Couples Counseling From a Psychodynamic Framework

I often reflect on how the skills we need to navigate our lives through adulthood were not taught to us in school. Most of us did not get taught how to identify and express feelings. We didn't take classes in how to nurture healthy relationships and how to sustain these throughout one's lifetime. While a great deal of effort may be given to one's career, an equal amount of effort might be missing when it comes to the relationships that we consider most important.

When the issues that bring people into treatment seem to center on their primary relationship, then couples counseling may be warranted as the preferred treatment modality. Unlike individual therapy where we delve into a patient's psyche to understand how one's unconscious processes inform current behaviors, in couples counseling the couple is the patient and the focus of our work shifts to attending to how the partners communicate, manage conflict, and show empathy for each other. Often my role is to teach specific skills along these lines. I might help them learn active listening and empathy skills. Perhaps I may teach effective ways to deescalate fights and constructively handle arguments. I may encourage partners to talk to each other and not simply to me so they can practice communication, thus bringing their relational issues directly into the room so that I can observe and intervene as needed. As the therapist, I am in the unique position of watching how they interact and I can pay attention to the moment to moment shifts in their conversation to see where they might get stuck or how conflict escalates. 

As a psychodynamic therapist, I also place importance on understanding each person's individual history and how these intersect in their relationship. It is not arbitrary when two people find each other and embark on a journey to form and maintain a relationship. Each person brings to the table their individual relational dynamics that they learned as far back as childhood. Often people reenact in their current relationship patterns that they experienced in their parents' relationship or in their own relationships to their parents. These relational patterns continue to get repeated and played out in their subsequent relationships throughout life. When we can identify these relational patterns and how they are reenacted, then we can set about to shift these in healthier directions. When we come to understand how each individual is triggered by their partner and how that may be connected to experiences they had in childhood and adolescence, it helps each person develop a deeper understanding of their partner, an awareness of how their own behavior is impacting their partner, and the potential for greater emotional intimacy. 

Relational patterns tend to get passed from generation to generation until someone takes the initiative to work through these in the context of psychotherapy. One can imagine how complicated this can be when each member of a couple is bringing to the relationship specific patterns that can be traced back to their own early relationships and those of the generations that came before. So a husband's behavior may trigger his wife in ways that are similar to how one of her parents triggered her or similar to how her parents and grandparents related to each other, and the same can be true for how the husband experiences his wife's behaviors. Usually these patterns aren't easily identifiable at the start of couples counseling, but over time, with the help of a trained therapist, they can be elucidated and worked on. The hope is that by working together in this way, each partner can come to experience a more rewarding and intimate coupling into the future. 

 

Mourning Losses

When we think about mourning losses we usually think of grieving a loved one who died or perhaps grieving the end of a relationship. Yet, much of the work of psychotherapy involves mourning losses that are less transparent - losses that can be traced back to childhood. This is the type of mourning that I wish to address in this blog post.

Most adult behavior has its origins in our early childhood experiences. We may unconsciously cling to relational patterns and beliefs that stem from the earliest years of our lives. Oftentimes, the reason we do this is to avoid incredibly painful feelings that may arise and engulf us when we allow ourselves to fully access these experiences. To recognize that one's parent was never able to love and accept them unconditionally, that this parent may never apologize for abuse or injuries they've inflicted, that the parent may never change and one may never have the mother or father they have always longed for and needed, that they will never be truly vindicated for the traumas they have endured - to come to terms with such losses is to open oneself up to tremendous grief. People may spend the majority of their lives engaging in all sorts of behaviors that are attempts to stave off such mourning.

Continued avoidance of mourning unresolved losses from our past comes at a devastating cost. People may suffer from depression, anxiety, and any number of other mental illnesses. They may experience chronic pain and health concerns, abuse substances, repeat unhealthy relationship patterns, and find themselves having ongoing difficulties at work and in their social lives. Even worse, they may inflict the same injuries that they suffered onto their partners and children. 

We can understand how not allowing oneself to mourn the death of a loved one can impede one's healing; we may allow ourselves and encourage others to take whatever time is needed to fully grieve, being gentle in the knowing that mourning can take various forms and evoke a gamut of emotions.  The same concept applies to mourning losses that are much more deeply buried. If working through these losses in therapy didn't have the potential to help an individual achieve greater self-awareness, profound healing, more satisfying relationships and one's personal life goals, then there would be absolutely no good reason to ask our patients to undergo a process which has the potential to stir up such pain. Still, I know of no other way to make long-lasting fundamental positive change. There's a corny saying in the business (alright, there are several) that you have to go through it to get through it. I think this expression is rather apt when it comes to this topic of mourning losses from one's childhood.

Acting Out Behaviors

In my last blog post I addressed the "acting in" behaviors of depression and anxiety. Here I would like to focus on "acting out" behaviors that people turn to in an attempt to manage uncomfortable internal emotional states. There are many ways that people may "act out," such as putting substances (alcohol, prescription and recreational drugs, nicotine, or food) in their bodies to "self-medicate," overworking, gambling, working out excessively, obsessively turning to plastic surgery for cosmetic changes, excessive shopping, binge watching tv, spending hours playing video games, or engaging in risky and/or excessive sexual activities. When these types of behaviors are being used to unconsciously (or perhaps consciously) manage one's feelings, it probably means that the individual is choosing to flee from living in the present moment or the "here-and-now" to avoid fully inhabiting and experiencing one's feelings.

Cognitive behavioral therapists would focus on these behaviors directly and work on helping their patients learn ways to change the behaviors. Psychodynamic or psychoanalytic therapists like myself view these behaviors as symptoms or coping mechanisms that the patients employ because they might be the most adaptive ways they have learned to regulate the unacceptable, scary, or threatening feelings that are buried beneath. Rather than focus so directly on these symptoms, we believe that if we can help patients access and express the underlying unresolved feelings and come to understand how they are internally organized in relation to their emotions and unconscious processes, then over time people can learn healthier, more effective ways to manage their internal worlds. As a patient does so, we find that the unhealthy symptoms start to dissipate because there in no longer such a strong need to rely on archaic defense mechanisms that served a purpose at one time but now are more likely to be hindering an individual's progress.

A behavior is always a choice (even when it may not feel like a choice); feelings are not. If we subscribe to the belief that most people are well-intended and would choose the healthiest methods available to them, then we can come to see inexplicably harmful behaviors as adaptive attempts to manage difficult internal states. When people are able to learn alternate ways to manage these internal states, they are apt to choose the healthier options. When people learn that they needn't fear nor judge their feelings and begin to practice ways to tolerate, effectively manage, and perhaps even embrace their emotions, then they are better positioned to fill their tool boxes with the most healthy and effective tools.