Category Archives for "Couples and Relationships"

Couples Therapy

By Cisais | Couples and Relationships

First, it is important to realize that couples therapy, marriage counseling, and marital therapy are all the same. These different names have been used to describe the same process, with the difference often based on which psychotherapy theory is favored by the psychologist using the term, or whether an insurance company requires a specific name for reimbursement.

Couples therapy is often seen as different from psychotherapy because a relationship is the focus of attention, instead of one individual diagnosed with a specific psychological problem. This difference only arises if you consider psychological problems to be similar to medical illnesses, and therefore confined to a “sick” individual who needs treatment. That medical model of psychological diagnosis and treatment is common, but is really inadequate to describe and resolve psychological problems. All psychological problems, and all psychological changes involve both individual symptoms (behavior, emotions, conflicts, thought processes) and changes in interpersonal relationships.

Couples therapy focuses on the problems existing in the relationship between two people. But, these relationship problems always involve individual symptoms and problems, as well as the relationship conflicts. For example, if you are constantly arguing with your spouse, you will probably also be chronically anxious, angry or depressed (or all three). Or, if you have difficulty controlling your temper, you will have more arguments with your partner.

In couples therapy, the therapist will help you and your partner identify the conflict issues within your relationship, and will help you decide what changes are needed, in the relationship and in the behavior of each partner, for both of you to feel satisfied with the relationship.

These changes may be different ways of interacting within the relationship, or they may be individual changes related to personal psychological problems. Couples therapy involves learning how to communicate more effectively, and how to listen more closely. Couples must learn how to avoid competing with each other and need to identify common life goals and how to share responsibilities within their relationship. Sometimes the process is very similar to individual psychotherapy, sometimes it is more like mediation, and sometimes it is educational. The combination of these three components is what makes it effective.

Conversations with Couples

By Cisais | Couples and Relationships

It is very common for couples to contact me and, in our first conversation prior to an appointment, ask for help in these areas:

• Infidelity/Trust Issues
• Communication ‘Tools’ or ‘Skills’
• Parenting Issues
• Anger Issues
• Intimacy Issuesand…last but not least….
• ”I’m pretty sure my husband is a Narcissist”

One might think that all of these issues are varied and drastically different from one another.  What might ‘anger’ issues have to do with ‘infidelity’”? What does ‘communication’ have to do with ‘parenting’ or ‘intimacy’ issues?  Actually, this is where therapy becomes therapy vs. communication coaching or teaching.

Follow me here……I can teach you communication skills, I can provide you models for effective parenting, I can provide you with self soothing/de-escalation skills to interrupt patterns of impulse and anger, we can even identify blocks to vulnerability or access to one’s own emotional responses, and, there is tremendous  initial value and insight by acquiring these skill sets….this is important stuff for sure.

However, these are what I deem to be behavioral changes vs authentic changes.  Have you ever heard of, or known a ‘dry drunk’ (excuse my slang)?  This is person who has changed their maladaptive behavior (alcohol = bad idea) for a less damaging behavior (sober = better idea)…but what about the reason the person drank, or had the affair or was a rigid parent or was prone to rage in the first place?  Changing behavior may not change the underlying dynamic…at all.  Dry drunks are difficult by nature, a person who has had an affair and stops is no less prone to a relapse than a person refraining from alcohol…..unless underlying issues are addressed.

Behavioral changes are only part of the process.  They are put in place to prevent more damage from occurring to the relationship, and, ‘they’ are in no way the fruition of a couple’s journey towards true partnering for life.

What all of these issues in fact have in common is, how we are attached or bonded, to others and ourselves.  At the core of us all we have experienced some loss or disconnect in our primary attachments very early in life.  Having had firm attachments to a healthy primary care giver, we are able to develop a strong sense of self and maintain that self even in the deepest of relationships.  When we have experienced poor attachment or bonding, or, when we have had a strong bond to a primary caregiver with a strong deficits, we develop our own deficits in our ability to access our self.  It is from these broken attachments (which literally we all have to some extent) we can cause problems in our relationships.  In Susan Johnson’s book, Hold Me Tight, she describes healing these attachments to one’s partner and within one’s self as the basis of the most effective approach to couples counseling to date.

As a couples therapist for over 16 years, this model has been extremely complementary to the work I do with couples.  This level of work with couples is profound.  Each partner is able to see how their own woundedness is working them from the inside-out, affecting perception of their partner, keeping them stuck in a cycle but not understanding exactly what the cycle is, how it starts or how to interrupt it.

As a couples therapist, I will often meet with partners individually, early on, to get a separate assessment of their current perception(s), a sense of their strengths in problem solving and communication, where blind spots might be and, family/relationship history.  This more progressive/aggressive approach to treatment is a departure from traditional couples counseling.  However, I have yet to work with a couple who has not appreciated this part of the process, and, benefited from it.

The direct benefit to the client is really being heard, without judgement, knee jerk reactions, making a big plan right away or, taking either side.  How it makes the process more efficient is by providing me clearer insight into isolating who is contributing what to the overall dynamic.  And when I say ‘efficient’ I mean it saves everyone time, money and allows us to get traction in doing the individual work necessary in closing the distance between partners.

Balance in Relationships

By Cisais | Couples and Relationships

Throughout the course of a successful marriage or long-term commitment, the two people in the relationship may shift in and out of various roles. For example, one person in the couple may support the other person going back to school. In order to do this, he or she steps into a supporting role, setting aside certain goals or aspirations in order to provide a stable base from which his or her partner can launch in a new direction. There are many gifts of learning inherent in this role—from having the opportunity to embody a nurturing stance to feeling the pleasure of seeing a loved one thrive. When our partner expands his or her horizons, ours expand, too, and we gain access to a world that would otherwise remain closed to us.

However, there is also much to be said for having a turn to be the one stepping outside the box, perhaps taking time to attend to our personal healing, spiritual pursuits, or other interests. In order to maintain balance within our relationships, it’s important that we address these issues each time one person steps into a supporting role so the other can try something new. When we are conscious about acknowledging that one person is bearing a bit more of a burden so that the other can grow, we stand a better chance of making sure the ebb and flow in the relationship remains fair and equal.

The most important part of this process is open communication in which each person has a chance to express how they feel and come to an understanding about the roles they have agreed to play and when they expect them to shift. Each time a dynamic shift occurs, a ceremony of acknowledgment can lend an air of distinction to the moment. This can be a simple dinner date or an elaborate ritual, depending upon what works best for us at the time. Perhaps the most important thing is expressing gratitude to the person in the supporting role and encouragement to the person moving in a new direction. When the flow of feeling and communication is open, a healthy closeness develops that allows each person in the relationship to have a turn at each of these important roles.

Lee Ockenden, LMFT – My Approach

By Cisais | Couples and Relationships , Motivation and Choice , Musings

Who we are and how we relate to the world and others is dictated by the meaning we give to our past. But if we choose to find the purpose in our experiences instead of the pain, we find new resources, giving us the catalyst to change, grow, heal and pursue the life we desire and deserve.

Traditional therapy was founded in psychoanalysis with the assumption that an individual’s growth and change process was hinged on gaining insight and into their behavioral patterns by processing, free-associating and reflecting on their past. Inside this traditional “treatment culture,” it is not uncommon for a client stay in treatment long periods of time, lasting anywhere from three to seven years or more, including multiple sessions per week.

I believe that traditional therapy can foster dependency and create barriers for lasting change. I often hear from new patients who have been to therapy for many years that they felt their last therapist(s) were too passive. Rather than embracing a “backward looking—coping” approach, I embrace a “forward looking—thriving” approach by focusing on resolving barriers to change, identifying solutions and creating choices. This approach, inside a safe supportive and consistent counseling environment, encourages clients to use their own innate resources to heal.

In addition, I am also clear that my clients will ultimately find their support and accountability through their partner, family or community and I encourage my clients to create a healthy support system outside the office.