What do you say to a client whose presenting issue is deep\nangst over the question of relationship? Whether the person is in a primary\nrelationship and deeply unhappy, questioning whether to stay or to go, or the\nperson longs for that primary relationship in order to feel happy and\nfulfilled, the issue is a profoundly unsettling one to those caught up in it. How\nare we, as mental health professionals, to be with clients’ inner conflicts of\nthe partnering kind? What should our clients know when considering whether to\nenter — or to leave — a relationship? And how can we know if their impulse\ntoward partnering or toward singlehood is healthy or not for them? We entertain\nthe questions of what we might be looking out for with such clients, and which\nnotions\/modalities may be helpful in sorting through the questions.<\/p>\n\n\n\n
Let us say up front that we are not considering here\nquestions of relationships where there has been violence or the client’s safety\nis at risk. With few exceptions, these are situations in which the client needs\nto leave: the sooner, the better. Similarly, we do not address our remarks to\npeople who are deeply traumatised. Neither are we including in our discussion\npeople who are happy in their relational status, whether that is wedded bliss\nor blessed singlehood. Rather, we bring to your attention common relational\nwoes where the client is either perpetually angsty over their status, or acts\nin unhealthy ways to eliminate the angst.<\/p>\n\n\n\n
One “red flag” to beware of — either in<\/em> your clients or for <\/em>them\n— is that of the person who must<\/em> be\npartnered to feel ok. <\/p>\n\n\n\n One middle-aged gentleman, an acquaintance of one of our\nwriting team, delivered a touching eulogy at his wife’s funeral. “She is forever\nmy wife,” Mark declared, “[Despite her death], that doesn’t change.” How\nromantic! How beautiful! Yet two months later, our writing team member learned\nthat Mark had re-married: after just one month of becoming a widower — and he\ndidn’t even know the woman who became his second wife before the first one\ndied. Not only that, but the second wife came from a very different country and\nculture to the one in which Mark grew up. Quite simply, Mark had grown up with\na powerful, controlling mother and many older and equally powerful sisters. Without\na woman around guiding and directing him, Mark literally did not know what to\ndo. Years of unhappiness ensued as Mark realised that he had finished with one\n“boss” only to marry another one — and the second one was hard to understand!<\/p>\n\n\n\n Related to the first red flag is the person, usually one\nrecently made single, who believes that they can’t plan or move on until the\nrelationship question is resolved. If they have just suffered a breakup, they may\npine continually for the person, even if, while in the relationship, they\nexpressed major concerns about the quality of it. Pippa, whose partner of four\nyears broke it off, told her therapist that she was putting off deciding\nwhether to move back to the city she grew up in (a move she had desired in the\nrelationship, but which he had resisted) until she saw whether there was a\nchance of getting back together with the man. She continued to feel this way\nfor months even though, when she spoke with him, he asserted that he was\n“settled” in his decision and even though Pippa had spent many hours in therapy\nbefore the breakup questioning whether this was the “right” relationship for\nher given the many differences in values and preferred life activities between\nthe two of them.<\/p>\n\n\n\n Rod went to his therapist wailing, “All I want is a\nrelationship, but with the long hours and travel of my job, it’s just not\npossible to have a relationship; I’m rarely in town”. Rod and the counsellor\nbegan working through ways in which Rod could get more time for things that\ntruly mattered. He got clearer on work-life boundaries, managed to reduce the\namount of travel, and made other changes. After some months, he quit the job\nwhich had demanded so much travelling and took up one which saw him work\nshorter hours, with little out-of-town travelling. He began to date women, but\njust when a woman and Rod were getting closer, Rod would back off, often\nbreaking it off completely. After some months, he had an epiphany. Rod realised\nthat he had set up his former lifestyle to shield himself from becoming too\ninvolved in a relationship. It was very telling when he related how, as a\nrecreational skin diver (meaning someone diving beneath the surface of the\nwater without SCUBA gear to breathe with), Rod could outlast anyone else in the\ndiving club holding his breath underwater. “I learned to do that,” he said,\n“when growing up. My domineering mother would hug me so hard she would\nliterally squeeze the air out of me. I would just hold my breath until she was\nfinished”. Rod’s impulse toward — and then away from — relationship was a\nre-play of what he had to do earlier in life to survive. <\/p>\n\n\n\n Sometimes as therapists we must be vigilant about angst from\nthe already-partnered, who contemplate returning to singlehood. They are\ntypically in relationships in which criticism, contempt, and defensiveness manifest\ntoxic patterns that undermine any possibility of relational harmony. This is\ntrue whether our clients are the ones on the receiving end or are perpetrating\nthe behaviours. Behold the relational “red flags” of the Four Horsemen.<\/p>\n\n\n\n Some relationship experts have written about what they call\nthe “Four Horseman of Relationship Apocalypse”. The phrase is a metaphor\ndepicting the “end of times” in the New Testament of the Bible, describing\nconquest, war, hunger, and death. In the relational metaphor, it describes\ncommunication styles that, according to research, can predict the end of a\nrelationship (Lisitsa, 2013) — or, we would say, the demise of any genuine\npossibility of right relating. So, what are the four “horsemen”?<\/p>\n\n\n\n Is the unhappy client frequently critical of the\nspouse\/partner? Alternatively, is the client on the receiving end of a partner’s\nfrequent criticism? We’re not talking here about the need to make a complaint\nabout a specific issue. Rather, it is the perpetual running-down of the other\nperson’s character — smearing their whole being with a tar brush, so to speak —\nthat is the problem. It sets up an escalating cycle of criticism and\ncounter-criticism which opens the door for the other “horsemen” to come riding\ntriumphantly through.<\/p>\n\n\n\n This, the second horseman, is seen when people treat their\npartners with disrespect, mocking them, ridiculing them, and\/or using gestures\nand paralinguistic expressions such as eye rolling, scoffing, or mimicking. Contempt\noccurs when someone expresses long-held negative thoughts, attacking the\npartner from a position of supposed moral authority. Apart from research\nshowing that individuals engaging it get more colds and flu than average\n(contempt apparently weakens the immune system of the perpetrator), it also is\nthe single largest predictor of divorce (Lisitsa, 2013). <\/p>\n\n\n\n Defensiveness, the third horseman, plays out in\nrelationships that are failing. It is usually a response to criticism in which\nthe accused feels unjustly blamed, looks for excuses, and proclaims innocence\nin order to get the accuser to back off. The strategy isn’t usually successful,\nbecause it displays an inability to take responsibility for errors or faults,\nand shows the criticiser that his or her concerns are not being taken\nseriously. Defensiveness escalates hostility and doesn’t allow for healthy\nconflict management.<\/p>\n\n\n\n When the first three horsemen have\nbeen running amok, trampling over the relationship, the natural response is to\nstonewall, which happens when the person on the receiving end of criticism or\ncontempt feels overwhelmed and withdraws, shutting down and stopping responding\nto their partner. Stonewallers, feeling too “psychologically flooded” to\nconfront the issues with their partner, tune out, turn away, act busy, or\nengage in obsessive, distracting behaviours. This behaviour can all too quickly\nbecome a habit, one which is lethal to the relationship (Lisitsa, 2013).<\/p>\n\n\n\n Thus, we see the “four horsemen”\ndepict a relational status of, “yes, I’m partnered at the moment, but I wish I\nweren’t. I’m so unhappy.”<\/p>\n\n\n\n Some of the most intense relational grief occurs to those\nwho are on the receiving end of a cheating partner. The hurt and sense of\nbetrayal can be overwhelming, and the client may wonder: if the partner did it\nonce, what would keep him or her from doing it again? It is a question worth\nasking, as the client contemplates what is of value in the situation, and\nwhether to stay or go.<\/p>\n\n\n\n While a solid therapeutic alliance provides one of the\ngreatest relational supports, there are also some important tools at our\ndisposal to accelerate the gaining of insight and healing that will reduce\nrelationship angst. Let’s look briefly at what some of the major “families” of\ntherapies can offer here.<\/p>\n\n\n\n One of the major benefits of psychodynamic therapies is that\nthey can help clients gain deep insights into root causes of the problem. Admittedly,\nsome of these modalities require intensive, long-term work, but much healing\ncan come from confronting situations of early unmet needs, as clients come to\nunderstand the relational templates they formed before they could even speak in\nfull sentences. Several modalities stand out here.<\/p>\n\n\n\n The aim of object relations\ntherapy is to help a client uncover early mental images that contribute to\npresent difficulties in the client’s relationships with others and adjust them\nin ways that will improve basic interpersonal functioning. Attachment theory,\nin particular, notes that if children are able to form a secure attachment to\ntheir caregiver, they are likely to use that healthy relational template to\nform workable relationships in their adult years. Sadly, the converse is true,\nand those who have come to form an avoidant, dismissive, or disorganised\nattachment — when caregivers have been cold, rejecting, or inconsistent — are likely\nto form relationships characterised by the woes we have identified above.<\/p>\n\n\n\n Acknowledging that human beings\noften have many unmet needs, this modality posits the existence of\nsubpersonalities: sub-selves which constellate in order to help us meet needs,\nor to shield us from experiencing the pain of needs that we have decided cannot\nbe met. Mark, mentioned above, is likely to have a subpersonality whose world\nview is that it’s a tough world, one that cannot be survived without a\npowerful, guiding woman to advise him. Working with subpersonalities helps\nclients see how they can meet acknowledged needs in ways that serve the whole\nself rather than just the narrower needs of the particular subpersonality.<\/p>\n\n\n\n For a psychodynamic therapy\nwhich is time-limited (often between 12 and 16 sessions), IPT helps clients\nimprove their interpersonal communications in order to improve both mood and\nrelationships. Its theoretical foundations are a combination of attachment\ntheory, communication, theory, and social theory. Clients with relational woes\noften elicit negative or unsupportive responses from others unintentionally. This\noccurs because those who have maladaptive attachment styles engage in specific\ncommunications which bring forth responses that do not meet their attachment\nneeds effectively. When the poorly-attached person then reacts to the\nnon-need-meeting response, it often escalates tensions, deepening the cycle and\npreventing those needs ever being met (Kiesler, 1979). Thus, this therapy can\nbe effective for those with specific interpersonal issues.<\/p>\n\n\n\n Self-defeating cognitive and emotional\npatterns that begin early in a person’s development and repeat throughout life constitute the context for\nschema therapy, which is an integrative approach to treatment combining the best aspects\nof cognitive-behavioural, attachment, Gestalt, object relations, interpersonal,\nand psychoanalytic therapies into one unified model. Thus it would seek to\nidentify clients’ dysfunctional, pervasive themes or patterns in relationships\ndeveloped during childhood and elaborated throughout their life. The memories,\nemotions, cognitions, and bodily sensations that clients report give clues as\nto which of five main domains have been impacted, and are therefore playing out\nin the client’s relationships. Schema healing involves diminishing the\nintensity of all of these to the point that they no longer impair the client.\nThe interventions are cognitive, affective, and behavioural. Thus, a client\nlike Mark, whose issues arise in the domain of\nindependence\/autonomy, would learn to feel more comfortable relying on his own\nresources when making decisions and organising life. <\/p>\n\n\n\n In these modalities where reality\nis seen to be socially constructed and maintained through stories, we can see a\nway to help clients re-imagine their relationships through re-storying\n(narrative) and finding unique solutions based on a fresh assessment of\navailable resources (solution-focused). Narrative’s search for “sparkling\nmoments” and the quest of solution-focused therapy to know what was happening\nwhen the problem wasn’t as much of a problem speak to a process of refocusing. Clients\nin unhappy relationships, or those who desperately wish to enter a relationship,\ncan learn to highlight different elements of their past: times, for example,\nwhen events showed that they were loved and loveable, or when they were able to\nsee that, indeed, they functioned very well autonomously, without a more\npowerful other directing them.<\/p>\n\n\n\n Rogers’ person-centred therapy emphasises\nthe self-actualising tendency in human beings and the need for therapy to help\nclients overcome conditions of worth, a state of incongruence in which clients\nbelieve that they are only worthwhile and lovable if they think, feel, and act\nin ways that meet the needs of others. This would seem to be a fairly spot-on\ndescription of either the client who stays in an unhealthy relationship because\nthey must<\/em> be in a relationship — any\nrelationship — at all costs, or alternatively, the client who perpetrates the\nunhappiness of criticism, contempt, or defensiveness because that is all they\nknow.<\/p>\n\n\n\n This modality’s notion of an\nabundant universe and its focus on a person’s strengths and virtues can help those\nlonging for love move forward with the confidence that there is enough love to\ngo around, and that they have many positive qualities to offer a relationship,\neven if they have been disappointed in the past. The P.E.R.M.A. model of\nhappiness (for Positive emotions, Engagement, Relationship, Meaning, and\nAchievement) underscores the importance of helping clients to refocus onto that\nwhich is positive in their lives, engaging in activities that have meaning for\nthem and could lead to a meaningful achievement, whether or not the area of\nprimary relationship is happening as they wish. <\/p>\n\n\n\n Humanistic, person-centred,\npositive psychologies can also help clients — or client couples — who have\ncreated toxic relationships with any of the “four horsemen” of relational\napocalypse. <\/p>\n\n\n\n Therapies such as REBT, CBT, and ACT have a useful role to\nplay for the forlorn in love, in that unhappy relationships — or an unhealthy\nlonging for one — almost always involve some elements of irrational, limiting\nthinking. Thus the role of the therapist may be to help ferret out the\n“shoulds” and other cognitive distortions which make clients so unhappy. ACT\nhelps clients to distinguish between that which is out of one’s control and\nthus must be accepted, and that which may be amenable to change if the client\nacts. <\/p>\n\n\n\n Relational challenges, especially those of primary\nrelationships, are rife in modern life and often revolve around intense desire\nto be partnered, intense ambiguity about coming into relationship, or equally\nintense dissatisfaction with the dynamics of an existing relationship. While a\nrobust therapeutic relationship can offer both support and a model for how\nhigh-calibre relating can occur, as therapists we also have numerous therapies\nat our disposal to help reduce relational woes while helping put the client on\na more stable road of right-relating.<\/p>\n\n\n\nCan’t plan or move on<\/h2>\n\n\n\n
Commitment-phobes<\/h2>\n\n\n\n
Partnered, but also critical, contemptuous, defensive, and stonewalling<\/h2>\n\n\n\n
Criticism<\/h3>\n\n\n\n
Contempt<\/h3>\n\n\n\n
Defensiveness<\/h3>\n\n\n\n
Stonewalling<\/h3>\n\n\n\n
Cheaters<\/h2>\n\n\n\n
Which modalities help us to help clients move toward right relating?<\/h2>\n\n\n\n
Psychodynamic<\/h3>\n\n\n\n
Object relations<\/h4>\n\n\n\n
Psychosynthesis<\/h4>\n\n\n\n
Interpersonal Therapy<\/h4>\n\n\n\n
Schema-focused therapy<\/h4>\n\n\n\n
Post-modern: Narrative and solution-focused<\/h3>\n\n\n\n
Person-centred and positive psychology<\/h3>\n\n\n\n
Rogerian<\/h4>\n\n\n\n
Positive psychology<\/h4>\n\n\n\n
CBT-based therapies<\/h3>\n\n\n\n
Summary<\/h2>\n\n\n\n
References<\/h2>\n\n\n\n