Need Management Therapy: A Clinical GPS for Couples Work

A new couple enters my office, and instantly I sense a faint but still discernible vestige of feelings dating to my early years as a fledgling psychologist. In those days, couples therapy struck me as overwhelmingly rife with complexities and sundry conundrums, all charged with intense, volatile emotion. Like the wild, erratic dance of a fallen power line, couples would fling verbal darts and threatening accusations at each other. On too many occasions, I felt stunned and intimidated under the full, onerous weight of my inexperience.

The Woes of Being Novice

My novice, impoverished clinical efforts were wobbly, halting and stumbling. I confess, there were moments where, not knowing how to helpfully involve myself, I froze in a stasis I called “interventional paralysis.” Even more regrettably, there was that notorious—and seemingly inevitable—disastrous session where, failing to harness the couple’s rage, both partners bolted inconsolably from my office, leaving me in their frenzied wake feeling deeply discouraged and clinically impotent.

Notwithstanding, these haunting professional nightmares ultimately proved to be de facto growing pains that richly informed me in crafting a treatment approach to couple’s therapy, a new GPS for navigating the craggy but fulfilling landscape of the couple relationship.

Too often, it’s been my experience that distressed couples present to treatment desperately teetering on a precipice of separation and divorce, compelling me to make a quick, hopefully effective “first-responder” application of treatment an urgency. But even under ordinary, non-emergency circumstances, it has become increasingly evident to me that the intimate relationship delivers a steady supply of challenges, some of which are Sisyphean-like in difficulty. Arguably, intimacy is in a league of its own, no other relationship compares in complexity, difficultly, nor fulfillment. Yet oddly, there are no formal institutions that prepare us for it, nor are there standardized marital manuals offering precise, dependable, science-based guidelines.

Nevertheless, despite its predictable ruggedness, intimacy still promises us life’s loftiest personal rewards and its greatest joys. The question is, what are the best tools for harvesting them? Both personally and professionally, I feel there’s a glaring need for a reliable GPS for navigating a successful, emotionally safe therapeutic route through intimacy’s uneven, often hazardous terrain, which is characteristically pocked with conflict, frustration, and disappointment. So, out of arguable necessity, this proposed GPS is intended to serve the practicing clinician, their couple clients, and, for that matter, anyone partnered within an intimate relationship.

A New, Brighter Day

Fortunately, things are much different for me today. Now, when couples present for treatment, my overriding feeling is best described as clinical self-assuredness, born, no doubt, of greater experience. However, I’m convinced the lion’s share of it derives from my growing confidence in the new couples therapy model I’ve added to my clinical tool belt. With equal portions of relief and gratitude, I’m now more prepared to helpfully intervene. Perhaps just as importantly, my clinical confidence is transmissible, that is, it can be emotionally infectious, like a positive contagion that boosts a couple’s confidence in the therapy process. Amusingly, Bruce Wampold alleged that the clinician’s conviction of the efficacy of their treatment strategies is, in itself, therapeutically powerful, likening it to a witch doctor’s “curative” influence. Similarly, at the risk of sounding clinically omniscient or lacking in humility, neither of which embraces scientific objectivity, I have come to feel especially prepared and confident in this approach. This GPS, as I’ve nicknamed it, was born largely of my earlier feelings of being lost and in need of firm grounding and direction when working with couples struggling with intimacy and embroiled in conflict.

If you were to join me in my office, looking over my shoulder, you’d see that I’m especially watchful of a common tendency among partners to target one another with vilifying, non-specific complaints and vague, undefined references to their cripplingly poor communication habits. Commonly, couples seem all too happy to showcase their partner’s faults, foibles and imperfections, but rarely their own. And the accuser’s finger-pointing is typically served up with an accompanying plateful of insinuations that their relationship would be better if only their partner were to change. Of course, this change is often defined exclusively by the partner making the allegation. Obviously, the couple’s ranting indictments of each other typically fail to bring significant, durable change, and finally out of growing despair and necessity, they drag their wounded relationship, kicking and screaming, into treatment.

So, frequently and to the couple’s surprise, I explain that they probably would not be at loggerheads with each other if either or both of them had brought invalid needs to the other. After allowing a moment for this thought to percolate, couples, almost without exception, accept the cogency of this premise, which, as can often be predicted, effectively prompts partners to ask themselves, “Why are we fighting, then?”

Next, with some active nudging, I encourage each partner to look below the attention-consuming mismanagement of their own need to their need’s deep taproot of legitimacy. For example, partners need to be heard in a respectful, sensitive way, which is without question valid, even sine qua non, but can easily be mismanaged, e.g., “You never listen to me!” Here, attention is drawn to the critical, judgmental tone of the complaint, which then mobilizes the taunted partner’s defenses, thus turning their attention away from the validity of their partner’s need to be heard.

Conversely, if the need to be understood were effectively managed, it would sound more like this: “When I feel heard, I feel respected, cared for, and I’d sure welcome your understanding now.” Clearly, there’s less economy of time and energy in the latter example, but its payoff is great and can be measured by increases in self and partner respect, and even an elevated probability of need gratification that rewards the added efforts of the need manager. I’ve found that partners who respect one another are more likely to gratify the other’s needs.

Need Management Therapy

Before I continue unspooling the specific steps of this model, be reassured that it has evolved over years in practice and flows from the work of pioneers in the field of couples therapy, including Aaron Beck, John Gottman, Sue Johnson, and Leslie Greenberg. My use of the acronym GPS is metaphorical, designed to be a catchy, descriptive epithet for the model, whose formal name is Need Management Therapy (NMT).

Theoretically, or perhaps ideally, a couple is composed of two individual selves. While this may seem obvious, what is not so clear is the very concept of “the self,” which is up for definitional grabs; it’s a theoretical construct, and there are several competing versions of it lining the shelves of the scientific and self-help marketplaces. So, cautiously exercising my own theoretical prerogative, I’ve stepped out on a limb and defined the self as a composite of circulating needs of varying types and magnitudes. Further, by my calculations, human needs are self-defining, self-constructing psychodynamic entities that require active management, including the management of the feelings orbiting about them. These concepts have significant diagnostic and therapeutic implications, especially within the rigorous context of the intimate relationship. Convincingly, optimal individual and couple health can be realized by the effective management of both individual and shared needs and feelings.

In its simplest, most encapsulated form, NMT teaches the couple the tools necessary for the effective management of their needs and feelings. So, here’s a brief preview, a quick synopsis of NMT punched out in a one-to-three stepwise form. Later, I’ll further flesh out the model’s three lynchpin steps while fitting each one to a concrete couple example for a clear demonstration of how the steps are applied.

Step one is “need identification,” which endows partners with the Socratic “know thyself” advantages of self-delineation and self-cohesiveness. Step two is “need legitimization,” which assumes that partners bring fundamentally valid needs to one another and encourages partners to actively represent them. Step three, “need representation,” centers around creating and preserving self and partner esteem—legitimate needs must be given voice along with the feelings associated with them. This expression of the emotions encircling a partner’s needs amplifies the personal meaning of the need, and more, creates a deep connection within individual partners, predisposing a better quality of connection between partners.

Need Identification: The NMT therapist encourages the couple to identify the personal needs that each partner brings to the other, especially those that ignite conflict. To illustrate, consider the case of Justin and Stephanie. What ignited their most recent skirmish and finally drove them into treatment was Justin’s non-negotiated demand to purchase a mountain bike—his identified need. Stephanie had other plans. Her identified need was to replace the family’s aging car, which she thought ought to top their list of spending priorities. At this point, both partners identified their manifest needs.

Despite its propensity for generating couple conflict, this active process of need identification effectively constructs the self, and again, a well-constructed self bodes well for personal mental health and the health of the partnership. Poorly defined needs are more difficult to manage. Moreover, the intimate relationship confers immeasurable benefits upon its constituents, but it can also be notorious for its ability to dismantle personal identities, as partners often under-manage or fail to adequately manage their own needs. Sadly, these failings can occur for reasons related to a partner’s lack of self-acceptance and/or for understandable but misguided attempts to preserve couple peace and harmony by dodging conflict and reducing friction, which is always ill-advised.

Need Legitimization: NMT trumpets this bold presupposition: most, if not all, individual needs are fundamentally legitimate at their most basic, irreducible level; therefore, they cry out for active, effective expression and management. For example, partners have a deep-seeded need for sensitive, respectful understanding of their needs and feelings regardless of the nature of the need or the inevitable surface-level disparities between their own and their partner’s needs. Moreover, a partner’s failure to adequately imbue their personal needs with this fundamental legitimacy predisposes the non-or-undermanagement of their needs, creating a potential breeding ground of self and partner resentment. For example, if I fail to manage the valid needs I bring to my partner, this self-imposed forfeiture of my needs diminishes my self-respect. I’ve become someone less than I optimally ought to be, or who I fully am. Now, as a lessor presence in relation to my partner, a chink develops in my personal identity armor, and as a consequence I don’t like who I am vis-a-vis my partner. Conversely, by deliberately imbuing my needs with positive status, I elevate the probability of their active management. And, perhaps of greater value, I simultaneously spawn self- and even partner-respect as I bring a more defined, fuller version of myself to my partner that also ferries the additional advantage of invigorating and nourishing my relationship.

Referring back to the example of Justin and Stephanie, each partner brings a valid need to the other, and therefore each one ought to legitimize the others need, as opposed to entrenching themselves in a competitive or adversarial argument in which one partner’s need is pitched as more important than the other’s. When couples purposely legitimize their own and their partner’s needs, they create a mutuality of respect that can be immediately conflict-preemptive and even lay down a longer-term prophylaxis against future couple warfare. Moreover, this atmosphere of mutual respect paves the way for the usual problem-solving conventions of compromise, negotiation, bargaining or other quid-pro-quo options for resolving differences. A qualifying caveat to this is that all too often, partners rightfully assume their need is valid but wrongfully assume it should be gratified on the spot because of the legitimacy it holds for them. This all-to-common need mismanagement pitfall fails to calculate the fundamental validity of one’s partner’s needs and can thus seed couple conflict.

Partners could conceivably lock horns in perpetuity because each, at least from their own perspective, brings a valid need to the table. Do couples fight for reasons that are not valid? Not likely. Partners believe and, more importantly, feel their individual needs have importance, or else why express them, much less defend them, or worse still, launch their version World War Three over them? Couples fight not because they bring illegitimate needs to one another but rather because they fail to effectively manage their own basic needs and adequately validate those of their intimate other. According to NMT, poor personal need management is the crucial point d’origine, the epicenter of couple rancor, dispute, and conflict. And when couple dissension is relentless and protracted, the accumulation of the toxic emotional by-products of poor personal need management—frustration, hurt, betrayal, anger, confusion, disillusionment, depression, to name a few—disease the relationship, until it can become moribund and dies. Extending this NMT logic, could every heated argument, or every fight, be framed as an instance of poor individual need management? If so, in a perfect couple-world, where needs are well-managed, fighting would be nonexistent.

Need representation: After greasing the wheels of communication by respectfully requesting a dosing of their partner’s time and understanding—a necessary preliminary—each partner is then encouraged to express their needs in clear, understandable terms. But with even greater emphasis, couples are strongly coached to express the emotions whirling about their needs. A need’s personal “weight of meaning” is conveyed through this accurate expression of the feelings connected to it. As needs and their related feelings are expressed with sufficient depth and accuracy, partners achieve a profound connection within themselves, which, in turn, serves as a precursor to a deeply emotional connection between partners. In briefer terms, “I can be no closer to my partner than I am first close to myself.”

Lastly, partners are taught to prioritize the effective management of their needs over their gratification. To be sure, I’m all in favor of need gratification, but it should come via the steps of effective need management and therefore be of secondary importance. NMT holds that it is in the effective management of our needs, and not their gratification, that we develop our emotional maturity. In stark contrast, like an untamed and feckless reflex, the pursuit of immediate personal need gratification can harm partners, as it puts one partner’s need above the another’s, thus risking the moment-to-moment health of the relationship.

Returning once more to the case of Justin and Stephanie, the third and final step of the model begins with a respectful investiture of partner respect prior to the expression of the need. For example, Justin might say to Stephanie, “Could I get a moment of your time?” or, “Are you real busy right now?” This common courtesy is a small investment in respect for Stephanie which literally credits Justin with a commensurate or reciprocating return of respect that can start the communicative ball rolling productively. Next, Justin makes plain his need for a mountain bike but, more importantly, he very purposely expresses the breadth and depth of his feelings related to his anticipated use of the bike. Lastly, and very importantly, Justin must strive to prioritize the management of his need for the bike over the immediate personal gratification of actually purchasing it. Challenging! But Justin’s goal is to learn that it’s the effective management of his need and not its gratification that ensures his maturation and growth and the preservation of the moment-to-moment health of his most prized relationship. The same exact process of effective need representation is repeated with Stephanie.

Adherence to this stepwise, simple orthodoxy of the NMT model can ensure growth in self and partner esteem as well as enhance the health of the relationship, meeting the highest needs of the individual. And, as an added incentive, good need management elevates the probability of personal need gratification.

A Personal Addendum

I have been deeply gratified and often immediately rewarded in “psychic dollars” as I’ve observed couples respond positively to NMT. Many times, within as few as one to five sessions, couple change occurs as partners learn to identify and validate the legitimacy of their needs by the deliberate, purposeful crowning of their needs with positive status. This process of self-generated validation of one’s needs can, and often does, encourage their active representation, and with it the door to a more fulfilled and maturing self is flung open.

Importantly, NMT theorizes that the intimate relationship is incomparable, like no other relationship because it creates the conditions by which the fullest maturation of the self can be realized. Outside its context, the same optimal emotional development may not be realizable. This is because of intimacy’s matchless features, chief of which is the endless stream of opportunities for personal growth through the development of effective need management skills.

By incorporating these simple, but compelling, principles into my treatment repertoire, I have been served a savory, delightful helping of clinical self-assuredness. But more importantly, I’ve witnessed the efficacy of this approach first-hand in the lives of the couples with whom I’ve worked. No more interventional paralysis, no more stumbling or bolting clients, and no more clinical nightmares!

When Psychotherapist and Client Share Similar Crises

It’s been almost nine months since I found out that my husband has been unfaithful, and my life and world have been turned upside down and inside out. It has been almost nine months of being in a seemingly unrelenting state of shock, disbelief, distraction, exhaustion, and overwhelm. From the start, sitting in my psychologist chair and doing my psychologist thing have felt fraudulent. How can I listen, really listen and comfort another, when I am in this raw and vulnerable place? I can’t say for sure, but I have been. In fact, my job has been the one consistent thing in my life that hasn’t really changed. It has been a welcomed distraction to focus on others rather than spending all of my waking hours being lost in my thoughts and the vast array of emotions that I feel on a daily basis.

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I am an empathic, highly sensitive person who also happens to be a psychologist who can become engrossed in the feelings and pain of others. This is likely why I was drawn to the field. Over time, however, I have learned how to create boundaries between myself and those for whom I care so that I don’t burn out. Yet as a caretaker, the potential for burnout remains ever-present.

Let’s take this one step further. In the midst of learning what the red flag signs were and are and understanding what my legal rights are as a divorcing parent, I recently began working with a woman who is slowly awakening to her sense of unhappiness in her marriage—a woman whose story is eerily familiar to my own. In one breath, it is difficult to reflect back on all of the accusations, fights, and sequences of events that she is facing, and that I have faced and continue to. In another, I can judiciously share some insights with her that I’ve gained in hopes of helping to foster her sense of self, her self-confidence, a trust in her instincts, and to acknowledge and respect her feelings of marital dissatisfaction.

Just as I was met with scare tactics and threats about my own marital relationship and its dissolution, she is too. Rather than becoming intimidated, my hope is to help her find her strength to do her own research and gain her own information to help reach her own conclusions.That is because if her story is anything like mine, she may be thrown off by inaccurate information that will disempower and wear her down.

These sessions have not been easy. On some days, they’re painful, as I listen to her story and feel the visceral reactions that I have and still experience and that she is having now. I experience flashbacks after the sessions, but my hope continues to be to try to change her story in an effort to process my own. On the flip side, I have found that being able to help another person in a similar position is cathartic and empowering for me. If I am able to give another woman a little bit of direction so that she is not blind-sided by the upcoming phases she may pass through, I can begin to find solace in my horrific experience.

Although I am still in the midst of the divorce and grieving process, there are a few things that are helping to keep me chugging along.

Self-Care

As a psychologist, I continually reflect on the need for self-care. However, it didn’t really click with me until I arrived in this very place. Self-care means different things for me right now:
It’s okay if I don’t cook dinner every night
It’s okay if my house is not as neat as it usually is
It’s okay to want to sleep more
It’s okay to want to be left alone
It’s okay to give myself a break and not beat myself over it
It’s okay if I didn’t accomplish as much as I intended because I’m fatigued
It’s okay to cry often

Self-care has also taken on the additional meaning of being forgiving and stopping when I think I should keep going on my to-do list. My sense of self-care has taken on the additional and much-welcomed elements of self-compassion and self-forgiveness for the upheaval that is now my and my children’s life. Self-care is the growing understanding and appreciation that this won’t be forever, but it is for now.
Self-care, at a more basic, moment-to-moment level is also:

Drinking enough water to stay hydrated on the days when I don’t wish to eat or drink
Getting enough sleep
Taking my vitamins
Exercising—walking, jogging, lifting weights, stretching, yoga
Taking a shower
Changing out of my pajamas even on the days when I’m not seeing patients in person or virtually, and accessorizing too
Dying my roots and getting a haircut
Scheduling a manicure and/or pedicure
Scheduling a massage and/or facial

Know When to Take a Break

I like to consider myself a diligent, persevering individual who can push beyond fatigue for the sake of learning something new or helping another person to find emotional relief. That high level of motivation and ability to delay gratification is what helped me to get through earlier challenges, including comprehensive exams, dissertation, licensing exam, post-doctoral training, and all of the other intensive training we psychologists have completed. The downside, if there is one, to my diligence is that I haven’t always acknowledged the importance of slowing down, pausing, putting on hold, rescheduling, or just stopping. My personal and professional experiences have centered around the axiom, “Keep on going until I reach the finish line.”

One thing I’ve learned is that I need—I mean really need—breaks on a daily basis. I need time to stare out my window or sit in the sun. I need to sometimes leave my desk and work on something monotonous like laundry because it’s a welcomed break from thinking so much. It’s okay to take that break even when there are phone calls, emails, texts, case notes, and invoices to prepare. That list will never be short, nor will it ever be “all done.” I’m embracing the unfinished nature of my work and realizing that it’s okay to walk away from my desk or office.

Grieving, Boundaries and Growth

Logically, I know that divorce is a loss, a huge loss. Now that I’m in it, I deeply understand that it is the true death of the life that I thought I was going to have, the life I thought I had, and the loss of the family unit that we created together. The sadness that I feel is quite unbearable on certain days and it drains my energy and results in physical pain (i.e., headaches, stomachaches, joint pain, muscle soreness). This experience gives me a new perspective on having a broken heart. Not only in divorce, but in loss by death and break-ups for people of all ages. Loss is loss.

And now, more than ever, in the shadow of this immense sense of loss and emotional exhaustion, it is an incredibly important time for me to set boundaries around when I start my work day and when I will end it. I am a bit of a workhorse, and I balance my practice with my three children and home life by keeping a hand in all three arenas—all day long. I can’t do this right now. I’m learning to understand that if I invest a few hours into a work project, then I won’t get to the items for my home. I need to let it go for another day or enlist the help of my children. And vice versa; if I invest a few hours into a project in my home, I will not be able to also accomplish work tasks.

This also means saying no to social plans or volunteer opportunities for my children’s school or activities. It means prioritizing what I need to get done and what I have energy for.

***

As a psychologist, I, like many of my professional colleagues, believe that I need to “pull it together,” because that’s what we do and because that’s the implicit expectation our clients have. We are “available” to others, and sometimes, that means our “stuff” has to take the side or perhaps even the back seat. However, what happens when personal issues and conflicts take over? It has and will continue to happen, because we are all humans, and psychologists are no different
 

When the Snow-Globe Shatters: A Counselor

Many clinicians are comfortable and familiar with suffering – the suffering of others, that is. But what happens to us when our personal world is rocked by tragedy? Fulfilling the duty to which we are called is not an easy task when we are hit by the loss of a relationship, financial devastation, or a terminal illness that befalls us or a loved one.

Several years ago, I suffered a heartbreaking tragedy as my first marriage ended after a long separation. The years of separation were filled with marriage counseling and numerous attempts at reconciliation, but in the end, my former wife chose a different path for her life. In the wake of this were two little girls whose worlds got turned upside down. As if this wasn’t bad enough, in the years following I endured a long custody battle that involved years of court and attorneys, as I attempted to be a part of my daughter’s lives. The aftermath of all of it left me devastated financially and emotionally, and I found myself seriously doubting if I could continue on in the profession to which I had dedicated my life.

Did I mention that I’m a therapist who works with kids, teens, and families? I can’t tell you how many kids from divorced and blended families that I have worked with and when this happened, it was like staring into a black abyss of reality that was going to swallow me whole. Suddenly, it was my kids asking why mom and dad didn’t live together and begging us to work it out. It was my kids who cried when it was time to go back to the other parent’s home. I was the one scrambling to defend myself in court and keeping time logs for the attorney and being summoned to depositions over ridiculous accusations. It was me having sleepless nights wondering about the emotional and mental damage my children were having to endure, and worrying about how this would impact their future development and relationships.

Our training and expertise is a gift when it comes to helping others. But when our personal lives start to crumble, all that knowledge can work against us in knowing exactly how to deal with it. What does the clinician do when this happens? How can we endure a personal tragedy but still effectively do our work? Here are a few things that I did that kept me held together while weathering the storms of my personal tragedy.

The first thing I did was seek personal counseling. Thankfully, I found a seasoned non-biased clinician who comforted me where it was needed, but also challenged me when it came to my denial about my abilities and how my personal issues may affect my professional work. Second, I kept the vision that tragedy represents growth opportunities and the goal isn’t just to survive it, but to thrive as a result of going through the process. I took the mindset of a client in regards to addressing the issues going on in my personal world. I set to work on confronting my denial and fears. I journaled daily, addressing my thoughts, emotions, and staying grounded to the moment. Third, I took an honest look at my caseload to see which cases I needed to refer to other practitioners. This was very hard for me, but looking back was very beneficial both to myself and to the clients. I reached out to colleagues and received excellent consultation.

Now, looking back, this period in my life was one of profound suffering but also immense growth. Here are some things I learned and gained from this experience. First, I identified with my clients in a new way. Emotional pain, fear, and the experience of loss struck deep chords within me that were new levels of suffering. I became more connected to my client’s emotional experiences and found new levels of empathy upon hearing their stories. Second, I became grateful for the small things. This sounds very cliché, but the suffering made me notice the tiny kindnesses of others, the wonder of nature, and forced me to look outside of myself. Third, I learned to value relationships in a new way. It is easy in our work to see people as appointments, a simple slot on yet another full calendar of events. My time with my daughters became sacred – the time with those that loved me and the encouragement they provided was like a steady drip of precious water that one craves during a desert experience. I slowed down and took in the moments. Fourth, I came to love our profession even more after realizing that counseling and psychotherapy are effective! I realized from a client viewpoint that my life was drastically improved despite the hardships by intentional focus on different areas of myself and by following the protocol for change upheld by theory, research, and practice.

We will no doubt suffer personal tragedies during the course of our careers. We are not immune simply because we are people-helpers. However, my experience taught me that we need not abandon our work when we encounter personal challenges, and in fact, as I found, working through the challenge may produce a better person, clinician, father, and partner because of the experience.