Wednesday, August 28, 2013

Does it take two for positive change in a relationship? Can one person do it alone?

From time to time I've had individual patients come to me requesting marriage counseling.  "Where's your spouse?" I ask them.  The reply: "He/she refuses to come."  My response has always been to explain that marriage counseling requires the participation of both partners; you simply cannot do marriage counseling alone.  But is this really true?

Change on the part of one person can certainly alter the dynamics of a relationship.  A dynamic is by definition an interactive system or process.  Change in one part of a system therefore changes the dynamics of that system.  An inter-action requires at least two individuals, each responding to the other.  Person A says or does something; person B says or does something in response.  Person A responds to what person B has just said or done; person B then responds to person A, and so on and so forth until the interaction is over.  Because humans are creatures of habit, two people in a relationship begin to develop "typical" ways of interacting with one another over time.  These sytles of interaction become increasingly automatic and are repeated across a variety of situations; they solidify into identifiable patterns.  If these patterns facilitate effective communication and serve to enhance the relationship the relationship will most likely thrive.  Sometimes the patterns of interaction between two people are dysfunctional: they interfere with effective communication and perpetuate conflict.  If the couple does not learn to interact in healthier ways their relationship becomes toxic and will probably not last. 

One person can disrupt unhealthy patterns of interaction in a relationship; it takes two to tango, so to speak.  To do this, one person in the relationship must choose to alter his or her reaction to the other person's behavior.  It only takes one person, for example, to walk away instead of engaging in conflict.  One person can choose to stop making demands of the other and learn to accept that their partner is not going to comply, give in, or otherwise do what they're being asked (or told) to do.  One person can decide not to become defensive when their partner makes a negative comment.  One partner can stop bringing up a topic that leads to arguments. 

There are a lot of things one person can do, particularly if the goal is to reduce overt conflict and/or confrontation.  And sometimes change in one partner can lead to change in the other.  The key word is sometimes

On the other hand, one person cannot "fix" a broken relationship.  One person cannot coerce another to acitvely participate in a relationship.  One person cannot force another to care about his or her wants and needs.  One person cannot convince another person to share his or her desires. 

If a person wants help in reducing conflict in his or her marriage then there are things I can do to help.  It is important, however, for the person to understand that this might mean accepting the behavior of his or her partner, even if the behavior in question is not really acceptable (e.g., cheating).   

Wednesday, August 21, 2013

Can a therapist with problems still be a good therapist?

I sometimes wonder why, in my personal life, I am not more competent interpersonally than I am.  In fact, for someone who spends a significant amount of time helping people learn to interact with one another I often find my own lack of skill in such matters embarassing.  I wonder if it is possible to be a good psychotherapist when I sometimes struggle with issues similar to those facing my patients.  Can I really help people learn to overcome problems I myself have not successfully mastered?  Can I teach others to do things I myself am not able to do?  And if not, does that mean I am not a good psychotherapist?  Am I doing my patients a disservice?  Do my personal limitations prevent me from providing adequate care?

Then again, I know I am not the only psychotherapist facing this problem.  I thinks about other therapists I know, colleagues both former and current.  Many of them have struggled in their personal lives.  Ironically, one of the best marriage therapists I've ever encountered has been married and divorced at least twice.  And yet, I refer my patients to him again and again, confidently touting his skill and expertise.  When I talk to patients who have seen him with their spouse for ocunseling, they always give positive feedback about the experience.  As good as he is at marriage therapy, however, he is apparently not that good at marriage. 

If a skilled marriage therapist can be terrible at marriage, it stands to reason that a competent psychotherapist can have unresolved personal problems.

Of course I decided to do some research.  In doing so, I stumbled upon an article written by an historic icon in the field of psychotherapy, Carl Rogers.  There was something in particular he said in the article that brought me peace of mind.  In the article, he proposes a theory in which he identifies the conditions necessarry for positive therapeutic change to occur.  One of six identified conditions is that the therapist be "a congruent, genuine, integrated person" within the context of his relationship with the patient.  He goes on to say that it is neither necessarry nor possible for the therapist to be "a paragon who exhibits this degree of integration, of wholeness, in every aspect of his life.  It is sufficient that he is accurately himself in this hour of this relationship..."

What a relief.  I don't have to have it all together all the time to be a good therapist.  I just need to bring my healthiest self each time I interact with a patient.

Wednesday, August 14, 2013


I realized quite some time ago that I don't handle stress very well.  This may seem strange coming from a psychotherapist.  Isn't a significant part of my job to teach people how to deal with stress?  Yes and no.

Learning to cope with stress effectively is certainly a goal for a lot of my patients.  But I think this means different things for different people.  For many people, effective coping involves limiting the amount of stress they expose themselves to (at least to whatever degree possible).  For example, if I am in the middle of a major life transition it is probably not a good time for me to take on a new project (unless I have to).

Here's another example.  Let's say I am someone who likes my home to be clean and tidy at all times.  Now suppose my spouse invites a large group of extended family members to spend the week with us.  Knowing this in advance, I might spend extra time cleaning up before they arrive and then give myself permission not to worry about trying to keep things tidy until after my guests leave.  (Because I can either spend my week trying to clean up after everyone and make myself miserable or I can spend quality time with people I love and enjoy myself). 

So because I know I have a low tolerance for stress I do my best to limit the amount of stress in my life at any given time.  Historically, this has been a pretty effective strategy.  Recently, however, there have been problems.  This is due, in part, to the fact that my husband believes I should be able to handle more stress than I do.  In making his case, he tells a story about how he used to worry about everything.  One day, he realized how miserable this made him.  He decided he no longer wanted to be miserable.  From that day forward, he resolved to stop letting things bother him.  He has been happy ever since.  The end.

It's a great story.  He makes a good point: excessive worrying does tend to make people miserable.  I know this.  And honestly, over the years I have learned to let a lot of things go.  What I think my husband fails to understand is that his experience of stress and my experience of stress are fundamentally different.  By nature, my husband is not easily exciteable.  His disposition is cheerful by default.  He likes to have fun and makes doing fun things a top priority.  When forced to choose between fulfilling some obligation (which can of course always be put off until later) and doing something fun, nine times out of ten he will choose to do something fun.

I, on the other hand, have apparently always been discontent.  My parents tell me I suffered from severe colic as an infant.  As a result, I cried a lot and was frequently inconsolable.  I can remember worrying about all sorts of random things as early as age four.  By the age of five, I had developed so many compulsive behaviors that my kindergarten teacher called my parents to express concern.  After a visit to a psychologist I was diagnosed with Obsessive Compulsive Disorder.  At the age of five.

So in my view, the cards were stacked against me from the start.  I have been dealing with anxiety for literally my entire life.  To me, the fact that I've been able to find peace in my life is remarkable.  And yet I do have peace.  Not all the time.  But I do have it, and I am grateful. 

On the other hand, maybe it would be good to push myself harder.  My husband says I need to spend more time outside of my comfort zone.  I'll admit that I've been a little resistant to this.  My comfort zone is where I have peace.  What if I stray too far and am unable to find my way back?  What if I upset the delicate balance I have worked so hard to achieve?

Then again, I believe we should never stop growing as individuals.  I have grown a lot over the years but that does not mean I am finished.  Who knows what I am missing out on while I stay here in my comfort zone? 

Wednesday, August 7, 2013


I think most of us are selfish, at least to a certain degree.  It's quite natural when you think about it.  We see things from our own perspectives and are influenced by our own thoughts and emotions.  This happens automatically, without effort.  We exist within our own bodies from the moment we are born.  And yet, no matter how much time we spend with ourselves there are always things we don't understand.  Why do I get upset over some particular thing?  Why do I have certain fears?  Why don't I have as much energy as other people?  Why do I worry so much?  Why can't I focus?  Why am I good at one thing but not at another? For every person, there is a part of himself that remains a bit of a mystery.

As difficult as it is to know ourselves, it is even more difficult to understand others.  In order to try to see things from someone else's perspective, we must first set aside our natural inclination to see things from our own perspective.  We must then imagine how that person sees the world.  This is easier to do in situations that are similar to those we've experienced ourselves; we can recall how we thought and felt.  Still, this strategy rests on the assumption that the person we are trying to understand reacts to the situation in question with the same thoughts and feelings we ourselves had.  This may or may not be the case.

It seems to me that the natural inclination is to see things from our own perspectives and to act accordingly; we are thus all inclined to be a bit selfish.  Empathizing with others requires intention and effort.  When we are under a lot of stress or when we are tired, sick, hungry, or distressed, we may lack the energy or the presence of mind to empathize with others.  These are the times when we are most likely to behave selfishly, often without even realizing it.

I've been thinking about this because someone recently accused me of being selfish.  My first reaction was to become defensive; I felt I was being judged, and unfairly at that.  It bothered me though.  I'm not selfish, am I?  I care about other people.  I constantly think about the people I love.  I call them.  I spend time with them.  I tell them I love them.

What does it mean to be selfish anyway?  Almost certainly it means different things to different people.  As I said before, I think everyone is a little bit selfish and I don't necessarally think it's a bad thing.  There are times when we need to put ourselves first.

Still, I've been thinking...Maybe I put myself first too often.  It is something to consider...     

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