Infidelity navigation: Summary * fidelity 101 * fidelity 108 * fidelity 2 * fidelity 3 * fidelity 4 * emotional cost * triangles * how to mend * models of mending * how to forgive * the unforgivable * relationship education * exits from intimacy * ending a relationship in peace * defences * emotional intelligence * re-romancing * on vulnerability
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How to mend navigation: 1. How to mend * 2. Models of mending * 3. How to be a grown up * 4. Hold me tight * 5. Becoming vulnerable * 6. Emotional bids * 7. Constructive fights * 8. Exits from intimacy * 9. The answer
Trauma navigation: complex trauma 1 * societal trauma 2 * write it out 3 * life events scale 4 * compassion fatigue 5 * first aid 6 * first responders 7 * post-trauma growth 8
*Last edit of this page 23/04/2013
Link to my how to choose a competent therapist page 2
1.0 The good news
Studies of therapists show their relationship skills and personal style have a greater impact on the outcome of therapy (40% of contribution to outcome) than the modality of treatment they provide (10%).
The most effective therapists ask their clients what worked and what didn't and then they practise over and again alternative responses that improve the feedback. It's that simple!
The outcomes for 3 evidence based couple therapies are excellent:
The most thoroughly researched, Emotionally Focused Couples Therapy (EFT), has decades of research studies that consistently indicate that the majority of couples improve (85+%) and that many (70+%) reach a recovered or non-distressed level. In addition, there have been a number of follow-up studies indicating that those who are considered recovered at the end of therapy do not relapse. These results are impressive. Source
Gottman's forty years of research into how couples create close, lasting relationships and what it takes to turn a distressed marriage around. Using his approach, Gottman Method Couples Therapy, 85% of couples were able to turn their relationships around.
The level of distress and severity of the problem (for both treatment methods) did not matter much – it explained only 4% of these couples’ counselling success. Source
With a third evidence based approach called integrative behavioral couples therapy (IBCT), in one study 67% of couples significantly improved their relationships in two and five year follow ups. Source
For all these approaches, couples continue to improve after marriage counselling is over.
That last sentence is pivotal
By the end of an effective relationship therapy, couples had established a self-renewing process at home, which they applied ongoingly in their relationship to keep it growing.
As parents, they can then teach this method when they provide emotion coaching to their kids. This is divorce prevention for the next generation. For more on this read my note here.
- If you did not take a self-renewing process home from your marriage or relationship counselling experience, don't give up on the marriage just yet.
- More carefully select your next couple therapist from the information here.
1.1 The bad news:
Orlinsky and Ronnestad are doing a large scale international study of what therapists bring to treatment, reported in the May/June 2005 Psychotherapy Networker.
Early results indicate that therapists experience the process of doing therapy in two distinct states of mind named healing involvement (alive, engaged and productive) and stressful involvement (bored and anxious).
About 50% of therapists in their sample at any one time, are alive and engaged in their work.
The other 50% of therapists were described as: challenged (25%); distressed (10%) or disengaged (15%).
As in any other field - buyer beware. Take as much care employing an individual, couple or marital therapist/counsellor as you would in taking out a loan or buying a house or a car.
Couple's therapy in particular is not always successful when provided by:
- inadequately skilled and supervised therapists whose fouc is the individual
- organization development practitioners moonlighting as marriage counsellors
- relationship therapies based on a conflict resolution methodology
- health practitioners who just tick the box but have no real passion for the work.
The outcome figures below attest to these observations:
The wide range of marital therapies based on conflict resolution share a very high relapse rate. In fact the best of this type of marital therapy has only a 35% success rate. Quoted from 'The Seven Principles of Making Marriage Work' by John Gottman.
In Gottman's studies, 50% of those in every type of relationship therapy (coming on average after 6 years of compromising and negotiating around key issues) continue on to divorce. Of the 50% who continue in their relationship, 35% report distress two years later.
These poor outcomes are NOT a result of the level of distress or severity or length of the problems in the couples.
1.02 How to choose
I don't think I really got the essence of couple's work until I was in my mid 40's after 20 years experience. I now think I work better at it every year. Experience, training and expert supervision counts for a lot in couple's work.
It takes about 10 years to train a clinical psychologist at University level. Add another 10 years of experience and then you begin to have an excellent practitioner.
Those maths are simple filters for choosing a competent individual or couple therapist.
'Evidence base' is another simple filter - does the method in which they are trained and supervised have a strong foundation of research showing evidence of its effectiveness.
In a sense you won't get to know that about the therapist in front of you until you have interviewed them.
There are a lot of 'how to interview a therapist' guidelines on the web. I like this one because it is street smart, matter of fact and conclusive, written by a customer rather than a therapist. Here's some more information about this topic on page 2 of this article.
2.0 What a therapist brings to the task affects the outcome
Therapy works. Over the last 40 years, study after study finds that the average treated (individual) client is better off than 80% of the untreated sample in those studies. Now for the bad news. In spite of years of careful research, the same data has not found any one model, method or approach that results in reliably better outcomes for specific diagnoses. From talkingcure.com
Carl Roger’s theories developed in the 1950’s are often over-looked and rarely cited in mental health literature these days. He predicted,
- much of the training which psychotherapists received in university professional programs would be irrelevant
- that a great deal in therapy depended upon the therapist having his ‘heart in the right place’ rather than on technical expertise
- the enormous amount of professional time and resources expended on assessment and diagnosis may be a waste of time
- there may be no essential difference between what constitutes a good psychotherapeutic relationship and what constitutes a good helping relationship in many other settings such as education, social work, child rearing or even management consultant
It is okay to interview a prospective therapist, and to ask them how they are traveling in their work. It directly impacts on their effectiveness with you.
A useful way to illicit that is to ask something like, what are the growing areas and the challenges in your professional life? How do you take care of yourself? How do you keep yourself interested and alive in your work? How do you know which clients you work best with?
How they handle the discomfort and deal with a direct question during a first interview about their own self-care, can give you a feel for how they might behave when challenged over a misunderstanding or a mistake during therapy.
Some therapists have a poor answering service or email process. This might indicate a lack of awareness of their client's desire for a soothing phone message when they are distressed.
Many ongoing clients just want to hear a familiar voice or see a kindly face or read their point of view on the web in the early hours of the morning.
2.1 How to find a psychologist or therapist
Use this short selection questionnaire to help shape your decision. [If link broken it is here in .jpg and here in .pdf formats.]
Internationally, here is the Emotionally Focused Therapy (EFT) find a therapist page. They also list EFT therapists like me who are in Australia.
Here is a useful article about choosing a therapist in USA and how to choose a therapist from grohol.com
Word of mouth referral from a friend or from another health professional are among the most common and effective ways we choose a therapist. Followed by a chat over the phone for about ten minutes before making an appointment. These are all good initial indicators of the potential for a working relationship. About 40% of my clients choose me from also reading this websites.
A phone chat will give you some information about the therapist - especially if you are clear on what you want and don't want and are unafraid to ask.
Theoretical models are not as useful as their ability to engage you in changing your behavior.
You don't want to waste time or money if you are clearly not in their bag. Both of you want a good fit and want to work that out early.
It then takes time to get to real talk.
Sometimes the most effective therapist responses are casual asides or throw away lines.
These powerful asides are rarely acknowledged by research into the effectiveness of interventions such as cognitive behavior therapy, yet they have a significant impact on individual outcomes.
I have had clients quote something I said decades ago that was just one of my thoughtless, throw away lines, which had served them well as a core principle in making subsequent life choices. I can never predict what that is going to be - which seed lands on fertile ground.
That has taught me not to be pre-meditated or formulaic in how I respond.
2.2 Telephone and recorded sessions
If you are in rural or remote Canada or Australia you may not have much choice of therapist.
Given the travel time, some sessions by email, telephone or skype will be important and necessary.
A therapist with clear, companionable telephone manner and a warm, unambiguous, jargon free writing style will help clarify and resolve issues using those media. Depending on your circumstances the same may apply in an urban setting, when unexpected traffic congestion means the first 15 minutes of the session are on a hands free phone.
A therapist's willingness to allow you to record a session is also a good sign of their accountability.
The recording can help you bring it back home to you partner; review what was said or done; track the change points; assess your authenticity, the therapist's listening skills and their clarity in hearing/reading you and responding to you correctly.
If the therapist asks for your permission to make a recording of the session and you agree, it then becomes a confidential health record, which has to be kept by the therapist for 7 years in Australia. You will be asked to sign a consent form limiting their use of the recording and honoring National Privacy Legislation. Be very concerned if you are not!
After an initial appointment I advise you to assess your experience with this how to choose a therapist selection questionnaire. If link broken it is here in .jpg and here in .pdf formats.
Also try to get get a reading of which 50% they are currently traveling in their career - particularly if they appear challenged, disengaged or distressed. Remember 50% of therapists were described as: challenged (25%); distressed (10%) or disengaged (15%).
Here is a list of focused questions to assess how your body feels after a session and in what proportions did you or the therapist influence the direction of the session.
The summary of the book Crazy Therapies by Singer and Lalich begins, there are very few sure things in life, but the following guide to recognizing an incompetent, immoral or quack therapist is about 99.9% guaranteed.
Here's a review of the book on The Skeptic, from which these quotes will give you the flavor of it:
Reading this book may even encourage some people now considering a career in therapy to go into law instead. You may do more good that way - if you devote yourself to suing or prosecuting "crazy" therapists.
Those thinking of entering therapy and those in therapy who have some serious doubts about their therapists might want to jump to the section on "Consumer Guidelines" in the last chapter. Singer and Lalich provide much practical advice for those who are being asked to put a great deal of faith in a stranger who will be meddling with your mind, your emotional well-being and your life. They remind the reader/patient that you will be revealing very personal things about yourself and other people in your life. The decision to hire a therapist can be a monumental one. It should not be taken lightly.
'If you are treated with disdain for asking about what you are buying think ahead: how could this person lead you to feel better, plan better, or have more self-esteem if he begins by putting you down for being an alert consumer? Remember, you may be feeling bad, and even desperate, but there are thousands of mental health professionals, so if this one is not right, keep on phoning and searching. (p. 205)'
'If there is a major weakness in "Crazy" Therapies, it is that the book does not address the issue of neurochemical disorders (aka mental illness). The authors do not attempt to distinguish people who are having "life problems" but not major neurochemical problems. If you are schizophrenic or bipolar, you will not find this book useful in trying to decide what therapist to see. If you are a family member or loved one of a person with a major neurochemical problem, this book will not help you figure out what you can do to help.' Source
3.0 Example of a candidate for couple's therapy rather than the individual therapy they initially chose
Q: 'My partner of 4 years has been seeing a psychotherapist for the last 8 months and there is no change in his behaviors or attitude. Apart from the financial issues involved I resent that he pays money to communicate with someone else when he doesn't communicate with me. He thinks that I am jealous - it’s more like a feeling of betrayal that he refuses to talk to me about anything. This is causing problems in our relationship and whenever we try to discuss these issues it always ends in a major argument. I feel betrayed by his reluctance to share anything with me and he feels that he is being restricted by my reluctance to support his therapy. I feel like the therapy is more important to him than working on saving our relationship and we always end up in a stalemate and neither of us can move past these issues. Is it normal for partners to feel this way? How do we get through this? I want him to give up for a while (not for good), he insists on going even at the expense of our relationship.' quoted from good therapy forum
A: It's impossible to build a mental map of a relationship when your partner doesn't let you in. Mind reading won't take you far. We require an accurate map in order to navigate the tides of intimacy and to know where we stand with our loved ones. When a stranger is getting a big look in at your expense, the ground can feel very slippery; the map obscured and you'd be unusual if you didn't feel a bit ripped off. From your point of view you are in a triangle
Some intimate conversation has been outsourced to a therapist, barring your access to all that is going on inside your loved one.
You fight to get back in, he fights back to protect his choice. The therapy has become in effect a third party and a new exit from intimacy that both of you have agreed to argue about and at the same time, feel yucky being wound up about a peripheral issue. It's unlikely to be the real issue, but at this stage it feels real; is perceived as a threat and has purchased yet another stale mate. Anyone could discount the impact of his therapy on your relationship by denying your experience and blaming you for feeling threatened, but neither discount will secure a relationship built on respect, friendship and love.
The current issue is probably the latest escalation of a pattern that has dogged you both from the outset. Each new version of the pattern erodes trust and safety and pushes owning and addressing the core issues further away. Many give up on a relationship at these points - too much like hard work - only to go on to create a new version of the old pattern in the next one.
My guess is that both of you have co-operated over the last 4 years in producing a now predictable disengagement, where one ends up the pursuer (mostly you, 'tell me what's going on with you, come closer') and the other the withdrawer (mostly him, 'I'll work it out on my own, give me some space'). It's a pattern also described as fuser and isolator. Weird to think that our exits from intimacy are co-operative behaviors like dance routines, defined by and refined in our peer groups and families of origin.
Step back from the dance and consider your contribution to its steps.
What's his take on this? Is he a bit scared showing tenderness and vulnerability with you? Of willingly exposing his heart to the risk of hurt or of being controlled by you as he struggles to maintain a sense of self, up close? There's an edge in getting close with love, when one can experience confusion about where I end and you begin. I wonder if the kindest explanation of your partner's insistence on his therapy at the risk of his relationship, is that at some level he knows he has to grow; develop more self-differentiation and learn how to care for himself up close with you. He may sense that postponing his growth will keep the relationship going around and around in circles, and fears that he can't make that leap in growth with you. It's difficult to articulate that knowledge when you are just in the process of learning about it.
How about the therapist? The kindest interpretation of the therapist's role is that of an unwitting participant in a triangle. Many therapists directly invite and re-invite the partners of their clients to come in over the course of individual therapy. Still, some of those partners refuse to attend until after it is too late and the horse has bolted. Were you invited in at the outset? Numbers of partners have and do feel the way you do and that normality doesn't make the normal omission of couple support okay. Your distress is foreseeable and it is not okay.
If those joint sessions have not occurred you can choose to call his therapist, raising your concerns and asking for a joint session to safeguard the relationship from further injury. BUT! Warning! Without your partner's blessing of that contact he could perceive it as an invasion by you and if it takes place, as betrayal by his therapist if s/he hasn't cleared that contact with him before talking to you. It could just be another escalation of the fuser isolator routine.
More on site about pre-commitment and marriage education.
4.0 Is counseling neutral, objective and value free
Therapists carry into their sessions, sometimes unexamined, culturally prescribed 'normal' prescriptions about what is good and poor health, good or dangerous therapy, male and female traits etc. Clients do the same.
A therapist urging or not urging a partner to 'seriously consider leaving a particular relationship' depends a lot on the client's ability to fairly represent what goes on in three sides of their relationship: his story, her story and the whole story; on what they have been told and what is omitted in the telling of their client; on how savvy the therapist is about the triangle of influence they inevitably join when they pick up or ignore an issue, and particularly on their views of what is unhealthy.
To one therapist the relationship problem may be an opportunity for growth but for another the same problems may be described as a bitter power struggle.
Whatever psychotherapy is, it is not about therapeutic neutrality. Therapeutic neutrality is a stance inherited from classical psychoanalysis, in which the silent, passive analyst refuses to react or comment on what the patient is saying or doing, thus encouraging the patient to regress into a "transference neurosis" on the analyst. Needless to say, such unresponsiveness brings forth all manner of crazy emotional responses. Except in classical psychoanalysis, neutrality is not only rude and inappropriate, it also makes you crazy.
Even if a therapist could be neutral about the issues at hand - impossible! - that neutrality would at best bring the therapy to a limping halt and at worst seem to be an endorsement of the client's persistence to barrel the wrong way down a one-way street. One of the horrors of psychotherapy is the affirmation clients may feel from their seemingly neutral therapists that they are "okay" even when they are doing terrible things to themselves and their loved ones. Therapists may actually encourage clients to feel better about themselves by blaming their lives on other people, on the nature of human existence, or on the peculiar mores of the society around them. Therapists should of course help people step out of their crippling state of victim hood.
Good therapy is not a chaste love affair between buyer and seller of psychotherapeutic services. The therapist and the customer don't even have to like one another. The therapy may be working best when you don't like your therapist, when you get the firm impression that your therapist doesn't like you very much either, and when you are being told that you have to do something you don't want to do if you are ever to feel good about yourself. In fact, the therapist is hired to scrutinize you sharply and find something about you that is unlikable and unworkable, and then to help you isolate and discard the offending behavior. If the therapist sees everything the way you do, the therapist would be in the same fix you're in. And if the therapist thinks you're wonderful the way you are and just wants you to realize it, the love affair that results is different from therapy. Therapy is an inherently adversarial process, not an alliance to buffer innocent victims against a world that isn't gentle enough.
Some therapists believe in marriage so strongly they see single hood as a state of emotional deprivation that is the cause of all the pain in the life of single people. Such therapists may rush people into ill-advised marriages, some of which will work and some of which won't. Other therapists distrust marriage so totally they see it as a dangerously oppressive state of exploitation and impending doom. They assume that any pain a married person suffers is brought on by the marriage. These therapists likely experienced disappointment in their marriages or their parents' marriages. In between are therapists who idealize marriage, and give full support to perfect marriages and short shrift to those with problems. Some therapists, especially those who didn't come in from the Sixties in time, still believe that mental health comes from running away from home, and if people are too old to run away from their parents, they can run away from their marriage. Quoted from 'A Buyers Guide to Psychotherapy' by Frank Pittman
Link to my how to choose a therapist page 2
© ZPJ Fox 2006 - 2012 All Rights Reserved peterfox.com.au