Category: Depression

Keeping or Ending Commitments

A life without interpersonal commitments is a life untethered. Notice that I did not say a life without “relationships,” which can be fleeting. Commitment comes with obligations and an open timeline. It often involves sacrificing immediate needs. The person I am permanently committed to knows I’m invested in their well-being and makes life plans accordingly. However, if I’m in an intimate relationship that does not involve a permanent commitment, all I owe the other person is a respectful goodbye if I’m ready to move on. The same for most friendships: I don’t owe friends years of hard work (and maybe therapy) to maintain a relationship that has become hurtful for an extended time. In other words, committed relationships have an ethical dimension that simply being in a relationship does not. In the world of therapy, we have barely begun to take the ethics of commitment seriously as we work with our clients. To make this point more charitably: the therapy literature is rarely explicit about the moral dimension of commitment in how we work with clients in relationship difficulty. (There is scholarly work outside of therapy on interpersonal commitment—for example, Stanley, 2005, and Tran et al., 2019.). In this chapter, I focus on how therapists can support (and how they sometimes inadvertently undermine) commitment in two important relationships: marriage (by which I mean a lifelong, intimate relationship) and adult relationships with their parents (particularly as the parents become frail).

Therapy and Marital Commitment

Shortly after I finished writing Soul Searching in 1995, the therapy blind spot with the ethics of commitment came home to me in the form of stories I received from married people who were close to me. In telling their stories, which they gave me permission to do, I am aware that it’s possible that they misunderstood their therapists or did not recall the details correctly. However, they are all credible people to me, and their stories fit a pattern I have heard from many clients over the years about their experiences in therapy. This pattern includes stories from fellow therapists about their experience as clients. In other words, although I can’t vouch for the accuracy of any particular story, I can be confident in the overall trend.

Monica, a relative of mine, called from another city to say that she was stunned when Rob, her husband of 18 years, announced that he was having an affair with her best friend and wanted an “open marriage.”(1) When a shocked Monica refused to consider this alteration in their marriage, Rob bolted from the house and was found the next day wandering in a nearby wood. After 2 weeks in a psychiatric hospital for acute psychotic depression, he was released to outpatient treatment. Although during his hospitalization, he claimed that he wanted a divorce, his therapist urged him not to make any major decisions until he was feeling better. Meanwhile, Monica was beside herself with grief, fear, and anger. She had two young children to care for, a demanding job, and a chronic illness diagnosed 12 months before this crisis. Indeed, Rob had never been able to cope with her diagnosis or with his job loss 6 months after that.

Clearly, this couple had been through huge stresses in the past year, including a relocation to a different city where they had no support systems in place. Rob was acting in a completely uncharacteristic way for a former straight-arrow man with strong religious and moral values. Monica was now depressed, agitated, and confused. She sought out recommendations to find the best psychotherapist available in her city. He turned out to be a highly regarded clinical psychologist. Rob was continuing in individual outpatient psychotherapy while living alone in an apartment. He still wanted a divorce.

As Monica recounted the story, her therapist, after two sessions of assessment and crisis intervention, suggested that she pursue the divorce that Rob said he wanted. She resisted, pointing out that this was a long-term marriage with young children and that she was hoping that the real Rob would reemerge from his midlife crisis. She suspected that the affair with her friend would be short-lived (which it was). She was angry and terribly hurt, she said, but determined not to give up on an 18-year marriage after one month of hell. The therapist, according to Monica, interpreted her resistance to “moving on with her life” as stemming from her inability to “grieve” the end of her marriage. He then connected this inability to grieve to the loss of her father when Monica was a small child; Monica’s difficulty in letting go of a failed marriage stemmed from unfinished mourning from the death of a parent.

Fortunately, Monica had the strength to fire the therapist. Not many clients would be able to do that, especially in the face of such expert pathologizing of their moral commitment. I was able to get her and Rob to a good marital therapist who saw them through their crisis and onward to a recovered and ultimately healthier marriage.

In another case close to home for me, Jessie, a friend of my family, emailed me upset when her new counselor, whom she was seeing for depression and complaints about her marriage of less than a year, suggested that she consider a trial separation from her husband because an unhappy (but not highly conflicted) marriage was keeping her from feeling better. Jessie recounted the exchange: when she told her counselor that she was committed to her husband, the therapist kept repeating that she may not be happy again if she stayed in this marriage and that a “break” might help her. Upset with this counselor, Jessie turned to her priest, who also stunned her by suggesting that if her marriage problems were causing her depression, he could help her get an annulment, given the newness of the marriage. As with Monica, Jessie turned to me to ask whether this kind of undermining intervention was common in the field—and what she should do next.

In another example, the anxious wife of a verbally abusive husband who was not dealing well with his Parkinson’s disease reported that she was told at the end of the first therapy session in her HMO, which offered only brief therapy, that her husband would never change and that she would either have to live with the abuse or get out.(2) She was grievously offended that this young therapist was so cavalier about her commitment to a man she had loved for 40 years and who was now infirm with Parkinson’s disease. She came to me to find a way to end the verbal abuse while salvaging her marriage. When I invited her husband to join us, he turned out to be more flexible than the other therapist had imagined. He, too, was committed to his marriage, and he needed his wife immensely. That was the leverage, along with a change in medications, for him to start treating her better.

One of my students experienced serious postpartum depressions after the births of her two children. She told me that both of the therapists she had seen at different times challenged her about why she stayed married to a husband who did not understand her needs. (Her husband was befuddled by his wife’s moods and sometimes became impatient with her, but he was not, according to my student, a mean-spirited man). In the first session, one therapist said in a challenging tone of voice, “I can’t believe you are still married.” Although it’s fully possible that my student invited these responses by potent criticisms of her husband, it’s the job of a therapist to hold the presenting sentiments of a depressed, postpartum client with a degree of caution before giving advice about ending a marriage. However, as Schwartz (2005) observed, because of our empathic engagement, therapists are “powerfully drawn to our patient’s point of view in their assessment of others” (p. 276).

A final illustration involves a friend who went to a well-regarded therapist for his depression. After a number of months, the therapist requested that his wife come to a session. The following week after the conjoint session, the therapist recommended that, on the basis of what she had observed and heard from the client, he consider divorcing his wife. My friend responded emphatically that divorce was not on the table for him and that he loved his wife and was committed to her. The therapist persisted, maintaining that his marriage problems were complicating his depression. My friend pushed back even harder: “There is not an ounce of interest in my body for divorcing my wife.” The therapist’s final words were, “I’m just asking you to think about it.” As in the other stories, my friend contacted me for help in understanding what had just happened, wondering whether this was standard care in the field. In this case, part of his confusion was that he felt he had received excellent treatment from a therapist he had sought out because of her strong reputation. How could a therapist who seemed so thoughtful and skilled in treating his depression be so clueless and undermining when it came to his commitment to his marriage?

Why Many Therapists Approach Marital Commitment This Way

These illustrations should not be dismissed as examples of random bad therapy or incompetent therapists—or just the biased recollections of the clients. (As I said, although no doubt clients sometimes misinterpret their therapists, when similar stories come up repeatedly, including from colleagues as clients, they cannot be dismissed.) In my view, these stories reveal the challenge for many therapists of how to think about and address clients’ life commitments in situations when those committed relationships are sources of pain and distress. It’s not that therapists deliberately undermine marriages; the rub comes when the marriage seems to be harming their client or keeping them from achieving their therapeutic goals. As I have repeatedly argued, when we lack a way to think about ethical issues in everyday life, we fall back on the mainstream cultural priority of individual self-interest. We challenge clients to privilege their immediate self-interest over relational commitments. This looks like neutrality, but it’s a heavily value-laden stance, one the therapist is usually not conscious of holding in an individualistic culture.

I was not immune to this way of working as a young therapist. I learned to treat the divorce decision with what I thought was neutrality. I remember working with Mary Ann, a 35-year-old woman in an unhappy marriage who wanted individual help to decide whether to keep working to change her marriage or end it.(3) She and her husband had two small children. This was the height of the divorce boom in the 1970s, and a number of her friends had recently left their husbands. Mary Ann felt stifled in a bland relationship with a man who didn’t connect with her emotionally in the way she wanted and who expected her to do the lion’s share of the parenting and housework, along with her part-time job. Sound familiar as a marital complaint? As I sat with her, I realized that I’d never been taught how to work with someone on the brink of divorce. My training in marriage therapy started with the assumption that both parties wanted to stay together, at least for the time being. My training in individual therapy had taught me that my job was to help my clients clarify their feelings, needs, and goals and then make their own decisions without my values and viewpoints getting in the way.

So, I did a kind of rational-choice consultation with Mary Ann, helping her clarify what she’d gain or lose personally from her decision. “How would your life improve from leaving your marriage,” I asked, and “What might it cost you to leave?” I asked the same about staying: “What are the pluses and minuses of remaining in the marriage?” (I was studying statistics at the time and even imagined a two-by-two contingency table!) When she worried aloud about the effects of a divorce on her kids, I responded, “The kids will be fine if you’re happy with your decision.” Mary Ann ultimately decided to file for divorce and start a new life.

Even at the time, I felt odd about treating this client’s dilemma as if it were a decision that only affected her. And I felt sad that another not-so-bad marriage was biting the dust. Not that I’d have admitted this to a supervisor or peer, because a hallmark of a good therapist in my circles was to be cool about the rash of divorces we were seeing among our clients and peers. No one wanted to come across as a moralistic marriage saver. Divorce was a hard-won right and a legally supported, no-fault personal choice. At this point in the early 1980s, Putnam (2020) observed that “expressive individualism framed marriage as a limited liability contract dissolvable with a ‘no fault divorce’—‘expressive divorce’” (p. 152). The common wisdom was that a therapist should not get too involved beyond clarifying the options and supporting the client’s autonomy.

Looking back, I’m struck by my naiveté about what’s involved in leaving a marriage, especially one with children, and my innocence about my lack of influence on the outcome. Like most people facing this decision, Mary Ann was caught in a morass of ambivalent feelings and values. (Harris et al., 2017, documented the volatile ups and downs of divorce decision making). She’d made a lifelong commitment to her husband and now was considering withdrawing it. She wondered whether her expectations for this husband, or any husband, were realistic. She hadn’t done much psychological work on herself and didn’t have an idea of what good marriage therapy might accomplish. She worried about her economic future, and she was deeply concerned about the effect of a divorce on her children, who’d lose their daily connection to their father, take a financial hit, and face a series of substantial life changes. She also believed that her parents and friends would be shocked and upset with her if she left the marriage.

Mary Ann’s journey toward her decision was, like most people’s, highly unstable and marked by ambivalence (National Divorce Decision-Making Project, 2015; Vaughn, 1990). But despite this instability and the high stakes, I treated her as if she were thinking of changing jobs from Walmart to Target: what does each company offer you, and what would be the downside of staying or switching jobs? And, by the way, you owe nothing to your current employer as you make this decision. Maybe her choice of divorce was the best one, and maybe she would have made the same choice regardless of how I’d worked with her. But she deserved a complex therapy to match the complexity of her dilemma, not an oversimplified, “neutral” therapy that failed to engage both sides of her ethical dilemma. Her husband, children, and future grandchildren also deserved better from me. As the novelist Pat Conroy (1978) famously wrote, “Each divorce is the death of a small civilization.”

As therapists, we are midwives for relational deaths and rebirths, the shattering and rebuilding of committed intimate relationships that are at the heart of human experience. But you won’t find much training, writing, or even conversation among therapists about how we handle these moments in therapy. The result is that we’re each left to make things up on our own, mostly using the implicit ethical norms embedded in our culture and profession.

Adults’ Commitments to their Parents

Riding in an elevator once in Singapore, I saw a sign for one of the floors of the government center labeled something like “Parent Court.” When I inquired, I learned that it was a place where parents who felt neglected by their adult children could seek the help of the court to enforce filial obligations. I knew I wasn’t in Kansas anymore! In the United States and similar Western countries, adult children have no legal obligations to care for their parents (just as the parents have no legal obligations to their children when they turn 18). Adult familial relationships are voluntary in the ethical realm, not the legal one.

The field of psychotherapy has been hard on parents from the beginning, seeing them as primary sources of the pathologies in their offspring. Whether it’s toilet training in traditional Freudian theory or inadequate attachment bonds and authoritarian or permissive discipline in contemporary models, there are plenty of parent deficiencies to sort through with clients in therapy. However, I suspect that the working assumption among therapists was that you could work to recover from poor parenting in the past while still having a relationship with your parents in the present. That began to change in the 1980s with the rise of cultural interest in “the dysfunctional family,” including intrafamilial sexual abuse and codependency on problematic parents and other family members (Bass & Davis, 1988). Parents were not just toxic influences from the past; they were continuing to harm their adult offspring in the present. What’s more, they could be a threat to their grandchildren.

From the mid-1980s through at least the mid-1990s, many therapists joined the recovered memories movement in the field, believing without evidence, for example, in the near pervasiveness of multiple personality disorder brought on by intrafamilial sexual abuse (Acocella, 1999). I recall case consultations where therapists, again without evidence, said that 90% of women with bulimia had a history of incest in their families. The next wave was about the since-discredited claim of widespread satanic ritual abuse of babies and children. The upshot was a wave of therapist-encouraged cut- offs from parents and often from other family members who did not accept the claim of that abuse. Parents would receive “goodbye” letters, crafted with the encouragement of therapists, from their adult children, especially their daughters, who were more apt than their sons to be in psychotherapy. Our field got caught up in a huge wave of cultural negativity about family life (Wylie, 1993).

Eventually, there was a cultural pushback, highlighted by a New Yorker article and subsequent book by investigative journalist Lawrence Wright (1994) on satanic cult accusations and an acclaimed PBS Frontline episode, “Divided Memories” (Bikel, 1995), which featured a high-profile therapy clinic where nearly all clients were encouraged to achieve the goal of “detachment” by cutting off from their parents and, in some cases, from their spouses and even their children while they recovered their sense of self. In these and other cases around the country, the therapists involved were proud of their work and had a theoretical model behind it (if no research data). After successful lawsuits ensued, therapists quietly abandoned their practice of suggesting family abuse via recovered memories, and they stopped taking as accurate the notion of large numbers of dead babies as a result of satanic cult abuse.

But the idea of a therapeutic cutoff from parents (and siblings who ally with the parents) had been loosed in the field and continues in practice and books by therapists for the lay public, such as Campbell’s (2019) But It’s Your Family…: Cutting Ties With Toxic Family Members and Loving Yourself in the Aftermath. That author described in detail how she came to cut off all contact with her pathological father and mother, and she urged the same for her readers after they evaluated whether the criteria she offered fit their parents.

In the mid-1990s, as my own children were entering college, I gave a presentation to a group of college counselors that included interns and staff. The topic was the value of seeing college students as members of families instead of just as emancipated individuals. I will never forget an exchange with a junior staff therapist who asked, “Aren’t there times when the student’s family is so toxic, not only in the past but also still now, that it’s best that the student break off a relationship with them?” I replied that I had seen some tragic cases where the past abuse was not only denied but also continued with intensity and that in those cases, it can be useful for a young person to take a time-out from connecting with family. Then I thought to ask, “I’m curious. For what percentage of your caseload do you believe a family cutoff would be called for?” I froze in my chair when he said, “Maybe 40%.” The chill I felt was that I was soon to launch my oldest child to college—what if he developed emotional problems and saw this therapist? No one present offered a counterview, and we moved on after I mumbled something about this not being my experience. In retrospect, I wish I had challenged him about how he came to his perspective. It was a failure of nerve on my part that I vowed never to repeat.

I have heard many clients report encouragement by therapists to end relationships with parents and other family members, and I’ve seen this in my extended family. These days, whenever I hear about a definitive cutoff from family, I ask whether there is a therapist in the picture. To be clear, I believe that these therapists want to help their clients avoid unnecessary emotional pain by encouraging them to exit relationships that continue to cause this pain. It’s not that therapists hate families or that there are never situations that call for a strategic time away from abusive family members (in my mind, always with the hope for later reconciliation). Rather, these therapeutic interventions reflect a cultural orientation where all relationships are transactional—what is the benefit I am gaining versus the cost to my well-being? If the relative psychological cost of maintaining a family relationship is too high, the healthy thing to do is to end it. I later return to the case of Laura, whose story opened this book on the note of adult commitment to a difficult parent. Here I just note that Laura told me that she had several therapist friends who encouraged her to “ditch” her mother. Missing here are two ideas: first, that parent–child bonds are not psychologically disposable—they go on until the death of the parent and beyond—and second, that there is an ethical dimension to the parent–child (and other family) relationship. A permanent cutoff means that adult children have no moral obligation to respond to their parents’ current needs and the eventual frailty and end of life. These two levels—psychological and ethical— go together. Like it or not, we are emotionally tethered to our parents and they to their adult children. Therapists come and go, but not parents. As I’ve heard the psychologist Mary Pipher (2008) say, “Nobody calls out for their therapist on their deathbed” (p. 2).

I don’t have a one-size-fits-all formula for obligations to parents, especially when the parents are in need of support and help. There are so many factors, including the history of the relationship. Obligation to a parent who abandoned you at birth and has now reentered your life wanting support will look different from obligation to a parent who has shown consistent care and support over the years. How much to be involved personally, with openness and vulnerability, with a frail or dying parent will depend on how much emotional safety there is in the relationship. Then there is the complex issue of what forms of help are, well, helpful. As asked earlier in this book, when is taking a parent home to one’s own house the best decision for all concerned versus placing the parent in a care facility? Culture comes into play here: in some cultures, an out-of-home placement is seen as an act of cruelty, while in others, is it considered loving when done at the right time. My main point here is that the job of the therapist is to help the client navigate these difficult waters, discerning the interests of the self, parent, one’s spouse and children, and others. Moral foundation theory can help to sensitize us to competing ethical intuitions: care/harm, fairness/reciprocity, and respect for authority seem particularly relevant here. Good ethical consultation does not mean that the therapist has the answers but that the therapist honors the client’s commitment to parents in light of all the other factors involved.

The Craft of Ethical Consultation about Commitment

I use the LEAP-C (listen, explore, affirm, offer perspective, challenge) skills to demonstrate strategies for ethical consultation when commitment to a marriage or a parent relationship is on the table—that is, when a client is struggling about staying in a marriage or about cutting off or withdrawing support from a parent in need.

Listen

Listen for the ethical part of the client’s decision making. For marriage, it might be a dilemma over personal happiness versus the original commitment or the needs of the children. For adults with their parents, it might come out in the form of the client’s guilt, sometimes accompanied with resentment, over not doing enough for one’s parent. As with all forms of listening in ethical consultation, it’s important to give a full hearing to both sides of the dilemma and to how the client is expressing a number of moral intuitions in light of their life experience and their culture, including intuitions such as authority and loyalty that do not come readily to mind for a Western therapist. In Laura’s situation with her challenging, soon-to-be-frail mother, I listened carefully to her ambivalent feelings and thoughts: on the one hand, self-protective ones for herself in the face of current and future burdens (the current one focused on her mother’s criticisms, and the future one added caregiving) and, on the other hand, a sense that it would be wrong to cut off her mother. Her friends were listening mainly to the self-protective side of her ambivalence. Laura said she came to me for therapy because she believed I would also listen to the other side.

Explore

The nuances emerge during exploration. For parent dilemmas, these include the quality of the relationship now and in the past, the possibility of manipulation versus genuine need, the availability of other caregivers such as siblings, and the resources of the client to help the parent in light of other obligations. Often a decision will emerge from this exploration, one that the client can live with in terms of resolving the tension between personal needs and responsibility for parents.

For Laura, the exploration revealed the details underlying her sense that she could not just walk away from her mother: it didn’t seem right as the only child of a widowed parent. But she also lived with an emotional burden of listening to her mother’s weekly phone monologues about how others don’t treat her fairly, including her daughter. Her mother also offered critiques of Laura’s mothering (those hurt the most). I especially paid attention to how the client responded to her mother on these calls, uncovering how passive and annoyed she would become but not set limits. This exploration opened up possibilities for her to remain regularly in her mother’s life while building healthier boundaries.

In terms of marital commitment, the following is a series of exploratory questions that I developed for a specialized approach to couples work called discernment counseling, where at least one spouse is considering ending the marriage (Doherty & Harris, 2017):

• What has happened to your marriage that has gotten you to the point where you are considering divorce? Notice that this is not framed as “What are the problems?” or “Why are you unhappy?” but in terms of the marriage being a major part of the client’s life that is now under question.

• What have you or your spouse done to try to repair the relationship—to fix the problems before you got to the point where divorce is on the table? This question carries the assumption that marital commitment is worth an effort to find a way to maintain—the relationship deserves repair attempts if it’s broken.

• What role, if any, do your children play in your decision making about the future of your marriage? This delicately crafted question brings the needs of the children into the conversation in a way that gives the client space to respond in a variety of ways.

• What were the best of times in your relationship since the time you met— the times you had the most connection and joy? This question brings clients back to what they used to love about their spouse and what led to their original commitment.

The point behind questions like these is to show that exploring ethical dilemmas over commitment can involve more than “tell me about both sides of your struggle.” There are lots of nuances and often more than two stakeholders— for example, third parties such as children who will be affected by the decision. Laura, for example, weighed the effect of a parental cutoff on her children, who would grow up without contact with the grandmother.

Affirm

Affirming involves acknowledging and supporting the client’s ethical commitments. In Laura’s case, I explicitly affirmed her moral sense that she should not take her therapist friend’s advice to “dump” her mother like a bad boyfriend. I used words like these: “I appreciate that you want to do right by your mother even though she’s a difficult mother. It’s not easy, but you’ve decided it’s important that you stay in her life, especially at this time when she’s pretty much alone.” Laura sat up straighter in her chair and said, “Right. That’s the path I have chosen. Now I want to figure out how to do this and keep my sanity.”

Affirmations on divorce decisions are trickier because of the inherent volatility involved for many clients in coming to a conclusion. When clients bring up their ethical concerns, say, about their marriage vows or the children, I affirm them without suggesting that those concerns are determinative—they don’t necessarily mean staying in the marriage. It’s just that commitment has an important role in the decision. In contrast to how I used to dismiss these concerns, I’ve learned to simply acknowledge and accept them with language such as “I appreciate that you are taking seriously your original commitment to your marriage; leaving is not something you take lightly,” or “I hear your concerns about the children, and I’m glad you are taking these concerns seriously. There is a lot at stake all around.” By the way, many older clients with adult children and grandchildren are concerned about hurting these stakeholders. I affirm that concern as well. And, of course, I affirm the client’s right to think about their pain and harm to self from staying in a bad marriage and their concerns that a highly conflicted marriage can also be harmful to the children. That’s why it’s an ethical dilemma: there are legitimate needs and claims in tension.

Perspective

As mentioned, it’s often not necessary to share one’s perspective on an ethical dilemma because clients sort out how to proceed with the help of the listening, exploring, and affirming skills. In situations when commitment is in play, however, clients can often benefit from the therapist’s perspective on how to have a healthy, satisfying life while maintaining commitments to others, such as a difficult spouse or a burdensome parent. Self-sacrifice for the sake of ethical commitments can be difficult to sustain and, in some cases, may not be healthy or wise (as with an abusive spouse who will not seek help).

In the case of Laura, I shared a perspective this way:

ME: I hear you on your desire to be a supportive daughter to your mother—saying goodbye to her is not an option for you. Now let’s talk about how you can support her in a way that’s healthy for you. The current situation is not working: you feel burdened by her weekly calls, stressed for a day beforehand, and upset for a day or more afterward. You go through the week with negative thoughts about her and then feel guilty for being so negative. Do I have that right?

LAURA: Yes, exactly.

ME: So, your bind is that you don’t feel like a good daughter when you are in touch with her, and you would not feel like a good daughter if you abandon her. [Notice that I used explicitly ethical language— “good daughter”—because the client had been using that kind of language. I did not substitute nonethical language such as “responsive” or “measuring up”].

LAURA: Oh, my, yes!

ME: So, let’s think together about two things: what might be going on for your mother that she acts this way and how you can learn a healthier way to interact with her. Right now, it doesn’t seem as if you have good boundaries with her on the calls—you let her go on and on, and when she criticizes you as a mother, you’ve said you defend yourself and feel angry at her. My idea is that we would work to find a way for you to have healthy boundaries with your mother on these calls so that you feel you are there for her and protecting yourself at the same time. And by the way, it’s not healthy for your mother when she treats you poorly. So, a better-boundaried relationship would be good for both of you.

Here, I was offering a perspective on how Laura could take care of herself and her mother at the same time. Over the course of our work, she did find helpful ways to listen to her mother’s complaints about her life while at the same time setting firm limits when her mother started to offer personal criticism of Laura’s mothering. All of this was standard therapy work on my part. The point of emphasis for present purposes is that I framed this, in part, as ethical work, a way to resolve a moral challenge for the client who had wondered whether it was unhealthy of her not to walk away from her mother as others, including her therapist friends, had advised her.

In terms of offering perspective on divorce decisions, a key is to honor both sides of the ethical dilemma in two main ways:

• Normalize the dilemma. It’s hard to know the right decision when dealing with ongoing personal suffering and hopelessness in a marriage, along with struggles about abandoning one’s commitment and putting one’s children at risk. And most people go up and down in their decision making.

• Share concerns. When a client seems to be making an impulsive decision to divorce (say, right after learning of a spouse’s affair), the therapist can share some general wisdom about the value of slowing down in making a lifetime decision. I like to use the phrase of a wise collaborative divorce lawyer: “Divorce is never an emergency; it takes months to play out.” A separation can be an emergency decision when there is threat and risk, but deciding to divorce rarely has to be done immediately and in emotional turmoil. Another example of perspective is when a client seems to be downplaying a future consequence of a divorce. I recall a married man who thought that his adult children would readily accept his lover (because she was such a great person) if he ended the marriage to be with her. I offered an alternative perspective so that he could be more realistic in his decision making: the likelihood of resentment from his children, at least for some time. A final example was a client in a volatile marriage who said that he could just stay away from his wife until the last child left home in 6 years. I offered that I’ve seen this work sometimes for couples who already have a lot of distance and little conflict, but I wasn’t sure it would be feasible in his more engaged, high-conflict relationship, especially if it was his unilateral decision to stay married but be functionally single.

Challenge

To discuss challenges in intergenerational commitments, I switch to parent-to-child commitment because it’s more commonly needed there. Recall my discussion in the Introduction about Bruce, who was about to move away and abandon his children after his wife kicked him out of the house. When I asked him the exploratory questions of how he thought leaving his children would affect them, he replied, “I’m sure it will bother them for a while, but they’ll get over it before long.” Given the urgency of the risk (Bruce had come to what he said was a final session to wrap up our work before he left town), I decided to immediately challenge him with these blunt words: “I don’t think so. Walking out of their lives will affect them for a long time, even permanently.” Bruce soberly replied, “I know you’re right.” I asked why he thought what I said was right. “They will feel hurt and not understand why this happened. You know, I left my daughter in California the same way, and I think about how it affected her. I don’t want to do that again, but I don’t know if I can go back to that house and see my wife, not in the state that I’m in.” Bruce and I were now in accord that he wanted to keep his commitment to his kids. Our work now was to figure out how to do this while maintaining his fragile emotional equilibrium.

Ethical challenges require a caring relationship so that they don’t come across as judgmental. I recall a divorced father who learned that his 7-year-old son was calling his new stepfather “Dad.” My client felt terribly hurt and replaced. I empathized with his feelings. Then he told me that he had told his son that day that if he ever heard that he was calling his stepfather “Dad,” he would never see the child again. I was shocked and worried for the child, but I held on to the craft of ethical consultation by first connecting with my client:

ME: Joe, I know you are in a lot of pain about your divorce and scared to death about losing your kids’ love and affection. And I know that you would never intentionally harm your children. [Slight pause] I also have to tell you that what you said to Bobby probably hurt and wounded him and left him fearing that he could lose you. You are the only father he has, and he should not have to live with the fear that if he slips and calls someone “Dad,” he will lose you forever.

JOE: [Looking worried] Do you think he could feel that way? I just wanted to get through to him about me being the only one he calls Dad.

ME: I’m really worried for him right now. That was a big threat you made to him.

JOE: I can see it now. I was beside myself upset, and I took it out on him. What do I do now?

We went on to discuss how he could repair what he had done, beginning with contacting his son right after our session. We went over the words he could use to apologize and offer reassurance that his commitment was forever and not contingent on something his son would say.

Most therapists would be with me in cases of parent commitment to young children: ethical challenges can be appropriate there. When it comes to marital commitment, many therapists take a neutral stance on whether clients divorce and would be reluctant to go beyond sharing perspectives for the client to accept or not (Wall et al., 1999). My view is that while there can be good reasons to let go of a marital commitment, it’s a weighty ethical decision because it affects the welfare of at least one other person who made life decisions based on an expectation of continued commitment, and usually, there are additional stakeholders such as children and extended family members. Therefore, I am willing to challenge clients when I believe they are not including concern for other stakeholders in their decision making. Keep in mind that challenge generally only comes after using the other skills of listening, exploring, affirming, and offering perspective. Here are some examples:

• Challenging a client to seek couples therapy. “I’m concerned that you are leaving your marriage without seeing whether it could become healthy again through good couples therapy.”
• Challenging a client to let a spouse know the marriage is on the brink. “I realize you don’t think your spouse can change. Maybe so, maybe not. What I want to challenge you about is not signaling to her that you are so unhappy that you are considering divorce. It seems to me that she is owed a chance to see whether she wants to make changes that might preserve the marriage. She’s flying blind now.”
• Challenging a client about ending a good-enough marriage when the client is depressed or in personal crisis. This challenge can take two forms: appealing to self-interest (“I’m worried that you will do something that you will regret when you are in a better emotional place”) and appealing to the interests of others (“This decision is going to affect a whole lot of people, such as your kids, and I’m worried that it’s hard for you to fully consider those consequences when you are feeling the way you do. You could look back with regret about the fallout”).

I end this chapter’s discussion of ethical commitment with words I wrote in Soul Searching:

Our therapy caseloads are like Shakespearean dramas suffused with moral passion and moral dilemmas. But we have been trained to see Romeo and Juliet only as star-struck, tragic lovers, while failing to notice that the moral fabric of parental commitment was torn when their families rejected them because of who they loved. We focus on the murder of Hamlet’s father and Hamlet’s own existential crisis, rather than on how Hamlet’s mother abandoned her grieving son. Commitment to loved ones, and betrayal of that commitment, are central moral themes in the human drama played out in psychotherapy every day. (Doherty, 1995, p. 46).

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From The Ethical Lives of Clients: Transcending Self-Interest in Psychotherapy, by W. J. Doherty Copyright © 2022 by the American Psychological Association. All rights reserved.

References:

1. This case example is from “Bad Couples Therapy: How to Avoid Doing It,” by W. J. Doherty, 2002a, Psychotherapy Networker, (November/December), pp. 26–33 Copyright 2002 by The Psychotherapy Networker, Inc. Adapted with permission.

2. This case example is from “Couples on the Brink: Stopping the Marriage-Go-Round,” by W. J. Doherty, 2006, Psychotherapy Networker, (March/April), pp. 30–39. Copyright 2006 by The Psychotherapy Networker, Inc. Adapted with permission.