our back fence and throw stones and litter at us alongside racist jibes. I feel they are treating us like animals in a zoo; I feel fear rise in my belly but feel compelled not to show it. My father appears and gently asks them if they would like to join us. I feel bewildered and betrayed by his reaction. The boys sit beside us and floating embers settle in our hair as we eat baked potatoes plucked from the fire. We make reluctant and inquisitive eye contact with one another and as the fear dissipates, I can see they want to be a part of this simple activity of togetherness. (Saira, ten years old)

Racism was a part of the backdrop of our lives. It was not discussed and I was given no guidance on how to make sense of it. It is only now, many years later, that I recognise the gift my father gave me that night: he showed me that I could acknowledge and stay with the disquiet and dread of racism and that I could find ways other than fear and dread to be with it. During my dissertation research on this topic, I held onto these memories like a talisman.

Authoenthnography as a way to understand racism and trauma

I wanted to become a therapist who was not bound up in the rigidity of her boundaries, so that I could begin to stretch and push the boundaries of otherness and sameness. As a psychotherapist, I wondered how racism is explored or avoided in psychotherapeutic work. I saw that racism can often enter psychotherapy in a disguised form as it is difficult to express due to the fearful and defended nature of racism. This results in racist trauma being overlooked and minimised, which can be oppressive and silencing in itself. In this work, I have tried to illustrate how stories were told and understood in order to facilitate empathy with groups that are sometimes neglected and marginalized.

Autoethnography¹ has developed from ethnography, anthropology, sociology, and cultural studies and serves to challenge traditional historical relations of power. Autoethnography is different from autobiography in that it describes the conflict of culture and identifies how one becomes othered within a cultural and social context. This method of research allows us to remake and understand subjective experience from creative and analytic first-person accounts of people's lives. It makes use of interviews, dialogues, self-conscious writing, and other creative forms to facilitate an expanded awareness for the author and audience. Autoethnography is the study of the awareness of the self (auto) within culture (ethnic); it is a way to connect the personal with the cultural.

I have tried to create a more heartfelt space where wounds can be subjectively named and understood. I wished to engage in new ways of thinking about how therapists' life events can change practice and awareness for themselves and the field. The illuminated relationship between the researcher and the researched is made transparent in this work as it took me to places, internally and geographically, that I had never been…

This is not just a story about racist trauma—it is a story about longing, loss, and discovery. It weaves back and forth in time, and as a result, it is written in both the present and past tense.

Straddling two worlds

As a child, I was a keen observer, soaking up the living memories of my parents' homeland, of dance, song, and food that produced solidarity and unity. As a group, they felt alienated and displaced from all that was familiar. My aunts told and retold stories; this helped them maintain their cultural voices, and this collectively made them a powerful force in my life. The men were on the edges of these stories and were largely uninvited to storytelling as it was felt they were both "too important" to be burdened with the tales and too "weak" to bear the sorrow associated with them.

I straddled both the ancestral and modern worlds, and I was given the gift of being able to find myself within these stories. Despite the fact that these mementoes of my heritage were somewhat fragmentary, I was still left fascinated by them. My aunts came from a culture that emphasised togetherness and unity. In their dependent and highly emotional world, they sought kinship and solace with each other. This was in part because they became increasingly ambivalent about their splintered place and identity in the world due to the forces of migration.

As I grew older, I started to embody a western culture, and it became apparent that cultural differences were intolerable to my family, as any individuation was an annihilation of the collective. I felt increasingly like an outsider, both inside and outside the home. I was inexplicable and perplexing to them, particularly when at 13, I dyed my hair pink and daubed hand-painted feminist slogans over my clothes. My family clucked with pride when I responded to their coaxing by wearing a sari for a family event. I felt such sensual pleasure in the swaths of beautiful pea-green silk that I did not want to lose its "magical qualities." In turn, [I refused to take the sari off, ruining their hopes by experimentally skateboarding in it.] I was continually challenging their ideas of what a traditional Asian woman should represent and grappling with the contradictions and paradoxes inherent in this process.

Myself as witness

How do I trace the roots of my estrangement and disconnection from these men who were central to my life, to my heart? I have waited for a long time for them to come home—psychically, physically, and emotionally. I have always wished that they would be returned to me, like at the end of fairy tales. Through my research process, I felt like I was making the decision that I could not passively wait for their return any longer. Whilst being immersed in this research, I felt a strong need to reclaim my deeply yearned for yet seemingly irrecoverable lost connections.

I did not know for certain when I started this research that my father, uncle, and brother were lost to me by racism and its effects. These experiences were unheard and unspoken in my rambling and rather tribal family. I believe the speaking of racism evoked fear and shame that might further tear at the fraying fabric of my family. Racism, for me, was bound in the wrappings of humiliation and silence. It was so tightly swathed, I only heard it as a fearful whisper. I have subsequently discovered these traumatic racist experiences ranged from vague, insidious and intangible experiences to shattering, violent acts.

As I felt the oscillations of these unspoken narratives inside myself, it led me to create musings, fantasies and assumptions about the subject matter. I sat at my desk, feeling bewildered and paralyzed at the horror and pain of the family narratives, and despair at their disconnection from me, wondering how it was possible to get closer to the subjectivity of such experience. This possibility felt charged, potent and unfathomable. I deliberated and wondered repeatedly if I should speak with my family about the research—would it harm them further? What are the ethics of taking this into the public world? What would the research do to our relationship? Issues around confidentiality buzzed around my head and my colleagues and I talked about them incessantly.

I questioned the possibility further: What will my peers make of me? Would I be derided and discounted by the "therapeutic community" for revealing not just myself, but also my family? Would I be able to produce something evocative, powerful, and representative of our experiences? Is this the story of significant men in my family or my story of loss? Can I find the words for trauma that sits beyond language to describe what cannot be spoken? The question remained with no easy answers.

My father's scars

My father was disillusioned and troubled when he fled to England to practice law in the 1940s. His best friend and neighbour during the partition in India stabbed him. He only mentioned the scar on his stomach in passing when I pressed him to let me into his interior world. He believed Britishness embodied fairness and justice as he had been successfully inculcated into the colonial belief that he and his kind were inferior. He beamed with pride at redefining himself as a "brown English man" and negated his "primitive and corrupt" cultural origins with vitriol, never wishing to return.

In remaking his identity, he resolutely refused to believe that his struggle to secure a job as a barrister was due even in part to his colour. He was a dishwasher, a porter, and a lift attendant—all the while, trying to maintain his respectability and pride. He would arrive to work with his bowler hat and impeccable pinstriped suit each day. then change into his overalls to start his shift. He was inaccessible to us as he strove to carve out a place in the world, and his identity was embedded in his need to work hard and achieve. His failure critically punctured his self-esteem.

The eventual disaffection and disillusionment with his idealization of Britishness seemed inevitable. However, its impact was made worse because he was unable to digest the racism he endured. He saw the hostile, racist persecutory world making him feel small and powerless. He seemed to see racism and oppression everywhere. These crises led him to alcoholism and admission to a psychiatric hospital for depression.  “He sat on his prayer mat and cried like a child as he spoke of England like a lover that had abandoned and disappointed him.” He turned away from it as he had his homeland.

In turning away from Britishness and all it represented, my father turned further away from me. Had I come to embody what he could not bear? I could not find any comfort in taking my distress to him and he could not bear the weight of his child's woundedness. The effects of his trauma marked our family, and although we did not live through his trauma, we did live within its confines.

It is frustrating to feel the familiar inaccessibility in his death as I did in his life. What would he have discounted or embraced in these descriptions? My father was a harsh man who shielded himself from the world and eventually lived a hermit-like existence, but he gave me the best of his capacity to love. All I can name is what I know: that every day I spent with him he was unpredictable and closed off, living in a desolate land. I could not find him anywhere. And now I cannot quite find him in the untranslatability of these narrative descriptions.

While my own father was busily being a perfectionistic workaholic, my mother was whimsical, dreamy, furiously caught up in her culture and clan. My uncle represented a world of calm and safety. How do I adequately describe how much I loved my uncle? I have always found great comfort in looking at his face, the familiarity I felt in watching him smoking his cigarettes—his recognizable outline meant that my life slotted into place.

My uncle leaves… the unanswered questions

I now realize he was a mere young man at the time, but seemed then to offer a very different quality of attachment. I remember him driving a maroon Mini with a squeaky leather interior that I would slide around on. He would sit with me on the stairs when I had undigested bad dreams about cowboys and Native American Indians and would speak softly of worlds full of magic and kindness until I felt safe enough to fall asleep again. He taught me to gently put the needle on the record and wait breathlessly until the song would start in the smoky recesses of his room. He would capture my crinkle-nosed smile in his photographs and I felt rewarded with his attention and gaze.

His leaving to emigrate to Canada when I was six felt like an unanswered question and for a long time I wondered why he left, and yearned for him to come back. His absence was profoundly painful to me as a child. I wondered if my mother had sent him away or if his new wife asked him to leave. As I grew up, a part of me imagined it was due to racism. Not that I knew much of his experiences with racism, but I overheard fragments of conversations of how he "hated England," and that "terrible things happened to him." It led me to conclude that racism was the only conceivable reason he left. Why did I assume it was racism? Had I made something up? Perhaps it helped me believe as a young child that something terrible took him away rather than facing the fact that he had chosen to leave me.

"It felt embarrassing to talk about the humiliating aspect of it, your sense of masculinity is wounded and injured, you feel that you should have taken a stand but you did not feel able to as a man." (Saira's uncle)

Early on, I asked my uncle what he thought about my research—was it meaningful to him? He said he had many stories of racism and its associated trauma that he had not spoken of, yet they were still alive inside of him. I instantly felt relieved that these experiences were real and not entirely the result of my imagination, although I feared I would not be able to hear and bear these stories. How might the telling of these narratives benefit him? At this stage, I felt lost in the littering of these broken attachments and in a turbulent state of anxiety and confusion, although later I recognised that this was a place of important struggle and sorrow.

Unwelcome in the new world

My uncle arrived in England from Pakistan in the 1950s at 10 years of age accompanied by a throng of older and younger sisters with kilos of sweating Indian sweets wrapped painstakingly in silver foil. However, the family was ill-prepared for the cold as they arrived in the dead of winter in only their thin cotton shirts. All 10 children started their life in Britain in an asbestos-ridden caravan, confused and unsettled after coming from a place of wealth and comfort. Later, the family moved into one room with little space, and their material conditions worsened. They lacked any comprehension of the new culture or landscape they faced. This migratory journey remained an untold story because it evoked shame of their struggle to find a place of belonging and the emotional and literal poverty of their experience. The exodus was supposed to be rich with offers of new possibilities, the enticement laced with the promise that they would be rewarded if they worked hard and managed to forget the familiar sun, and the textures and colours of home.

My uncle was pleased to find that people were initially curious about him, his history, and difference. Later, this changed and it seems humiliation and shame coloured much of his experience as a young man. He remembers standing at a bus stop racially abused whilst those in the polite orderly English queue silently looked on, witnessing him being scorned and disrespected for simply existing. He felt the disdain when he was spat at for embodying and personifying otherness, his palpable foreignness and physicality making him a threat to himself. The skin he represented made him exquisitely visible and invisible.

"Look what the cat's dragged in" was his greeting on the first day at his new job; he was 16. He felt cheated; where was the promise of a better life? Then he was threatened with a knife in a public bathroom where a gang of men in a savage racist attack set upon him, dousing him in their anger and fury. He felt unwelcome in the new world.

He walked around in shame and isolation, wondering how he could make a mark on the world when his voice had fallen away. Humiliation tearing at his throat, he swallowed the contempt and its effects began to house themselves inside of him.

Connection and disconnection

My brother on my Uncle's shoulder, me in the park… I chew on the long feathery grasses that sway in the wind, shimmer in the sunlight; I thought I was eating the sunshine. (Saira as a young child)

These are the happiest times I can remember. I felt connected to the world and myself when I was with my uncle. My adoring view of him was in part due to the way he invited us into other worlds of music, song, and nature. I was full in the stillness.

He and the white English woman that he loved and hoped to marry sat together in the ordinary familiarity of the train carriage. He loved train journeys, watching familiar landmarks appearing and disappearing from view as the train juddered out of the station. This defining journey turned bad for him as a heavily built white man sitting across from him began to mumble and then roar at how "his kind" had defiled his partner's virginity, taking something from him—from all white men. “The pain of past racist violent blows he had experienced did not compare in their intensity to this expression of violent hate that was coming at him now.” The torrid racist expletives bounced around the walls of the carriage, exposing and belittling him.

The emotional impact was initially shock; he described feeling a numbing paralysis in his body. As they decided to escape and disembark at the next station, he wondered how his body would support him, when it felt so insubstantial. Time slowed to a stop as he felt the flush of disgrace and helplessness overcome him. The other travellers in the carriage looked on, some with interest, others with avoidance; did they find themselves agreeing with this man's hate? Is that why they did not protest? Or was it fear that this contempt would be directed towards them?

He felt his girlfriend was defiled in her association with him; it was as if she was contaminated by the colour of his skin into something more sexualised and objectifiable. They never spoke of this incident, but it was the beginning of the end of their relationship, because in that long moment, amongst all of the shame and emasculation, was her witness of his diminishment.

When he moved to Canada, he left me too, but more poignantly he left himself. The racism that had infused his world disconnected him from himself and those around him, such an unspoken cruelty when contact and connection was the gift he gave me.

"Racism was not the main reason I left"

I journeyed to Canada to meet my uncle, 30 years after he left England. To engage in a dialogue about something so personal and painful leaves me anxious and curious. I am researcher/niece/ psychologist/ therapist/child all at the same time. These multiple selves offer a dynamic shifting of one into the other, each adding a new voice. He is a stranger to me now, but there is a strong memory of childhood intimacy that attracts me to him. Yet I feel shy. I want to hide away in my researcher/therapist self to anchor me, but this dialogue requires courage to be intimate and honest. I wonder if I am capable.

We sit in his basement with a scratchy blanket on our knees, as I anxiously wonder if my new tape recorder will work. At the same time I wonder how my husband is, as I left him making polite conversation with my uncle's wife upstairs. Are they wondering what we are discussing downstairs?

He says slowly, "No, racism was not the main reason I left." My long-held assumption momentarily floats away. What does this mean now? He tells me he came to Canada to begin again: a new life, a new job. He does not want to be perceived as someone who cowardly ran away. Did my questions about his leaving further diminish him? It seems to me that he needs me to clearly understand his reasons for leaving. I feel a need to honour this, while still I wrestle with what this means for me and for him. Self-doubts creep in… Were my assumptions off base? Was I too committed to these assumptions before hearing his version of events?

Acts of reinvention

It is as if racism had blighted his life for many years; the hurt and the vividness of the memories live on and become ignited as he speaks of it after 40 years. He says he felt like a victim, which left him terribly alone and split him apart. He says, "I don't know if white people could relate, or appreciate the racist experience. You have to be on the receiving end of it. Only our people could understand this shared experience, to know what it is like to be spat at, to be hated. I do not know if they would be able to really make a connection. You have to live through something like that."

He became vigilant and wary of whiteness. It has been 30 years since he experienced such overt racism, yet he still sees all white people as outsiders. I can psychologically understand this but emotionally it does not fit for me. I cannot feel this way because our narrative experiences are different.

His own racism remains unacknowledged. He does not see it as racism, but rather as a wish to preserve the integrity of his culture, with the lines drawn in a colour-coded way. Whiteness must be kept out or at best treated with a large dose of scepticism. I try to wonder with him whether his racism precedes or emerges from his own racist trauma. How does whiteness threaten his cultural and religious beliefs? I try to get into a dialogue about this, but he is rigid and fixed in his ideas just like those who hated him for what his skin represented.

It seems these feelings became more pronounced when he began to reinvent himself. This reinvention of himself, he believes, was born from the isolation and emasculation of the racism that penetrated him. He needed to recreate and recapture a self by finding value in his culture after coming from such a place of shame. He found a resilience and strength that came from his community and culture, mainly from his spiritual connection to music. He made these connections to preserve a self that had been discounted. “He felt embraced and accepted in this place… a place to stand with his hurts.”

The more toxic effects of the shame and indignity went away, yet he remains mistrustful of anyone who tries to get too close. This mistrust includes me and I realise there is an awkwardness that sits between my uncle and me that does not go away.

I felt deeply hurt and angry by the racism he described, but more so that he had nowhere to take his woundedness. I begin to wonder if I in some way represented the England he had to leave behind. How do I speak of my anger at being left and feeling forgotten? I try to talk about this but the words do not come out right and they stick in my throat.

He reads the narrative that I have taken from him and insists he has nothing to add or

change. "It's an accurate description and it's interesting to know of you through doing this," he says. He sees my expression of sadness at his leaving England as his failure; I cannot quite find the words to explain how much he meant to me that made his leaving so agonizing for me. Is it too late? It is as if he has already turned away. His world seems to exist of outsiders and insiders. I think I begin to exist somewhere in between for him, as the residual effects of this trauma mean that he remains far away.

As we are preparing to leave, he shows me photographs he took of me as a child from an album as closed as his past. He tells me that his happiest memory of those times was the crinkly smile that I saved for him as a child. Despite this, I feel heartbroken all over again.

Healing some wounds

As I listened to and then transcribed my uncle's story, he maintained power over his words as he revised and amended his descriptions. I wrote the narrative piece that he had editorial control over. He was able to acknowledge his loss of self due to racist trauma, but the recognition of his resilience and his sense of agency was made real by the act of linking events to his act of self-expression. I noted that his resilience was activated to survive adversity. He expressed this resilience in the form of forgiveness: "I have survived so much and learned that forgiving others (racists) has helped me have another chance at life."

I grappled with the need to see my uncle as a survivor and hero, and preserve my continued idealisation of him. I can see how he continues to bear terrible scars that I naively believed could be bridged by this research. Yet, what was healing was making sense of these previously unspoken trauma experiences that we were no longer compelled to exclude, a behaviour that was normalised within the family. These narratives brought validation and the possibility of new attachments. However, this narrative was not entirely healing with orderly resolutions.²

My uncle's residence abroad meant the dialogue we were able to share in person was concentrated over a week and followed up by telephone and email contact. I felt disappointed that I did not have more time with my uncle in the research, but is this not how I began, lamenting the loss of my time with him? He seemed unengaged after a time and denied wishing to change the material in the text after the first few revisions. He said there were no negative effects of the research on him, but I wondered if he felt discomfort at our increased contact. I have now not heard from him for a number of months and suspect he wishes to re-establish some distance and renewed separateness. I have honoured this for now and so I continue to feel his absence every day.

In writing about racism and trauma, I am writing about my life, family, and community, which is quite charged. I have become careful not to contribute to the splitting in the world of racism, or in believing that the racist monster prevails and that those of colour are helpless and victimised. I have found that by opening up categories and sitting in between these splits and divides that I can see the situation more clearly. I cannot simply hate the racist, because I have loved those who have voiced racisms of their own, like my father and my uncle. Similarly, I have been touched by this work, wrestled with forgiveness and humanness, and appreciated that the resulting embodied awareness may go a long way in creating connections across divisions.

Coming home again

A gang of boys corners me and threats me, but they become half-hearted and change their minds because they are unsure of where to locate my colour or ethnicity. I feel initially relieved and then angry that they do not recognise me for what I am. I try to call them back. (Saira, eight years old)

I go to Mexico, Mexicans claim me; in Italy they speak to me in Italian that I grope to understand; in Paris, the police stop me and assume I am an Arab; and in India, they do not know where I am from. A client comments to me about how much she despises Pakistanis and how relieved she is that she can speak openly of her contempt, as it becomes clear that she thinks I am from Jordan. (Saira as an adult)

My family would joke and say, "You may as well be white." This was not just a form of shadism, but to emphasize my difference from them. My skin colour is not easily identifiable, yet I am kept othered and my difference is imagined. All of this points to the idea that skin colour is unimportant in itself, but the projections, internalisations and consequences it carries do matter. We cannot ignore or minimise this impact as sometimes it becomes a matter of life and death, be it physical or psychological.

I internalized the shame of my cultural difference, and my Asianness seemed inexplicably both a bad and a good thing. I have struggled with the shame that glued my insides together and writing this has been a battle of sticking and unsticking those glued parts. This work gave shame a place to speak from. I have wrestled with finding my voice and I recognise that the humiliation and guilt at being a witness to racist trauma has been like an eighteenth-century corset encasing me and defining my shape. I have reframed this narrative as one of transgenerational and intergenerational racist trauma. I intimately feel the terrible loss and abandonment by these significant males. Now I am less bound up and defined by this trauma. I am not sure, though, where I go from here.

The effects of these traumatic absences have left emptiness in my life, and acknowledging the pain and sadness of missing these men who were once vitally present has changed something between us. I am able to love them just as they are in the hope that there will be moments when they will be returned to me, which happens every now and then with a smile a word, a gesture, or a memory.

I am changed in other ways, as well. This is best illustrated with an ordinary encounter of getting into the same taxi with four years in between.

Sometime during the beginning of my research, I slide into the taxi as I register the racist hate in the taxi driver's eyes; he glares at me. I am surprised and uncomfortable as I inhabit his confined territory, his taxi seems like a closed-off, taut world of hate and revulsion that leaves me unsettled and unsafe but reminds me that this work means I have to be able to dwell in this place. (Saira)

Four years later, my research is in the final revision process, and another taxi ride…

After spending an afternoon revising my research, I am cooking rice with my mother… the aromatic Indian herbs and spices envelop me… nice to be home again. I feel a mixture of self-consciousness and pride about my project. I get into the waiting taxi preoccupied with these very thoughts. I look up and slowly recognise it is the same taxi driver. He recoils from me, as if I am able to pollute and invade his being. I look at him steadily, filled with curiousity. Where does this contempt come from? What does it do to him? I experience what I can only describe as warmth, expansiveness and loving compassion for him. I happily beam at him because he is representative of the journey that has reshaped me. I do not experience his hate as a terrible wound. I feel no fear. I am not shamed. In that moment and for a long while afterwards, I feel completely free. (Saira)

The implications of autoethnography for psychotherapy

I think about autoethnography interacting with psychotherapy not necessarily as an approach in itself or a distinct form of therapy, but as a set of attitudes towards self and other which can facilitate the creation of an internal bridging and connection. This means that rather than having a set of explicit tools to work with racist trauma, therapists are required to develop and seek out heightened processes of awareness and embodied ways of being. This awareness migrates into practice in a more accessible and less defensive way by helping the therapist engage in highly sensitive and profoundly painful areas of the client's story through varied subjectivities and reframing processes.

The interaction between autoethnography and psychotherapy is also a journey of personal discovery and a self-reflective process. This work became a therapeutically available surface that I could work on inside and outside my own therapy, transforming the relationships with those in research that I love.

For myself as a therapist, “this journey has enhanced my capacity to be more accessible and present in my client work”. I also feel more able to generate conversations and dialogue about racist trauma and the racial experiences of my clients in the therapeutic relationship. Through disentangling racism within myself and others, I find there is an encouragement of an alternative state of awareness that is more self-reflective, and less guilt-ridden and avoidant. This process produced a deepening of understanding and processing of self-generated and self-defined identities that was empowering as it undermined racist and racial stereotypes and helped me to encourage my clients to do so. I think I am better able to seek out such disconnections and attempt to create a worked for connectivity where I can be less constrained in my language and thinking, having developed the capacity to be more available to enter into the webs of racialised discourse in my clinical work and in myself.

Autoethnography can be a profoundly useful way of accessing memories of complex racially traumatic experiences that may be implicit and built upon sediments and layers of racial slights and injuries that contribute to psychological grief and social maladjustment. Skin colour plays an important part in structuring of the world, and the colour coding of the self and psyche. As therapists, we are called to work through this for ourselves and our clients; otherwise it will reappear as the therapist's unexamined countertransference and will perplex and confound the therapy.³ The engagement with otherness takes us out of what is seemingly familiar and encourages us to travel to alternative places within ourselves. It is from this position that I wish to dissolve detachment, isolation and marginalisation to create connections and healing.

Refuse to wither and die

These stories have found a home inside of me, and I realised that I have been writing this story for the whole of my life. Now that it is committed to paper, I can see how it has helped me to love.

Notes

2 Franks, A. At the Will of the Body: Reflections on Illness (Boston, Houghton Mifflin, 1991).

3 Dalal, F. Transcultural perspectives on psychodynamic therapy; Addressing external and internal realities in The Journal of Group Analysis, 30 (London, Sage publications 1997) p. 203.

4 Bronson, P. Why do I love these people: The families we come from and the families we form (London Harvill Secker, 2005).

For further information on authoethnography:

Ellis, C. The ethnographic 1, a methodological novel about autoethnography ( NY, Altamira, 2004).

Gottschalk, S., Banks, A. and Banks, S.T. Fiction and Social Science, By Ice or Fire, (Walnut Creek, Altamira, 1998).

Getting Off to a Powerful Start in Couples Therapy

Posted on by rezendevknowfully.com

I am pleased to offer you this lesson from my online couples therapy training program. It has been adapted from a lecture, and includes commentary from Michelle, our moderator, as well as comments from the audience. This will give you a glimpse into some of my principles for “Getting Off to a Strong Start” in Couples Therapy.

In this article, we’re going to focus on the following points:
  • Getting Off to a Strong Start
  • Three Types of Goals and Effective Goal Setting Questions
  • Six Essential Elements of Early Interviews
  • Developmental Change vs. Behavioral Change
  • Identifying Vulnerable Feelings
Speaking of “strong starts,” let’s get going on our lesson…

Getting Off to a Strong Start

Ellyn: Today, we’re going to talk about getting off to a very strong and powerful start in couples therapy. And I’m going to teach you principles that have to do with both your mental set, so how you think about what you’re doing in those early sessions and how you position yourself with clients; and I’ll also be teaching some specific how-to’s. But this is not a cookie-cutter approach.
 
You will be looking at integrating pieces of this in the way that works for you, and also integrating pieces in terms of what is best for the kind of couple that you’re working with. I’ll highlight some of the pieces that work better with some couples and some that work better with other types of couples.
 
First, getting off to a strong and powerful start means you being a leader. By the time you’re finished with this course, “I want you to feel like you are a leader—that you are active in your work, you’re not reactive, and that right from the beginning you’re getting the couple’s attention.”
 
You’re establishing yourself as somebody who is strong, and somebody who understands and is able to help them. Also, they’ll know that they’re going to do the work and that coming to therapy is not waiting for you to wave a magic wand. If they will do the work, there is hope they can get out of the conundrum that they’re presenting to you.
 
The tone that you set from the very beginning is crucial and is based on the answers to the following questions: Do you see pathology? Are you looking for pathology or are you looking for developmental stuck places?
 
Seeing impasses as developmental stuck spots will help you and your couple be more optimistic. You’ll be able to inspire them that they, in fact, can overcome and can get out of their negative cycles.
 
Your style and what you pay attention to will indeed determine the direction of the therapy. I am always thinking, “How do I challenge my clients to develop themselves and to look at the development of themselves as something that is positive, that’s exciting, that can be rewarding and not something that’s a drudge or way too difficult for them to do?”
 
There are predictable reasons for why relationships fail. The primary issues that most couples struggle with are:
  • There is a lack of development in either or both of the individual partners.
  • They have a repetitive history of re-triggering emotional trauma in each other and not repairing it.
  • They don’t have the ability to repair when they hurt or do damage to one another.
  • They lack skills or knowledge.
Couples often don’t understand why they are struggling. They think that there’s something wrong with them or something is inherently flawed about their relationship. When you are thinking about the couple in front of you, the goals that you are going to set fall in one of three main arenas:
  • The couple is coming to you for change, growth and development.
  • They are coming to dissolve the relationship, to be able, in fact, to say goodbye to one another, to go through a divorce or separation, to get help with the kids and the parenting and in the process of separation to resolve any resentment so it doesn’t fester and impair their future relationship or their parenting.
  • They need help making a decision. A common one is, “Should we stay together or separate?” Maybe one wants to have a child and the other one doesn’t, or there’s some kind of move or job promotion situation that’s creating enormous difficulty about whether they’re going to stay where they are or move. And of course, there is, “Shall we get married or shouldn’t we get married?”
You can slot each of your couples into one of these three areas as you begin to think about goals that make sense for them.

An effective couples therapist will, over time, become both decisive and incisive and be able to sustain positive momentum. So when the couple starts backtracking, or when they start getting bogged down, those are times that you want to intervene and intervene quickly so that you can keep the momentum moving forward in a positive way.
 
It is absolutely essential that you not get stuck in their negative cycles or allow their negative patterns to go on for a long time in front of you. You only need to see it briefly so you understand what they do.
 
Michelle: At that point, Ellyn might you point out the cycle that you’re seeing and explain it back to them?
 
Ellyn: Yes, I will point it out, because having a grip on the negative cycle is the beginning to disrupting it. It’s the first step of changing it. So as long as you’re sure that you’re not doing it in a negative, judgmental or critical way, pointing out their negative cycle can always be an effective intervention. What we’re going to look at a lot is the essential elements of early sessions and the whole process of goal setting.
 
Too many couples ignore their shortcomings and do not seek help until it is too late. Therefore you have people very often coming in to see you when they think it’s too late, when you might wonder if it’s too late—and indeed, sometimes it is too late. But the patterns have been going on a long time, and that’s why getting their attention and assessing with them whether they’re there to dig in and do the work is important. If the couple is ready to dig in and do the work, one of the things you want to ask yourself is do you have the time to see them? Do you have the time to work with them?
 
When I do a first session, I never do it shorter than a double session. It’s almost impossible to assess a couple, in my opinion, in a 50-minute hour. You’re talking about assessing two individuals and the relationship. Most of us would never spend just 25 minutes assessing an individual client, so I’m always asking people to come for a double session to begin with.
 
Usually when I’m getting started with a couple I want to see them frequently. I want to see them for a minimum of two-hour sessions, and this is especially true for those that are disorganized, hostile, fighting or on the verge of splitting up. It’s not a good idea to accept a couple who is in a bad situation if you’re not going to be able to make time for them in your schedule.
 

Essential Elements of Early Interviews

  • Make contact with each partner
  • Understand the problem
  • Name feelings being experienced
  • Empathically embellish those feelings
  • Describe the destructive cycle, but…
  • Set a clear direction… a way out (including delineating the importance of containment, repair and autonomous change)
  • Define your role and your expectations for them
These essential elements are spread out through the first couple of sessions. The first essential element is making positive contact with each partner. That is, establishing the relationship and being able to understand the problem from each partner’s perspective. Sometimes it takes more work to understand it from one partner’s perspective than the other.
 
As you’re listening, name feelings that you’re hearing that are being experienced. Be able to empathically embellish them, to describe the destructive cycle and point out a clear direction for change. Delineate the importance of each partner containing their reactivity. Another part of the early sessions is defining your role and expectations for them as clients.
 
Making contact is something every therapist learns in psychology or counseling 101. One way to assess how hard it’s going to be to make contact is to ask your clients when they first come in, “How do you feel about being here even though we haven’t done anything yet?”
 
Their responses to that question will let you know who’s going to be easy and who’s going to be difficult to connect with. It’s a common situation for one member of the couple to say, “I’m so relieved. I thought we would never get here. I’ve wanted to come for a really long time. I’m glad we’re here,” and for another member of the couple to say something like, “I don’t believe in therapy. I didn’t want to come and I think this is just a waste of time.” It’s pretty obvious who’s going to be the harder partner to make contact with!
 
Other aspects of making contact include:
  • Being friendly, kind and interested.
  • Appreciating their anxiety. Couples therapy is more unpredictable than individual therapy.
  • Acknowledging lack of control over what the other partner says or does.
  • Hearing their story in the context of the structure you provide.
  • Giving lots of positive strokes can be highly valuable in the early sessions.
Particularly, I like to highlight areas where I see a partner taking a risk, where I see them making themselves vulnerable and where they’re stretching themselves. I will do a lot of positive stroking of those aspects rather than focusing on anything that I think is contributing to their cycle. I also think it’s helpful to appreciate their anxiety. “Couples therapy is harder in many ways for partners to come to than individual therapy. They think to themselves, “It’s unpredictable what my partner is going to say about me.”” In individual therapy we have complete control over that, but in couples therapy they’re often anxious about what’s going to be revealed.
 
Another thing I would let the couple know is that I will provide a safe structure and context for them to tell me their story. So if the partner keeps interrupting or keeps saying, “No, it didn’t happen that way,” I’ll say, “Wait, stop. I want to hear the story from each of your perspectives.” I want to get the whole picture and not let them be interrupted by the other one.
 
Michelle: Can you say a little bit about the beginning of the session when you ask them the question, “How do you both feel about being here?” and one person seems motivated and the other one not? Can you tell me what you do with that information? Do you orient the sessions differently?
 
Ellyn: Yes. When one person says they’re motivated and the other person says they’re not, I know it’s going to be essential for me to make contact with the partner who’s not motivated. I’m going to be especially observant about how I make a connection with that partner.
 
“Sometimes making that connection might be as simple as saying, “I’m glad that you came in today. Do you know that you can come to couples therapy and not have to change anything about yourself?”” Because they are so afraid that the focus is going to be on them and that they are going to be required to change. You will always have better buy-in for homework with the motivated client. So I am less likely to give the unmotivated client homework until I have a stronger connection with them.
 
I’m working to understand the couple’s problem both cognitively and affectively. The problem that they are bringing to me is usually understandable based on a couple of things: It’s understandable and predictable based on the attachment style of each partner. It’s also predictable based on the developmental stage. For example, if the couple has been together more than two years and they’re still stuck at the symbiotic stage, that’s going to be a problem, and that’s going to require them to be able to work in the area of differentiation.
 
The problems that they’re coming to you with will be a function of their arrested development—and once you have a full understanding of our Developmental Model of Couples Therapy, you’ll be able to describe that to them. It’s also predictable based on how long the partners have been together. A couple that’s been together just six months is not going to have any effective differentiation and I can’t possibly expect that they would.
 
On the other hand, with a couple who’s been together for 10 years, has a chronic history of conflict avoidance and has never differentiated, I know that it’s going to take a lot of risk, push and challenge for them to get out of that if they’re going to change the core dynamic of their relationship. Part of understanding the problem is asking helpful, insightful questions. In that process I want them to begin to think more deeply about what they’re saying. I also want them to understand the problem from an emotional or affective standpoint, so I’m going to be feeding back a lot of their feelings as well.
 
Here is an example of how you might describe a destructive cycle. I made it a little more complex than you might with most couples just to put a variety of both feelings and behaviors into it. I might say to Sally, “When you feel hurt by something that Ted says, it’s difficult for you to tell him that you’re hurt or to request an apology. Instead, when you feel hurt, a part of you wants to hurt him back so you tend to criticize him.”
 
Then to Ted I might say, “When you feel criticized by Sally, your tendency is to disengage and withdraw. Sally then ends up feeling lonelier, and instead of the two of you being able to repair and reconnect, the cycle keeps escalating. It keeps repeating and each of you is left in pain.”
 
Then I might ask them how they’re responding to what I’ve just said. And I look for their non-verbal cues, as well, to see if they agree with me. Are they connecting with what I’m saying, and does it make sense to them? Then you are able to not only connect with their feelings, but empathically embellish on them even more. The more you empathically embellish on your clients’ feelings, the more understood they’re going to feel, and the more able you’re going to be to confront that partner later on.
 
I want to have those moments of good empathic connection early on. Those might come from commenting on their deep loneliness or their helplessness, or you might say to a client, “You have tried and tried. You’ve tried everything and you’ve been really stuck, because nothing at all is changing. In fact, it looks to me like at this point you’re beside yourself with frustration and you wonder if there’s even a way out.”
 
A lot of people will nod their heads or begin to cry. They really know that you know how hard it has been for them, because they have been trying. And they didn’t know what to do. They didn’t know how to get out of that stuck position. So they might feel like you get and understands them.
 

Goal Setting

Michelle: A lot of couples at that point will also say, “Yes, you’ve got it.” Their anxiety will come up and they’ll say, “Okay, so what do we do about it?” And they’ll want to move fast at that point.
 
Ellyn: Right. And because they want to move fast, that can actually be a good bridge to goal setting. It’s not enough to be understood. I know that it is going to take change on the part of each person to change the dynamics between them. So I’m going to spend some time now talking to you about goal setting.
 
When you hear the words “set goals,” it’s so prevalent in our culture that it sounds like it should be something easy to do. And yet “to do good goal setting with couples is an incredibly sophisticated and complex skill that takes time.” It’s usually integrated into several sessions. It’s not something you can do in just one session unless you have an incredibly insightful couple who’s been in therapy before and they know what they want to do.
 
The more disorganized the couple is or the more hostility there is, the more challenging it’s going to be for you to arrive at effective goals. And I want you to come away from this lesson actually being able to reflect on the couples that you’re seeing and really ask yourself, “In which of these cases do I have strong goals that make sense and that will help move this couple forward?”
 
If your answer to yourself is, “I don’t” for any particular couple, then you can back up and say, “This is a good time to reassess. Let’s see what we can look at as the next goals to undertake.” One of my favorite cartoons is of two couples talking in one couple’s living room. One says to the other, “The work being done on your marriage… are you having it done or are you doing it yourselves?”
 
The reason I love this cartoon is because so many couples wish that the work would be done for them. They come in either hoping that you have a magic wand that you’ll wave to change their partner or that they can sit back, wait and watch for their partner to change.
 
That’s why the skill of getting each person invested in changing something about themselves that will move the relationship forward means that you’re dealing usually with character issues in each partner. You’re also dealing with motivation issues and possible resistance to therapy issues.
 
What is an effective goal? To me an effective goal is one that requires an individual to do some self-reflection and self-confrontation. And you’re asking the couple about their values and you’re implying that a change is needed in their pattern of reactivity. You’re asking them to self-select some new standard of behavior and to hold themselves accountable to whatever the change is that they are working on.
 
One way to think of the change needed in their reactivity is to think about what this person needs to stop doing in order to create the space for change to occur. You might think about it in terms of what this partner needs to start doing, or what both of them need to do differently that would enable them to take risks and move themselves forward.
 
Michelle: Ellyn, do you ever explain to your couples the concept of making a shift within themselves? I think that’s counter-intuitive to most couples when they come in, because they believe the problem is with their partner.
 
Ellyn: Yes, I do, and one of the things I talk about with some couples is the principle of autonomous change. What I mean is, not saying, “I will only change if you change,” which is a common thing that partners do—they tie their changes to whatever the other person does. I tell them, "If you make changes regardless of what your partner does, you will be able to have a very rich learning opportunity, because as you make changes, you’re going to see what unfolds; you may be very pleasantly surprised by the changes that start to occur, or you may find that your partner does nothing." Saying something like that is actually directed at both partners, including the partner who may be inclined to do nothing because they’ll realize that it’s going to be observed if they, in fact, are doing nothing.
 
A good solid goal will be clear and it will contain action and behavior. You and I know some about the intrapsychic change that’s behind any particular behavior, but by putting it in behavioral terms for them it becomes concrete and somewhat measurable.
 
When you’re looking for these changes in behaviors and actions, you’re also looking at whether the person has a real motivation to accomplish them. If there’s no motivation to change, it’s a useless goal and not one that I want to accept.
 
If somebody says to me, “I should pick up more clutter. I should pick up after myself,” I might say back to them, “I wonder how badly you really want to do that. Is that something you want for yourself or something that you think somebody else is telling you that you should do?”
 
Usually they’ll say, “I’m getting so much criticism from my partner that of course I think I should do it.”
 
And I might say back to them, “I wonder how picking up would be helpful to you. Is there anything that you can see that would motivate you to begin to pick up more?”
 
That can go into a 20- or 30-minute conversation until you get the piece of motivation that would genuinely be motivating for that partner to start to clean up more clutter. You’re always looking for goals that are individually focused, not dependent on what the other person does. The goals can be contradictory, and by that I mean even as extreme as one partner saying, “I’m here to get help with ending this marriage and I’d like to do some of the steps that are involved to end this marriage in a good way.” The other person might say, “I’m here to build a positive marriage and I do not want this marriage to end.”
 
Even though these are such contradictory directions that will create anxiety in the room, they are genuine for each partner. And then you can figure out what that literally means for each of them to be able to carry those goals out. Always remember that knowing the presenting problem is not a goal. Typically, couples will say things like, “We have a communication problem and we need to communicate better.” Nothing about that is a goal.
 
“Don’t assume you have goals and objectives when you know the presenting problem.” When you ask most couples why they are there, the typical response is a description of their partner’s failures, shortcomings and things they do badly. They want to get relief by having their partner make the necessary changes. It’s very rare for them to describe to you what they need to do in order to strengthen the relationship.
 

Homework Assignments

Over the years I’ve challenged myself to come up with lots of different ways of setting goals with couples. I’ve used lots of different kinds of questionnaires, and I’m encouraging you all to experiment with what works for you in your practice and what works with different kinds of clients.
 
One very simple form instructs them over the week to go home and answer the following five questions:
 
What type of relationship do you want to create? I give them examples to help get them started: “You might say you want to create a loving intimate relationship, a relationship with a lot of team work. You might say you want a more companionate relationship.”
 
How do you want to be as a partner? This is asking for a frank self-assessment. How do they in fact want to be? Do they want to be somebody who makes time for the relationship, somebody who wants to negotiate solutions that are working for both people? How do they want to be in their day-in-and-day-out life?
 
What do you want to learn about yourself or the relationship? This is a request for cognitive knowledge that each partner would like to obtain. An example would be understanding your patterns as a reflection of some early childhood experiences.
 
What do you want to stop doing? Common examples are blaming, name-calling, withdrawing, or avoiding conflict.
 
What do you want to start doing instead? In evaluating responses to this question you are looking for constructive behavior that each partner will do when they stop doing the behavior that is contributing to the negative cycle.
 
Before I have people take it home and fill it out, I give them some examples of answers. A lot of times people will say things like, “I want to stop blaming and criticizing. I want to start giving my partner more positive strokes. I want to start saying what I appreciate and I want to start looking for more win-win resolutions.”
 
I ask them not to share their answers with each other until they come back the following session. Then I have them read their responses to each other and we work at refining what makes sense as a goal. You can also use this form to assess their progress as you go through the next few weeks.
 
Here’s another questionnaire I sometimes give couples as homework:
  • What do I want to learn or understand?
  • What do I want to stop doing? 
  • What do I want to start doing differently to build a more loving, giving relationship? 
  • What is most urgent for me?
One couple, Cindy and Jack, answered these questions. When they came back here’s what they had written:
 
Jack said, “I want to learn where my blind spots are that come from my family of origin. I want to stop withdrawing, and start being less defensive. It’s urgent that I be more able to do what I want to do.”
 
Cindy came back and said, “I want to learn about where I get stuck in loving my husband. I want to stop being like his mother and accept that I am his equal. It’s urgent that the abundance in our relationship continue.”

What do you think is wrong with these goals?
 
Participant: I think that neither one of them actually said something concrete about what they could do. They talk about what they want to happen, but they aren’t coming up with anything concrete that they could do.
 
Ellyn: That’s right.
 
Participant: “Learning my blind spot” might be necessary to understand and to stop withdrawing, but under what circumstances or how would he do that?
 
Ellyn: That’s right. There’s nothing concrete here; it’s vague. You don’t get a sense of what they’re going to do. With Cindy we don’t have any idea of how she might be like his mother and why it would be important for her to stop being like his mother. “When you ask the question about what’s most urgent, urgent usually has a timeline, not something so open-ended as wishing for “the abundance in our relationship to continue.””
 
For Jack, you can’t picture what he really means by being less defensive. And when he said that it’s more urgent that he be able to do what he wants to do, I wanted to know what kinds of things he wants to do. When I pursued that with Jack, he felt like it was completely impossible to spend any of his non-work time away from Cindy. When we began to define it further, one of the things that was urgent for Jack was to have the ability to have some individual time alone each week. And then it went even further that he wanted to be able to take some golf lessons. So we were getting into something that could disrupt the intensity of this enmeshed, conflict-avoiding couple.
 
Next Cindy started to refine her goals and it shifted to, “I want to understand why I feel depressed when Jack and I disagree. I want to stop walking out of the room when we have a disagreement. I’d like to learn how to talk through a conflict from beginning to end, and be willing to listen to Jack’s side. And it’s urgent that I stop catastrophizing conflict to mean that the marriage is over.” She was a very conflict-avoiding partner who was fearful. She would become extremely anxious at any moment there was conflict and because she would get so anxious she would leave, disengage, or get out so that the conflict couldn’t surface. She was terrified that conflict would end the marriage.
 
I talk about the principle of character a lot with couples: when you’re in a committed partnership, it tests your character. It tests your character in a way that most other relationships don’t test your character. It’s easy to be nice, warm and loving when you fall in love with somebody. And it’s easy to be nice, kind and loving when everything is going right. But when your partner acts like a human being, do you get indignant?
 
Do you get incensed that your partner is human and has normal flaws? Can you accept that maybe your partner gets a little anxious and testy if they think you’re going to be late for an airplane? Or if they’ve had two or three cranky kids all day long and feel spent, when you walk in the door and they don’t say “hello” to you in the best possible way, can you give them a break? Can you be forgiving?
 

The Three-Circle Exercise

To finish up this lesson, I am going to give you one more concrete way to set goals. At the end of the article, you will find a diagram with three circles, called “Uncovering Vulnerability and Shifting Negative Patterns.” This three-circle exercise is a way to establish more effective goals.
 
I ask partners, “When you are at your worst, how do you act with each other?” Sometimes I’ll even brainstorm a list and put it on a white board that I have in my office. We’ll create a little list of things like “get critical, blame, yell and break things.” Encourage them to tell you what they do when they’re at their worst. I choose four of the items in this list and write them in the circle diagram.
 
The next part is tricky. “Ask them to tell you the emotion that is hardest for them to show to their partner when they’re at their worst. When they’re at their worst the way that they act is covering a more vulnerable feeling.” In this particular case one client said, “When I puff up and get grandiose I’m covering up fear.” We worked to get to that. “When I break possessions I tend to be hiding the fact that I feel a lot of shame. When I scream and escalate it’s usually covering up the fact that I feel inadequate and helpless. When I yell, I don’t want my partner to see that I’m feeling very vulnerable or fearful.” Write four of their answers in the second circle diagram.
 
Then circle number three is designed for what they want to do instead of these things. When they’re at their worst, what do they want to shift that will make a definite change in the relationship? And here what that client said was, “What I want to do instead is I want to say that I’m frightened, be able to admit that I did something that may have been stupid and unthinking, and know that that’s just human. I also want to be able to take deep breaths and be able to take a timeout.” And the last one was, “I want to be able to say ‘I don’t know how to help you now,’ to my wife.”
 
I sometimes ask clients to take these diagrams home and post them somewhere that feels comfortable: somewhere they can look at them and refer to them. It gives you a wonderful tool when they come back and they’re talking about having had a difficult fight or difficult interaction. You can ask, “Where does it fit on here? Were you able to stretch at all? Were you able to do something new? Were you able to take a risk? Were you able to show your fear? Were you able to show that you felt vulnerable?” This is a powerful way to set some effective goals.
 

Conclusion

One way to know if your goals are effective is to see if the partners begin to grow and change. Over time they’ll assume new roles with each other, new responsibilities, and new ways of being. And the relationship will begin to move through its stages of development and become increasingly more interdependent.
 
I want you to ask yourselves, “Is there noticeable change in the couples and partners I’m working with or are they just spinning their wheels?” If they are spinning their wheels I would say it’s time to go back and reset goals with them. Couples work is one of the most rewarding, wonderful things you can do with your time and it will always challenge you to stretch and grow. It is not for the faint of heart.
 
If you would like to learn more about the couples therapy training program from which this lesson was excerpted, please go to http://www.couplesinstitutetraining.com/developmentalmodel. Or if you’d like to read a handout to prepare your couples for being in couples therapy please go to http://www.couplesinstitute.com/freehandout.