Attraction to Psychological Approaches

April 15, 2013 at 2:48 pm (Ideas, Pair Bonding)
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I’m an avid lover of theory, all kinds of theory—psychoanalytic, systems, humanistic-existential, and so on. I think my appreciation of theories grows as I age, as does my appreciation of people, relationships, music, art, and politics. As I grow older and hopefully wiser as a clinician and educator, my appreciation increases for the various approaches to psychotherapy available today, just as the illusion decreases that my particular approach to couple therapy is better than the other ones out there. In the couples arena, I greatly admire the work of Sue Johnson, Ellyn Bader and Peter Pearson, David Schnarch, John and Julie Gottman, Esther Perel, Dan Wile, Harville Hendrix, Marion Solomon, Terry Real, Rob Fisher, and many others. These are not only master therapists, but enormously creative producers of inspiration to couple therapists worldwide.

Having developed an approach myself—in part, a result of having been personally influenced by other approaches—I have come to understand that the success of any approach hinges not only on its utility in providing clarity and organization for the therapist, but also on its ability to inspire personal meaning. In other words, therapeutic approaches are first “sold” (wholesale) to clinicians, who “buy” its organizing principles because it speaks to them, fits their personality and style, and works for them in a deeply personal way. The clinicians then sells (retail) this template for organizing experience to their patients (consumer). Theory and approach are for the therapist directly, and therefore only indirectly benefit the patient.

I think it is fair to say that people who are attracted to PACT are attracted to my particular thinking about the problem of adult romantic relationships. With EFT, students are attracted to Sue Johnson’s epiphanies about relationships. Same with Gottman, Schnarch, Hendrix, Perel, and so on. Interesting, to me at least, is that the people I mention here agree with one another more than they disagree, although it may appear differently at times to others. We’ve all put our finger on something that rings true about relationships, and many of our ideas are similar, give or take some terms and nuances.

John Norcross, a specialist in psychotherapeutic approaches and their effect on behavioral change, has collected compelling evidence that what changes people is not any particular therapeutic approach or theory per se, but rather the relationship that develops between clinician and patient. He argues for integrative approaches that allow therapists to tailor interventions to respond with flexibility to the unique demands of each patient or situation in a manner that best fosters change. The matter of effectiveness in psychotherapy, therefore, may be as elusive as is our understanding of the complexity of the human mind, and more mysterious still, the phenomenological, intersubjective nature of human relationships.

© 2013 – A Psychobiological Approach to Couple Therapy® – all rights reserved

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A Moment of Clarification on Mindfulness

March 12, 2013 at 4:26 am (Conference, Ideas)

Last weekend I had the pleasure of presenting at the UCLA conference on How People Change: Relationships and Neuroplasticity in Psychotherapy. I was among some of the best of the best: Dan Siegel, Irvin Yalom, Peter Levine, Bruce Perry, Mary Pipher, Bonnie Goldstein, Pat Ogden, John Norcross, Russell Meares, Margaret Wilkinson, Dan Hughes, Jessica Benjamin, and Allan Schore.

I must admit, it was difficult to maintain my cool in the presence of so many I admire. As a result I apparently misspoke.

Participants heard me say that mindfulness practice is ill-advised because it reduces empathy. Clearly this notion disturbed the mindfulness meditators in the audience, and I can understand their dismay because it is not what I believe or intended to say. I would like to correct any mistaken impressions posthaste.

Having myself been a long-time Vipassana meditator and even once a teacher/facilitator of Vipassana (mindfulness) practice, I am an advocate of insight meditation, in both formal and informal practices. I have given presentations on Vipassana meditation and have cited the many research findings that show the astounding neurobiological effects this and loving-kindness practice provide. In no way is mindfulness connected in my mind with reduced empathy. To the contrary, I wholly believe it contributes to increased empathy as well as to increased capacity for self-regulation and interactive regulation with others!

The point I initially attempted to articulate (and tried to clarify during my panel discussion with Dan Siegel, Bruce Perry, and Peter Levine) was this: I have personally witnessed some partners in couple therapy use a meditative self-regulatory strategy during periods of mutual distress. This strategy can prove disastrous to mutual regulation of distress when only one partner employs it. The result tends to be sustained misattuned moments that lead to dysregulated states in the other partner. The reason, I suspect, is that the meditating partner is not responding to signals in real time and becomes too still, unresponsive, and even still-faced. I also have witnessed some supervisees practice meditation while doing therapy (without informing their patients), which caused problems for the patients, who found themselves dealing with an under-responsive therapist.

The fact that I conveyed anything other than what I have stated here is deeply regrettable to me. My hope is that some who were at the conference will be able read this blog with nonjudgment, acceptance, and compassion, and recognize that in fact we are not living in different realities.

© 2013 – A Psychobiological Approach to Couple Therapy® – all rights reserved

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Each Romantic Partnership is Unique

February 21, 2013 at 11:29 pm (Attachment, Ideas, Pair Bonding)

Much like a fingerprint, every romantic partnership is unique. The intersubjective, phenomenological system formed between two separate nervous systems can never be exactly replicated, nor is it likely to be fully understood by the participants.

If the notion of human cloning seems unimaginable, the cloning of a relationship is ridiculously inconceivable. The process of human pair-bonding is enormously complex, mysterious, and perplexing. Two individuals create what I imagine to be similar to Thomas Ogden’s “intersubjective analytic third,” whereby two people give birth to a distinctly novel third entity that is their relationship.

Although the notion of unique pairings may seem intuitively obvious, it is sometimes denied or dismissed by couples and couple therapists. For instance, one-person psychological approaches tend to focus on the individual in a dyadic relationship as if that individual were elementally static and predictable. On the one hand, a therapist may say, “If you don’t change your ways, you will be doomed to recreate the same relationships over and over again.” On the other hand, the individual may assert, “I can start over with a new person and everything will be better.” Both ideas may be true, but they lack complexity and are misleading. It is also true that “Your ways can change depending upon this pairing as opposed to that pairing.” Or that “I can start over with a new person, but it will be different in ways I cannot predict.”

Does denial of the uniqueness of each relationship lead to devaluation of relationships? And can denial be a contributing factor to the repetition compulsion common to some personalities, or to the casual switching out of pairings that is common to other personalities? For that matter, can denial of romantic pairings as irreplaceable lead to increased divorce rates?

Both the denial as well as the acceptance of relationships as unique and irreplaceable can present a fundamental problem for the grieving process when couples split through dissolution or death. Denial can interfere with regret, which can interfere with learning from our mistakes. Acceptance can lead us to profound grief, anaclitic depression, and even broken heart syndrome (takotsubo cardiomyopathy).

At this point, my wife is reading over my shoulder and complaining that this diatribe is too depressing. So I should mention that denial of the uniqueness of relationships can allow us feel more independent; less vulnerable to loss; and if need be, to move on like Scarlet O’Hara in Gone With the Wind. Acceptance also has a positive side: it can endow our relationships with value, meaning, and an ephemeral preciousness. Ultimately, I suggest we learn to celebrate the truth that each love relationship exists as a separate life form, one that is irreducible and magnificently inexplicable, and therefore should be regarded as it is: something to be cherished.

© 2013 – A Psychobiological Approach to Couple Therapy® – all rights reserved

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Security Questions Require Security Answers

February 15, 2013 at 4:18 pm (Arousal, Attachment, Ideas, Maxims, Prevention)
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Many of you who know my work or take my training have heard me talk about the difference between security questions/security answers and reality questions/reality answers. However, I do not think I have written about this specifically so here we go….

Many people become confused when considering how to respond to matters of relationship insecurity, especially during periods emotionally dominated by fear, ambivalence, or doubt. Bids for affirmation or reassurance can therefore be met with either a secure (reassuring) response or a reality (dice roll) response. For some, the “reality” principle seems a more “secure” option. That may in fact hold some subjective truth, particularly for those who themselves feel fearful, ambivalent, or doubtful (“I can’t reassure you because I, too, feel insecure about us”). And I suppose there are good arguments against providing a secure response when a reality response would be the safer choice (“Our relationship is in danger and so let’s go to therapy”). However, for those who are generally on the fence about this, I’d like you to consider the cost of making a big mistake when that is not your intention.

Let me start by giving examples:

REALITY QUESTION: “What time is dinner?”
REALITY ANSWER: “Around 6pm, give or take 10 minutes.”

SECURITY QUESTION: “Daddy, am I going to die?”
SECURITY ANSWER: “No honey, not for a very, very long time.”

    REALITY ANSWER: “Well sweetheart, I can’t lie to you. There’s a nasty virus going around and it’s killing lots of little children your age. But let’s not think about that right now.”

SECURITY QUESTION: “Will you love me forever and ever?”
SECURITY ANSWER: “Yes. Forever and ever.”

    REALITY ANSWER: “Hmm, that’s a very long time. I don’t know if I can answer that truthfully. I can love you for right now. Let’s take that up again in a year.”

There is a time and place for reality answers and I’m not going to say that it is always appropriate to answer security questions with security answers. However, I will say that in primary attachment relationships, security concerns must be addressed swiftly, simply, and unequivocally if the relationship is to remain safe and secure. Replies that are complicated, contradictory, qualified, evasive, or lacking confidence or seriousness will be read as threatening by the receiving partner. A vote of non-confidence is also read immediately with non-verbal displays such as delayed responsiveness (milliseconds), deflected gaze, vocal changes, and facial controls.

So then, how to avoid shaking your partner’s (and your own) fragile sense of security? The answer is to be prepared! Consider ahead of time the cost/benefit of providing secure responses to insecure bids for reassurance. You will then be prepared to respond with more congruence. If you are among those who believe the best response is the one that is most truthful (realistic), then accept the cost that comes with that stance for there will be a cost in the currency of safety and security. If that is not your concern then go for it. If however you wish to create and maintain a secure relational ecosystem for yourself and your partner, you may want to go with the secure response.

© 2013 – A Psychobiological Approach to Couple Therapy® – all rights reserved

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Sit, Down, Stay!

February 14, 2013 at 8:13 am (Arousal, Attachment, Ideas, Maxims, Prevention)
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This addendum to my previous post, Train Your Partner, is intended to clarify another important concept in relationship management. So many of us struggle with how to “parent” or “train” our partner when we feel rejected, dismissed, ignored, or flat out resisted by him or her. We often get angry and attack or withdraw and give up. While both reactions are reasonable they will likely be received as threatening (yes, I know…you were threatened first). Also threatening are complaints, especially in the form of questions:

“Why do you always do this to me?”
“Why can’t you just do what I want for once?”
“What is wrong with you?”
“Why do you always take his/her side?”

…and so on. The problem with questions, particularly of these kind, is they require resources in your partner’s brain and it is likely that your partner’s brain is either mostly offline (the *autoregulatory state of the island/avoidant) or under-resourced (the *external regulatory state of the wave/angry resistant) and if that weren’t enough, he or she is wired to resist and dismiss and anticipates your intrusion. It can mobilize certain folks and contain others.

Hence, the only sensible workaround are commands such as “sit, down, stay.” *Anchors, islands, and waves respond very well to commands so long as the command is short, easy to process, and made with a friendly but firm tone. We want friendly to quickly disarm primitive alarm systems that are sweeping you for threat. We want firm to enable the fast brain (the primitives) to respond without consulting the “higher-ups.” In other words, proper use of commands should avoid threat while acting quickly to bypass defenses that arise out of increasing arousal. Commands work well when used skillfully because we hear them and we act before thinking and with less arousal expenditure. It should be fast, confident, and friendly.

“Come here.”
“Sit down.”
“Look at me.”
“Repeat what I said.” (for the attention-challenged)
“Let’s go.”
“We’re leaving.”
“We’re walking.”
“We’re staying.”
“Stop.”
“Go.”
“Kiss me.”

WARNING: It is very important that you DO NOT yell commands from outside the same room as your partner. The auditory cortex is very close to the amygdala and can cause a startle response from your shrill or booming voice. Add your partner’s first name to your call to attention and… well start running.

I’ve written about the importance of attraction in love relationships and the danger of using fear, guilt, or threat as a relationship management tool (I will probably write more about this in my next post). The proper use of commands can be attractive. However, don’t expect your partner to smile and be pleased by your commands. The purpose is not to please your partner but to get your partner to do what you want/need without becoming threatening.

*For those of you who are unfamiliar with some of my terms mentioned above, you can find them fully explained in both Wired for Love and Love and War in Intimate Relationships.

© 2013 – A Psychobiological Approach to Couple Therapy® – all rights reserved

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Train Your Partner

February 13, 2013 at 6:52 am (Attachment, Ideas, Maxims, Pair Bonding)
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In case you haven’t heard me say this before, we come to relationships basically feral, untrained, and barely parented. Therefore, as romantic partners we must train one another to be in secure-functioning relationship. This IS NOT accomplished by whining, complaining, threatening, withdrawing, or avoiding. Rather we train each other head-on with statements made directly into the eyes. Make sure YOUR eyes are friendly and try some of the following or make up your own:

“Put that [insert distraction here] down and be with me.”
“Try that again and this time say it like you love me.”
“Look at me and tell me that you think I’m terrific.”
“Tell your handsome guy/beautiful gal [that would be you] that you’ll always be mine.”
“Protect me and I’ll protect you.”
“Come here and sit by me.”
“Do this with me.”
“Tell me how wonderful I am.”
“Tell me how much you appreciate me.”

If your guy or gal resists, refuses, makes jokes, or does ANYTHING other than give an equally direct and sincere response gently repeat with the prefix, “Try that again.” Do this only once again with friendly eyes and up close. If your partner responds properly thank him/her and make it worth his/her effort. If your partner still resists, just say something like, “We’ll do this again later until we get it right…for both of us.” And drop it.

Always helps to have a bunch of treats in your pocket!

Good luck,
Stan

© 2013 – A Psychobiological Approach to Couple Therapy® – all rights reserved

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Am I An Anchor, Island, or Wave?

January 29, 2013 at 9:03 pm (Typologies)

So many people get stuck with this issue of “what am I” when it comes diagnostic classifications. Unfortunately I have become part of the problem. In my book, Wired for Love, I introduced what I thought was a friendlier attachment terminology: secure = anchor; avoidant = island; and angry resistant = wave. I was never fully happy with the classification system as laid out in the book because it seemed to perpetuate the human need to classify and be classified as either this or that. So, let’s put this issue to rest and establish the obvious: most of us do not neatly fit into categories or classifications. In Wired for Love terms think of yourself as being “anchor-ish,” or “island-ish,” or “wave-ish.” And this “ish-ness” can be understood to be state-related (temporary) rather than trait-related (permanent), such as “Last night I behaved in a wave-ish manner,” or “You can be island-ish sometimes,” or “I tend to be more anchor-ish in this relationship than ever before.”

I hope this clears the question of “what am I” to which I say we are all mostly “ishy.”

© 2013 – A Psychobiological Approach to Couple Therapy® – all rights reserved

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Waiting for Inspiration

December 31, 2012 at 11:15 am (Trainings)
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Inspiration should be the guiding incentive for doing interventions, not pressure. Many therapists, including experienced ones, act on pressure rather than from a creative place. Pressure can come in various forms: pressure from the patient, pressure from time, pressure from one’s own need to perform, pressure from a supervisor, etc. Pressure to act may lead the therapist to make mistakes: ill-timed or ill-placed interventions, incorrect assumptions, misattuned moments, or countertransference acting-out.

In contrast, inspiration comes as an “aha’ moment when the therapist has waited a sufficient amount of time to allow for percolation of his or her ideas, impulses, fantasies, etc. Inspiration comes as a result of a convergence of implicit and explicit experience, of both fast and slow thinking (Daniel Kahneman), and of a relaxed body.

Unfortunately for new therapists inspiration usually must take a backseat to pressure as the novelty and complexity of the therapeutic situation draws too many internal resources from the brain and body. For experienced therapists, however, the reverse should be true: inspiration should be driving the therapist’s actions. Inspiration is akin to creativity, novelty, and collaboration. Pressure to act is more akin to threat, fear, and self-protection and should be seen as an enemy of good therapy.

Tell me what you think! Agree? Disagree?

© 2013 – A Psychobiological Approach to Couple Therapy® – all rights reserved

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Find Your Mentor Couple

December 27, 2012 at 1:11 am (Ideas, Pair Bonding, Prevention)
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One of my mentors, Marion Solomon, introduced me to the brilliant idea of mentor couples. Also known as marriage mentors and sponsor couples, this concept originated in the church setting but is becoming increasingly popular. Basically, a mentor couple is one you admire and and look to for guidance. I was impressed that Matt and Marion Solomon have at least one mentor couple. Tracey and I proudly claim two mentor couples. One of course is Matt and Marion. Their relationship is the epitome of secure-functioning. They protect each other in private and public; they most definitely maintain a secure couple bubble; they tell each other everything; neither would ever threaten the relationship or be threatening to the other; they take one another’s distress seriously and provide prompt relief to each other; they know each other and most definitely have each other’s owners manual; and they are a lighthouse to other couples. They put relationships first.

Tracey and I have another mentor couple: Jim and Myrtle Pinsky. They are parent-like figures to us, and we aspire to be like them, as we do to Matt and Marion. Jim is 91 (just turned) and Myrtle is short of that figure (by how much I don’t know). They knew both my parents, and like them, belong to a culture of human beings that puts relationships first. Like Matt and Marion, they serve as a beacon of light to others and authentically live by secure-functioning principles. As world travelers, they are like magnets, drawing people from all over to their warmth, kindness, generosity, and modesty. They put relationships first.

I’d like to give mention also to my late cousin, Pat Kaplan, and her surviving husband, Harold, because they, too, exemplified secure-functioning in their long marriage together. Both put relationships first.

The happiest people I know put relationships first. They value their loved ones, their friendships, and their ability to remain loyal and true. Many of us didn’t experience secure-functioning love relationships as we grew up, and many of us never saw our parents take good care of each other. In a great too many families, relationships do not come first.

It starts with the couple. If the state of that union is poor, everyone living beneath the same roof (and beyond) suffers. It always starts with the couple. If we don’t have a good model, we typically look for it somewhere… in literature, film, or those around us. But we may not have thought of looking to a mentor couple. My hope is that this blog post inspires some of you to keep an eye out for at least one mentor couple, and perhaps even endeavor to be one for others.

© 2013 – A Psychobiological Approach to Couple Therapy® – all rights reserved

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How People Change: Relationships and Neural Plasticity in Psychotherapy

December 13, 2012 at 6:23 am (Conference)

The time is nearing when it’s important to make arrangements for the upcoming UCLA conference extravaganza. Wait too long and you miss out. Lots of famous people. You can make your arrangements by clicking here!

UCLA

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