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?

Does Everybody Need to Differentiate?

Recently, I wrote a three-part series on differentiation of self. If you missed it, you can find it here: part one, part two, part three

After I wrapped up the series, I realized I still had more to say. In fact, I want to address an aspect of differentiation of self that is not often discussed: cultural considerations. 

Differentiation of self is very important to my work, and it is the lens through which I tend to approach relationships. Most of my clients get very excited when I talk about the three aspects of differentiation, and are very interested in building that skillset. They may not know how to get there, but they can see how their life and relationship would improve if they increased those skills. They’re on board. 

But what if you have a client who doesn’t actually want to differentiate, doesn’t believe in differentiation, or is very conflicted about it? Not everyone aspires to be seen and accepted as a unique individual. Some people, and some cultures, believe in upholding the family connection or carrying forward cultural norms, and hold those things as higher goals than individuality and unique expression. They may or may not want to shift to cultural values that include individuation. 

Additionally, there are some people who have discovered an aspect of their personal expression or identity that is in direct conflict with family or cultural belief systems. In that case, they will have to make some very hard choices. If they choose to differentiate, there will probably be significant losses associated with that choice. They may stand to lose family, friends, or an entire cultural identity. If they choose to stick with their cultural or family values and beliefs, they will have to let go of some dreams and desires, and possibly even some important parts of themselves. 

Rebellion is not for everyone, nor is it a higher form of being. Shifting cultures is a big deal. It’s not something we should assume is preferable, or push our clients towards. The world is a diverse place and there is a lot of room for differences between us. I don’t want to work at cross-purposes with my client’s values or belief systems, or set them up for family or cultural consequences that they don’t see coming and freely choose. Being differentiated ourselves, as therapists, requires us to recognize that our clients may make different choices than we would. 

I have often had clients who are wrestling with an internal dilemma: differentiate from family belief systems, or don’t. When this happens with an individual client, the first order of business is to resolve that impasse. When it happens with one partner in a relational therapy, the first order of business is to help each partner express their thoughts, feelings, and point of view so they can understand one another better, and ultimately come to a decision as a team. 

There is no one-size-fits-all rule book for life. Honoring diversity means upholding the right to differ. Supporting differentiation means deeply listening to and grasping the thoughts and feelings behind any point of view, not just the ones that are comfortable to hear. Our work in therapy is not to push our clients towards any one resolution, but to allow them to voice all sides of their impasse fully, so that they can make their decisions on their own terms. If, at the end of that process, they decide that they value their closeness with their family or their connection to their culture over expressing their individuality, that is a valid choice, and a good outcome for the therapy.

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.