Working With Relationship Problems in Individual Therapy

A few weeks ago, I asked my readers to answer this question: “What is your single biggest challenge when working with clients with sex issues?”

I’m so grateful for all the thoughtful, nuanced answers I received. I’m still sorting through them (and they’re still rolling in; bring it on!). Over the next few months, I’ll be answering as many of those questions as I can, beginning today. 

A few people wrote to me about the challenge of working with an individual client whose partner has problems that they are unwilling or unable to work on in therapy, and which are negatively affecting the relationship dynamic. This can manifest in a huge variety of ways. Perhaps the partner has a medical problem that is affecting both their lives, but they are unwilling to seek treatment. Perhaps they have difficulty self-soothing and managing emotions, and that’s contributing to unnecessary stress and tension in the household. 

In any case, it can be a tremendously frustrating position to be in as a therapist. What do you do when you know that you have interventions at your fingertips that could help your client and your client’s partner, but you’re unable to directly reach the person who needs them the most? 

  • Consider bringing them in for a joint session. This hinges on your client’s partner being willing and able to access therapy. But if it’s an option in your case, it’s a great idea. You can get a fuller, more accurate picture of the dynamic at play, and speak directly to the partner. I often provide a bunch of psychoeducation about sex in this manner, so one partner isn’t in the position of carrying information home to their partner from me, some of which might be a little challenging to hear, and some of which might lose something important in translation. In particular, if sexual satisfaction, desire, orgasm, or consent/willingness are part of the issue, I always prefer to see both partners together if possible. 
  • Consider collaborating with a relationship therapist. Again, this hinges on your client’s partner being willing and able to access therapy. 
  • Get some inspiration. I often suggest the book It Takes One to Tango to clients in this situation. It’s written by a Developmental Model therapist, Winifred Reilly, and is about how she used the Developmental Model to transform her relationship–all without her husband’s participation. If you want to help your client feel empowered to make a change in their relationship single-handedly, in ways that are compatible with the Developmental Model, this is a great place to start. 
  • Focus on your client’s part. Part of the challenge of being an individual therapist is that, when you’re talking about relationship dynamics, you only get one part of the story. Everything you hear is coming through the filter of your client, and they are almost certainly missing important aspects of their partner’s perspective. It is incredibly tempting in individual therapy to focus on the many annoying things their partner does. Don’t do it! Instead help your client identify their own meaningful goals for change…within themselves. If their primary distress is relational, ideally the things they decide they want to change will have something to do with improving how they show up in their relationship. At the end of the day, all any of us can change are things that lie squarely within us. 
  • Help your client show up as the partner they aspire to be in their relationship. If your client lacks insight into what they might be able to change that will make a difference in their relationship, here are some very common areas of potential focus:
    • Does your client self-soothe well? 
    • Are they able to figure out what they want, feel, and think? 
    • Are they able to communicate those things to their partner in non-dramatic ways?
    • Can they tell the difference between things that are about them, and things that are about their partner? 
    • Can they hold steady when their partner is telling them something they find difficult to hear? 
    • Can they take action on their own? 
    • Can they recognize a desire to set a boundary, and then set one? 
    • Can they hold that boundary warmly if pushed by their partner?
    • Does your client listen well, and then are they able to get curious about what their partner’s experience is?
    • Can they express empathy, even if they don’t agree?
    • Can they show love even when they are annoyed or disappointed? 
    • Can they feel their partner’s love even when they are annoyed or disappointed?

Three Aspects of Differentiation of Self: Part 3

This is the third post in a three-part series about differentiation of self. Earlier, I discussed the first aspect of differentiation of self, which is the ability to look within yourself and identify what you think, believe, feel, and prefer; you can read that post here

In my last post, I wrote about the second aspect of differentiation of self, which is the ability to express what you think, feel, believe, and prefer, even if you think the person you’re expressing it to won’t agree. The third (and final) aspect of differentiation of self is the reverse of that equation. It’s the ability to hold steady when someone expresses their feelings and beliefs to you, even if you have some uncomfortable feelings or don’t like what you’re hearing.

Before I dive into how you can develop this aspect of differentiation, I’d like to discuss a bit about why it’s so important. Think back to the second aspect of differentiation. Have you ever told a little lie to avoid starting a fight? Have you ever hastily changed what you were about to say after seeing a certain look in your partner’s eye? Have you ever decided to postpone a conversation when you just know it’s not going to be received well, and then somehow forgotten to get back to it? 

Now put yourself in the other person’s shoes. Do you want to be in the position where your partner isn’t telling you everything, or is avoiding bringing up important topics, because they’re worried about how you will respond? 

Developing the third aspect of differentiation of self is about creating an atmosphere of safety in your relationship. It’s about being a person who encourages others to identify and express their truth. 

Consider the kinds of reactions and responses that are likely to discourage honest disclosure. If you happen to have a conflict-avoidant partner or loved one, pretty much any dramatic response will do it. For some people, even a small gesture, like an eye roll or crossed arms, can result in them deciding not to talk about a difficult topic.

Having an emotional response to something your partner is saying is probably not going to change your partner’s opinion or behavior. It’s more likely that they’ll continue to think whatever they think, and even possibly dig in a little deeper–and they might decide to stop telling you about it. 

If you want to get the truth, the whole truth, and nothing but the truth, you need to show your partner that you can handle hearing it. 

Of course, aspiring to hold steady when your partner tells you something it is hard for you to hear is easy enough. But in the moment, when you’re blindsided by a hurtful revelation, and your mind is leaping ahead to all sorts of horrible conclusions, it’s a different matter. Fortunately, just like the other two aspects of differentiation of self, this gets easier with practice. Here are some tips to get you started:

    • Get clear on why you want to get good at holding steady. This may be the most important part. How will your life, level of happiness, and relationships improve when you are in control of your reactions? Get specific. Make a list. “When I am great at managing my automatic reactions, my life will be better because…”
    • Come up with a mantra, power word or image to remind you of why you want to do this. When your brain is in freak-out self-protective mode, and you would prefer not to go along for the ride, you will need some strong motivation to do something different, and it will need to be something you can grab onto with half your brain tied behind your back. What word or image would get your attention and remind you of your “why”? Cement it in your brain. Think of it often. Use it frequently, including in less extreme situations, over and over. Train your brain.
    • Recognize your reaction. Notice very early body signs that indicate you are starting to get activated. Do you feel nauseous? Tension in your neck or shoulders? Headache? Get familiar with your earliest possible warning signs, and take a small breather when you first experience them. Waiting will result in you needing a huge time out to hit “reset;” while that strategy is fine if you need it, it is not really the goal. The ultimate goal is to learn how to calm while the action unfolds so you can stay in the game. 
    • Calm your body. When you notice your emotions rising, and you are practicing managing your automatic reactions early, try breathing with a long exhale. Also try blinking slowly. Use your mantra or power word; call your image to mind. These are all strategies to tell your body and your brain that you are safe. Look around for evidence of safety. Put your feet on the floor. Breathe. Take a bathroom break and splash water on your face.
    • Take a connection break. Ask your partner for a little safety break; just hold hands and connect without talking, hug for two minutes, or maybe put on some music and do a little dance together. You could walk the dog together, or make a nice soup before you continue. Not exactly a time-out, but a break in which you work together to change the atmosphere to something relaxed and positive. Reassure yourself and one another that all is well; you’re just having some conversation and some feelings. You’ve got this. 
    • If you’re really having trouble, take a time-out. Sometimes despite trying all of the above, we just need a time out. Here are a few signs that indicate you could benefit from a substantial break:
      • You or your partner are getting mean
      • You or your partner are having trouble thinking
      • You feel confused and can’t figure out what’s going on
      • Your heart is racing, or your face is flushed
      • You are pointing your finger at your partner and saying “You….” at the start of your sentences, or your partner is doing that
      • You are thinking your signature negative thoughts that you have come to realize are probably actually catastrophizing
      • You feel like you might be digging yourself in a hole or making it worse

 

 

For more on how to use time-outs to work through conflict effectively, check out this post.

The Three Aspects of Differentiation of Self: Part Two

This is the second post in a deep dive into the three aspects of differentiation of self. In my last post, I wrote about the first aspect, which is identifying what you feel, think, believe and prefer. You can read it here.

This time, I’m focusing on the second aspect of differentiation of self—holding steady while expressing unique and individual thoughts, beliefs, feelings, and preferences to someone else. There are two distinct and important aspects to this:

  • Holding steady, by which I mean getting grounded and remaining calm while saying your piece. This skill is foundational to effective communication, and underlies all aspects of differentiation.
  • Stating thoughts, beliefs, feelings, perceptions, and preferences as clearly, deeply, and fully as possible, regardless of what reaction is likely from the listener. Depth is important. Often people make the mistake of staying on the surface of the topic, rather than going deep. That’s because it often seems like depth would be more difficult for the listener to receive gracefully. More often, the opposite is true: providing enough depth helps the listener access empathy for the speaker. A full communication should cover not just what was perceived to have happened (framed as a perception, not a “truth”, since partners may very well remember events differently), but also the feelings that occurred for the person who is speaking, and the stories or meaning made by them about the events and feelings. It is important that this communication be explicitly framed as being about the speaker’s perceptions, feelings, and meaning-making.

The second aspect of differentiation is tricky because it exists relationally, as part of a dynamic between people. Consider:

  • Someone might be very worried about how their partner will react to something they want to share. They might be able to figure out what they think, but have a lot of difficulty sharing their thoughts. 
  • If the listener begins to show emotion about what the speaker is saying, for instance by getting angry or starting to cry, the speaker might backpedal, soften, or completely change what they are saying in order to avoid a difficult discussion.
  • If the listener has a history of becoming upset during a difficult conversation, someone might choose not to disclose difficult things. This is a real pitfall if the listener becomes quite dysregulated. It can be very challenging to speak up when your partner tends toward extreme responses. Nonetheless, the downside of not speaking up is undeniable: an upsetting interaction will have been avoided, but the person who decided not to speak up will not feel seen, understood, or accepted for who they are in this relationship.

There are many reasons a person might have difficulty holding steady and expressing themselves deeply, calmly, and fully. They could be responding to echoes of past trauma, perhaps having been punished in some way for speaking up, or for individuated non-conformist thinking. They may have gotten subtle but pervasive messages that children are to be seen and not heard. Their parents may have modeled never discussing difficult topics, or difficult topics discussed by family members may have led to chaotic interactions, drama, anger, or abuse. It is also possible that their current partner engages in dramatic responses to difficult discussions, or even shuts down some conversations entirely. 

Whatever the cause, as a therapist, it is important to help clients identify how they want to be in their relationships. Do they believe in creating relationships where both partners feel seen, heard, and known? Do they believe in creating emotional safety so everyone can figure out their deeper desires, thoughts, and feelings, and discuss them? If so, the therapy will need to support the development of all three parts of differentiation. 

Here are some tips for increasing your ability to express your beliefs, preferences, and feelings:

    1. Take a deep breath. If speaking up makes you anxious, take some time to notice how you’re feeling. Breathe deeply (concentrating on a long exhale) and relax your muscles. Blink slowly. Exhaling and blinking slowly tells your limbic system that you are safe, so you can gather your thoughts more effectively.
    2. Take a few minutes to get clear. Don’t start talking until you think through what you want to express. You could even take notes or rehearse, if you’re really concerned. Get your message boiled down to one topic or one aspect of a single topic. Biting off too much at a time is a great way to flood yourself and your partner, and create confusion that makes it hard to get anywhere.
    3. Recognize that you can’t control your partner’s response. Maybe what you have to say is going to irritate or disappoint your partner. That’s survivable. “No tension ever” isn’t realistic, so don’t make that your outcome goal. Keep your eye on the real goal: saying what you intend to say.
    4. Remind yourself what kind of partner you aspire to be. Do you believe in being honest? Do you want to be fully and deeply known by your partner? Fix your focus firmly on the long term goal of building the kind of relationship you want to have, rather than the short-term goal of avoiding an uncomfortable discussion. 
    5. Keep it relatively brief. Particularly if this is a big challenge for you, keep it to 10 or 15 minutes. Don’t get distracted by other topics. 
    6. Ask your partner to say back what they are hearing. This is important because it makes it so you can clear up any misunderstandings right away. People mis-hear things all the time when stressed, so don’t skip this step.
    7. Thank your partner for listening to you. Positive feedback actually works. If your partner listened well, said something insightful, or responded in any positive manner, be sure to take the time to appreciate it. Even if it went badly, thank them for showing up and trying.
    8. Find something connecting to do after you talk. A relationship that involves constant processing leaves no room for fun. Develop the ability to intentionally create some positive experiences together. Go for a walk or bike ride, watch something fun on Netflix, or just snuggle on the couch. Pet the animals. Hush and connect.