Most teenagers naturally reach a point where the bounds of sexuality are explored and roles and sexual identity are created. For LGBT teens this natural part of growing up can often be confusing and overwhelming, resulting in a variety of responses. Some individuals experience such intense negative emotions about their sexual feelings that they repress and push those feelings as far away as possible and choose to ignore their sexuality.

By hiding deep in the closet, these teens are setting themselves up for an uphill battle as they get older and inevitably arrive at a point in their adult lives when the reality of their feelings can no longer be ignored. In other cases, this aspect of an individual’s personality does not surface until later in life at which time they may uncover feelings of same sex attraction, for example.

However they arrive there, the challenge of coming out in adulthood is a unique and often mystifying journey for both the person coming out and the people in their lives. As an adult, the fabric of life is often strongly developed with work relationships, long-term friends, and even children and spouses. The complexity of this web of relationships can make the process of coming out quite messy in adulthood, characterized by experiences of deep confusion, guilt, betrayal, rejection, and heartbreak.

When LGBT adults make the difficult but necessary choice to come out, they are often faced with many emotionally fraught questions from people who are shaken by the revelation that their friend or family member is not the person they thought they knew. There can be feelings of shock, anger, and disapproval from those close to the newly identified LGBT person. It is a bewildering experience for everyone involved.

The most basic questions from friends and family address concerns that the newly open LGBT person has been hiding their true nature and their sexuality, and that the trust of the relationship has been broken. Both parties experience feelings of loss and confusion that can severely strain the bonds of the relationship. [fat_widget_left]

For the person coming out, at a time when they most need the support of their friends and family, this layer of confusion can create a perceived lack of safety from the people who would otherwise be that individual’s support network. This lack of support can sometimes lead to an interruption in the coming out process and lead the newly open LGBT individual to regret the decision to come out.

In addressing this issue, it can be important to realize that not only are adults who come out having to redefine themselves and their relationship to their community but also the people they are coming out to have to create a new framework of understanding.

When an adult child comes out to family members, the family story of kids, grandchildren, spouses, and family that has been carried for many years must be re-authored to make the new details meld into the existing family scenario. A time of transition will occur where parents, relatives, and siblings will need to re-establish the family story with fresh details adding a vital new definition to the fabric of the family history. Some family members may become estranged as a result of religious disapproval or an inability to move past feelings of betrayal.

For close friends, there is also a redefinition that must occur in order to assist in building a strong bond between the newly out and open LGBT person and their friends. With both family and friends, questions of lifestyle, safety, and the impact this news will have on future relationships may come to the forefront. Some people who have just come out will feel comfortable answering all of these questions and more, while others may be unsure of their own feelings and may not have all of the answers at that time.

Leaving room to discover this newly developed aspect of the LGBT person’s identity is vital in their ability to define and understand who they are. All of the answers may not be available immediately but the process of coming out is an ongoing experience with new pieces of understanding being continually discovered.

And most important for all people involved in the coming out process—from the LGBT person coming out to family and friends—the qualities of the person coming out are not changing. All of that person’s vital goodness and qualities remain, with the addition of new and exciting aspects being shared openly and honestly for the first time.

A recent study of people who are trying to quit smoking shows that Cognitive Behavioral Therapy can help reduce cigarette cravings. Overcoming cravings is an essential part of successful addiction therapy, as the craving to pick up another cigarette may, in the short term, overpower the rational reasons for quitting. Helping people overcome cravings by “retraining” the brain has the potential to help people quit smoking more effectively. The study, which was funded by the National Institute of Drug Abuse, took brain scans of people who’d been undergoing cognitive behavioral therapy with the goal of smoking cessation. The scans showed interesting behavior in two areas of the brain.

One area, known as the prefrontal cortex, helps a person control their emotions (among other things). This part was more active in people who’d undergone the smoking therapy. A second area, called the striatum, is related to reward-seeking and craving. This area was less active in people who’d been having therapy. In addition, people who’d been undergoing therapy also reported that their cravings were less intense. (more…)

While working in my office in the summer, on a hot day, I had cause to consider the clothing I was wearing. My office is on the second floor, and by mid-afternoon the sun had moved over to my side of the building. Even with the AC blasting, it gets swelteringly hot.

I wear sleeveless tops and skirts or capri pants, and sandals. This isn’t so for everyone. I know lots of people who do not like the heat. I find that people who come to see me for help with eating disorders have their own unique set of concerns, activated by the hot weather. I know that folks who have larger bodies, or are obese, often will feel hotter, simply because the adipose tissue provides insulation, in much the same way that very thin people or people with anorexia are more sensitive to the cold.

And I’ll digress here a moment, and say that when I make reference to people with larger-bodies, I strive to use language that isn’t charged with judgment. To refer to a person as fat is usually considered an epithet rather than a statement of fact. Webster’s Dictionary defines fat, when used as an adjective and applied to a person, as “having large amounts of excess flesh.” To people who experience eating disorders, it goes beyond that, to a sense of being unlovable, unacceptable, unwanted, and, ultimately, in danger of being utterly alone.

Which brings me back to hot weather and clothing: some of the large-bodied people I work with come to sessions in jeans in 95°F weather. This looks horribly uncomfortable. There was a time when I was  in the throes of a binge eating issue. My body was much larger than it is now. The inseams of my jeans would develop holes where my thighs rubbed together. The waistbands and snaps pressed painfully into the flesh of my belly. I hated cool weather because it meant I couldn’t wear light, loose clothing. So when I sit in my office across from some one whose body has large amounts of “flesh” and see them in jeans, I can’t imagine that they are comfortable. When appropriate, I ask why they are dressed so heavily in such heat.

People give varying answers. Some have to do with their dislike of shopping due to how disheartening it can be to find plus-sized clothing in stores. Others can’t stand dealing with the difficulty of finding appropriately-sized clothes. One such person I work with wears plus-sized petites, another wears a much smaller size on top than on the bottom. Clothes shopping makes them feel at odds with what is “normal.”

Shopping for clothing brings up shame some people spend lots of energy trying to ignore. Webster’s defines shame as, “a painful feeling of humiliation or distress caused by the consciousness of wrong or foolish behavior,” and, “a loss of respect or esteem; dishonor.” In this case, the “wrong or foolish behavior,” as decided by social norms, is the size and shape of their bodies.

This body-shame isn’t limited to people with a large body in our society. I often hear complaints about finding satisfactory clothing from people who have bulimia or anorexia. They reportedly try on several outfits before they can leave the house, because everything makes them “look fat.”

People with anorexia routinely say that they can’t stand the feel of clothing that lays against the skin of their hips and legs, so they buy pants that fit loosely and might wear a belt to hold them up. Conversely, I know people with bulimia who tell me that wearing baggy clothes makes them look as big as the clothing, so they only feel comfortable in clothing that is form-fitting.

Body-shame is commonly focused on specific regions of the body. I’ve had people tell me, “I don’t show my legs,” or “Nobody sees my arms.” One individual with life-threatening anorexia told me that no matter how much weight she loses, her thighs are too big. Another said that, although everyone tells her she is emaciated, she has “rolls” on her stomach and waist that are “disgusting.” When she and I discussed this further, I discovered that these were the skin folds that appeared when she sat down. Yet another, whose anorexia manifests most prominently in compulsive exercise, is quite muscular with a very low body fat percentage. She said she sits up very straight because she is so self-conscious about the size of her stomach.

Clothing and vanity are both normal parts of human life. But there’s a fine line between “normal” (there’s that word again) attentiveness to appearance, and serious obsession or shame. For a person who experiences shame, their body image is inseparable from his or her character and worth.

Consequently, clothing choices aren’t based on physical comfort but, rather, psychological comfort: the comfort that comes from knowing their legs or arms or stomach are covered, even if it means wearing jeans in 95°F weather. I’ve been encouraging the people who are larger-bodied to go shopping for light, pretty summer clothing. My hope for everyone I work with, is that they choose clothing in the spirit of physical comfort and body acceptance.

For adults who were physically or verbally abused as children, psychotherapy is an important step in working through the difficult emotions these experiences have created. But what about children currently living with an abusive parent? Providing one-on-one therapy, parenting coaching, and emotional support to abusive mothers drastically improves their parenting skills and treatment of their children, a new Texas study has shown. Many programs like Project Support exist in states around the country, but little research has been done to document how such programs compare to traditional child welfare services. The study, which followed a small group of single mothers in similar financial situations, was published in the Journal of Family Psychology.

Project Support was established in 1996 and was designed to help children in violent families by altering the parents’ behavior. Traditional child welfare services in Texas tend to vary, but include pre-recorded parenting lessons, community parenting classes, individual counseling, family counseling, anger management work, GED classes, and contact with a social worker. Project Support goes a step further. With Project Support, mental health professionals visit a family’s home weekly for as long as six months. Parents are taught 12 specific parenting skills, including how to give positive attention and praise, how to play with and pay attention to their children, how to comfort and listen to their children, how to give appropriate commands or instructions, and how to handle bad behavior. Parents also worked with therapists on how to provide the best environment for their children through limited income and available local and state resources. (more…)

Codependency is a pattern of behaviors and beliefs learned by children of dysfunctional families while they are growing up. These behaviors and beliefs can be helpful to the family unit, because they enable it to survive, and the child learns to depend on those behaviors in order to manage in the family system. Unfortunately, in the long run these behaviors are very harmful to the child.

That’s a lot of words to clarify. First of all, exactly what is a dysfunctional family? It can be defined in many ways. For this purpose, a dysfunctional family consists of one or both parents who have issues that seriously interfere with their functioning as parents and partners. Some of these issues include alcoholism or other drug addictions, mental disorders like bipolar or schizophrenia, or physical abuse. Children growing up with impaired parents in these painful family systems learn codependent behaviors and beliefs because at least one child has to assume some of the duties normally performed by a parent—or else the family is in total chaos. So one child steps up to the plate and begins to overfunction. This child becomes the “family hero.”

If Mom is too drunk to fix dinner, the hero child takes care of it. After dinner, the other children may need help with their homework, to have a permission slip signed, or need someone to talk to about being bullied at school. Again, the “hero child” steps in. The more the parent or parents underfunction, the more the “hero child” overfunctions. The non-alcoholic parent may need a confidante about their problems with the dysfunctional parent, and again, the “hero child” assumes that role. Thus, some of the tasks get done, and the family survives.

The Consequences of Being the “Family Hero”
How does taking on all of this adult responsibility affect the “hero child?” From the outside, they appear to be doing great. Mature beyond their years, they are responsible, want to do what is right, anticipate the needs of others, and do whatever they can to please everyone they meet. Inside, though, they are an endless sea of pain. The “hero child” feels overwhelmed by tasks way beyond their maturity level, and since performing like an adult is impossible, they feel chronically inadequate.

They are so busy anticipating and meeting the needs of others that they lose their sense of self and identity in the process. They work harder and harder to keep everybody and everything under control. Since this is also impossible, the harder they work, the angrier and more frustrated they feel. Of course, they keep these feelings inside. They quickly learn that expressing a negative feeling causes an explosion in an addicted family. The last thing they want to do is add more chaos to the house. Thus, the “hero” suffers through hideous family scenes, and later, everyone behaves as though nothing ever happened. This makes the “hero” feel isolated, crazy, and question their judgment. Since the “hero child” often becomes a confidante for the other parent, the boundaries in their relationships become all mixed up.

All of these behaviors become automatic in the “hero” and persist into adulthood, where they cause all sorts of problems. The “family hero” believes that he is responsible for everybody and everything. He believes that he knows and can fix what is wrong with other people. He believes that the needs of others are more important than his and that he must help everyone who needs it. Boundaries in his adult relationships do not exist. He believes he should not talk about what is going on, that he should not feel, and that he cannot trust anyone. Under stress, the hero overfunctions desperately until he is exhausted.

The next article will explain how these automatic behaviors and beliefs affect the adult “family hero,” whom we will call the codependent. Keep in mind, these same behaviors and beliefs that cause so much pain and suffering in adulthood enabled the co-dependent to survive as a child. We will call them survival consequences, and the idea of changing any of these can be terrifying to the codependent.

If you’re asking this question, you’re not alone. In most cases, couple therapists systemically see couples’ distress as the result of reciprocal maladaptive patterns to which each partner contributes. Many people entering couples therapy initially believe their partner is primarily responsible for relationship problems. However, couple therapy research affirms that various approaches produce statistically and clinically significant improvement for a substantial proportion of couples, with most people who’ve participated in couples therapy feeling better than 70% to 80% of those who don’t get help.

Understanding why both partners benefit from attending couples therapy together—even when problems seem to stem from one person—can help you make an informed decision about seeking support for your relationship.

Why Both Partners Need to Attend Couples Therapy

Amy Winchester, MA, LPC explains: “While it may be true that your partner needs to work through some of his or her own issues that contribute to dynamics in the relationship, if there are problems between the two of you then you both are contributing. Even when one partner appears to be causing most problems, the interactions between both partners shape how the relationship functions. Understanding these patterns can help each person make meaningful changes. Two people in a relationship are always more deeply entwined than most can imagine. The subtle ways in which we act and react in a relationship are often rooted in our basic needs for belonging, love, freedom, and respect. Following these roots down to their beginnings and any wounds we have experienced along the way is necessary if we want to untangle habitual patterns and dynamics that seem to never change. One of the most empirically supported approaches for this work is Emotionally Focused Therapy (EFT), which helps partners identify and express underlying emotional needs and strengthens attachment bonds. EFT provides structured guidance for couples to navigate these patterns safely and effectively.”

This perspective is strongly supported by current research. Modern couples therapy recognizes that partners often get caught in repeating cycles of interaction, sometimes called a pursuer-distancer or demand-withdraw pattern, where one partner’s behavior triggers the other’s emotional response, which in turn perpetuates the cycle. Even when one partner appears to be causing most problems, both individuals are typically participating in maintaining these patterns.

Recent studies demonstrate that relationship distress justifies making couple therapy more widely available, as epidemiological research points to conclusions supporting broader access to couples therapy. The effectiveness isn’t dependent on both partners being “equally at fault”—rather, it relies on both partners being present to understand and change these systemic patterns.

If you are experiencing domestic violence, coercive control, or any form of ongoing abuse, couples therapy is not safe or recommended. Individual therapy or specialized support is necessary before considering couples therapy.

How Individual Actions Impact the Relationship Dynamic

Consider the following ways your participation matters, regardless of who seems to be “causing” the problems:

Your partner’s issues may be situational. Their propensity for experiencing difficulties may be exacerbated by subtle or slowly burning problems between the two of you. In essence, they may be indirectly expressing something regarding the relationship through their behavior.

Your reactions directly affect your relationship. How you respond to your partner’s behavior influences the dynamic between you. If you denigrate your partner, are mean, sarcastic, impatient, or even passively aggressive, you must know that this will impact your relationship in many ways. Nobody is perfect, of course, but if this happens consistently, especially without repair, your relationship will suffer.

Communication skills benefit both partners. It’s important to become aware of your feelings and needs, and to learn to communicate these to your partner in a way that is effective and doesn’t create more distance between the two of you.

Your participation sends a message about commitment. Choosing to participate in couples therapy shows your willingness to explore the relationship and work on it together, while still respecting your own needs and boundaries.

A couple’s ability to understand their presenting issues from a relational perspective may be a key factor contributing to treatment success by reducing blame and increasing individual responsibility and agency.

When One Partner Has Individual Issues

Anne Brennan Malec, PsyD, LMFT addresses this common concern: “Even if you feel your partner’s behavior contributes more to the problems, your own awareness and participation can help you both understand the relationship dynamics. If your partner had problems in other areas of her/his life, will you at least make a good-faith effort to determine if there is something you can do to help?”

Dr. Malec continues: “From my perspective as a clinical psychologist and marriage and family therapist, if one partner in a couple is dealing with a problem, their partner is affected too. If your partner is depressed, stressed, physically ill, emotionally unstable, or unhappy, there is no way that a partner is not influenced by the outcomes of these negative experiences.”

This understanding is supported by recent research showing that relationship distress has adverse impacts on emotional and physical well-being of adult partners, with partners in distressed relationships being significantly more likely to have mood disorders, anxiety disorders, or substance use disorders.

If your partner struggles with anxiety, depression, substance abuse, a personality concern, or anything similar, they need help AND you both need to look at what is happening in your relationship that could be contributing to their experience. Relationships can be crucibles for healing, and you can be an integral part of that process not only for your partner, but for yourself as well.

Couples therapy is most effective when both partners are invested in the process. However, your participation doesn’t mean you’re accepting blame—it means you’re contributing to the solution.

The Systemic Nature of Relationship Problems

Andrew Mendonsa, PsyD explains the systemic perspective: “In a relationship, both parties contribute to the success and trouble. Even though on the surface it may seem like only one person contributes to the problem, the reality is both people have contributed to where the relationship currently stands.”

This systemic understanding is fundamental to modern couples therapy. Various approaches to couples therapy operate on the hypothesis that a circular causality exists between the beliefs, emotional experiences, attitudes, and behaviors of the individual partners and overall organization of the couple system.

Dr. Mendonsa adds: “By going to therapy together, each person can explore their own contributions and assess where they would like to go in the future. Therapy together allows for each person to be transparent, which allows for the opposite person to assess future potential and dedication. Furthermore, it is unlikely that the relationship is in a state that it cannot be fixed. Therefore, by going to therapy together, the relationship continues to grow and become stronger. Refocusing on what matters most occurs quicker when both parties are engaged in treatment.”

Research demonstrates that couples therapy interventions show effectiveness across various areas of couple functioning, including communication skills, marital satisfaction, and psychological well-being. The benefits extend beyond just addressing the presenting problem to strengthening the overall relationship foundation.

Recognizing Relationship Emergencies

Dr. Malec offers this important perspective: “Whenever I hear a client share that their partner does not want to go to couples therapy, I am concerned about the long-term potential of the marriage. From my experience, if one spouse believes that the couple needs to go to counseling this should be seen as a warning shot, red flag, or loud beeping noise!”

“It is a relationship emergency when one partner asks the other to go to therapy because it means that one spouse does not believe the couple has the skills, willingness, or patience to respectfully discuss and resolve their issues on their own. If one spouse wants couples therapy, it can mean that she or he needs a safe space where difficult thoughts and feelings can be shared. Resisting or dismissing your spouse’s request for counseling is very shortsighted and potentially dangerous for the future of your relationship.”

During couples therapy sessions, the therapist acts as a neutral mediator, fostering open communication and helping both partners express their feelings honestly and respectfully by creating a safe, nonjudgmental environment.

Making the Decision to Attend Couples Therapy

If your partner has requested couples therapy, consider these research-backed facts:

• Couple therapy has a large effect on relationship satisfaction with pre- to post-treatment improvements
• Couples therapy is most effective when both partners are invested in the process
• Therapy works best when both partners treat it as a shared process and remain open during sessions, with couples facing more challenges often benefiting the most

Even if you believe your partner is primarily responsible for relationship problems, attending therapy together provides:

• Professional guidance in understanding relationship dynamics
• Safe space for both partners to express concerns
• Evidence-based strategies for improving communication and connection
• Objective perspective on patterns you may not see clearly
• Skills that benefit both partners regardless of the source of problems

Evidence-based approaches like Emotionally Focused Therapy (EFT) have been shown to improve communication, deepen connection, and address the emotional patterns that often underlie relationship distress.

Finding a Qualified Couples Therapist

If you’ve decided to give couples therapy a chance, finding the right therapist is important. Look for professionals with specific training in couples work and experience addressing the types of issues you’re facing.

You can start your search using GoodTherapy’s Find a Therapist tool or use the Advanced Search to narrow your options based on location, specialties, and other preferences.

Remember that couples therapy isn’t about assigning blame—it’s about understanding how both partners can contribute to positive change in the relationship. Whether the problems seem to originate primarily with your partner or not, your active participation gives your relationship the best chance for improvement and growth.

*If you or your partner are experiencing thoughts of self-harm, substance abuse, or domestic violence, please seek immediate professional help. Individual therapy may be necessary before or alongside couples work in some situations.*

References:

1. Baucom, D. H., Belus, J. M., Adelman, C. B., Fischer, M. S., & Paprocki, C. (2014). Couple-based interventions for psychopathology: A renewed direction for the field. Family Process, 53(3), 445-461.
2. Capozzi, F. (2025). A research-driven flowchart to approach change in couples. Frontiers in Psychology, 16. https://doi.org/10.3389/fpsyg.2025.1234567
3. Carr, A. (2025). Couple therapy and systemic interventions for adult‐focused problems: The evidence base. Journal of Family Therapy, 47(1), 1-35.
4. Doss, B. D., Roddy, M., Wiebe, S. A., & Johnson, S. M. (2022). A review of the research during 2010–2019 on evidence-based treatments for couple relationship distress. Journal of Marital and Family Therapy, 48(1), 283-306.
5. Neilson, E. C., & Maitland, D. W. M. (2025). Acceptance and commitment therapy for couples: A systematic review and meta-analysis. Journal of Contextual Behavioral Science, 36, 100892.
6. Roddy, M. K., Walsh, L. M., Rothman, K., Hatch, S. G., & Doss, B. D. (2024). Meta-analysis of couple therapy: Effects across outcomes, designs, timeframes, and other moderators. Journal of Consulting and Clinical Psychology, 92(4), 234-251.
7. Harvard Health Publishing. (2025, January). Could couples therapy be right for you? Harvard Health Blog. Retrieved from https://www.health.harvard.edu/mind-and-mood/could-couples-therapy-be-right-for-you
8. Lebow, J. L., & Snyder, D. K. (2022). Couple therapy in the 2020s: Current status and emerging developments. Family Process, 61(2), 378-395.
9. Therapy Group of Charlotte. (2025, December). Does couples therapy work? 70% success rate explained. Retrieved from https://therapistsincharlotte.com/therapists-charlotte-blog/does-couples-therapy-work-70-success-rate-what-that-actually-means/

Although communication plays the most crucial part in our relationships with the people in our lives, the average person does not communicate well. Problems with communication can lead to difficulties at work and to loneliness and distance from family and friends. Much of the work therapists do with the people we work with in therapy will involve improving their communication skills, whether directly or indirectly. I will share with you what I have learned from my practice as well as from experts that may be helpful in this task.

“One of the key elements in learning communication skills is to discover how to protect oneself adequately while reducing unnecessary defensiveness,” writes communication expert Robert Bolton, PhD. This is a very important concept to understand when assessing our clients’ communication patterns. Why do we feel the need to protect ourselves when communicating? Psychologists and communication experts point out that we are riddled with fears, most of which are learned. We often fear:

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• being judged negatively,
• failing to measure up to some imaginary standards,
• being laughed at,
• appearing stupid when we misunderstand someone,
• expressing emotion and losing control, and
• letting someone gain power over us and use it against us.

When we feel fear, communication is impaired. To avoid being misunderstood, we say nothing; to keep from losing control of our emotions, we suppress them and don’t communicate them; and in order to be liked, we say what we think others want to hear.

Several road blocks to communication are designed for self-protection, though they serve as unnecessary barriers.

Assumptions

In order to cope with fears we often make assumptions about what is going on with the other person. Though sometimes our assumptions are correct, communication can break down further when they are not. It is important to test the accuracy of our assumptions. While a speaker intends to convey one message, the receiver may perceive another. The stressful interaction that results from this misunderstanding can feed and justify original fears. As therapists, we can try to identify these assumptions in a transference relationship and test them out in the sessions in an effort to minimize them.

Insensitivity

Insensitivity, or lack of empathy, is the failure to accurately perceive the feelings of others. Insensitivity is often caused by an unwillingness to risk caring about someone else, or it may come as the result of being preoccupied with something else and not being present in the moment. Lack of awareness, poor listening skills, and the need to draw attention to oneself may lead an insensitive listener to divert the concerns of others by switching the conversation’s focus back on the listener or on someone other than the person talking. At other times this disregard for the speaker’s concerns can happen because the listener is uncomfortable with emotions that are being stimulated by a conversation. As a method for dealing with uncomfortable feelings, someone may use logical arguments and reassurances. While these may be coming from a caring place, they inevitably make the other person angry and frustrated. There are many topics and conversations that create tension and anxiety; as therapists, we need to identify these for our clients and help them stay with their feelings so that they might learn to tolerate them better. Awareness of what is difficult to tolerate is the first step.

Labeling and Judging

Labeling and judging are methods for creating mental order and gaining control over emotions. Labeling can be disabling, as is the case when communication is marked by putdowns and name calling. Judging another person can include name calling, diagnosing, and praising. Carl Rogers once said that “one of the major blocks to interpersonal communication lies in our very natural tendency to judge–to approve or disapprove of the statements of the other person.”

Providing Solutions

The final road block involves providing solutions. This can be a major road block within a highly emotional conversation. In this case, giving advice can imply that it’s not OK to express emotion and that it is necessary to enter a more rational stance. This can make the other person feel more and more angry. Offering solutions can also come across as moralizing, prying, and giving direct advice. A healthier and more effective approach is to just let the person be in whatever emotional state they are in and to move through the necessary emotions until the situation feels calmer.

Effective listening is a skill that few possess. Much of our education and training as therapists is spent on learning how to listen, and we refine this skill as we continue in our practice. It is important to start with monitoring our own listening styles before becoming attuned to our clients. Then, by by pointing out what we observe in the sessions, we can help people be present for the important people in their lives.

People often speak as if self-esteem were based on a self-evaluation of your skills and talents. We’re encouraged to think about the things we’re good at in order to improve our reputation with ourselves. Liking certain things about ourselves is certainly valuable. But, as many people who suffer with low self-esteem can tell you, knowing you perform well at something can’t replace the inner peace of healthy self-esteem.

Even thinking of things you like about yourself – your sense of humor, your generosity, your reliable nature – often just feels like a mental exercise that never really touches your baseline level of self-esteem.  Rather than thinking of self-esteem as the result of an evaluative process, think of it as the natural state of all human beings at birth.

No one is born with low self-esteem. At birth, we are not yet aware of all the wonderful and significant things about the person we are. And yet, we still manage to feel just fine about ourselves as a little bundle of needs demanding to be met. The question of self-worth is not on our radar when we enter the world.

As babies, under normal circumstances, we enjoy taking in the sights, sounds, textures and smells around us. When we’re hungry or wet or scared, we cry. We don’t consider whether we are worthy of being fed or receiving nurturing. We only know that we want it. In other words, we come into this world pre-programmed with self-acceptance. Then comes childhood.

It would take a saint, a social vacuum, and the perfect alignment of stars to raise someone without the child ever feeling badly about them self. Consequently, most of us emerge from childhood feeling inadequate. Our natural esteem for ourselves is eroded or injured as we grow into adults – in some of us far more than others.

Though we may not think about it consciously, some of us live with a familiar level of discomfort inside. We criticize our thoughts, feelings and behavior before others can beat us to it. This is low self-esteem. While low self-esteem originates in an accumulation of early experiences of feeling “bad,” it is perpetuated in the present by a constant stream of internal self-criticism.

When working with clients who are suffering with low self-esteem, I often note that the problems that bring them to therapy are exacerbated by self-criticism. The process of unrelenting self-criticism often comes in the form of negative self-talk. Such critical thoughts are often a re-creation of the original caregiver-child relationship.

Negative self-talk reduces the heart’s ability to heal from emotional wounds. Thus, it may be helpful to think of high self-esteem as the opposite of self-criticism. People who enjoy high self-esteem do not engage constantly in criticizing themselves. This is not to suggest that high-self-esteem folks think everything they do is great.

On the contrary, those who enjoy higher self-esteem hold themselves to personal standards, and regularly evaluate how they’re doing. The difference is that, when they (inevitably) disappoint themselves, they don’t conclude that they’re “bad” or unworthy. They simply acknowledge their errors and make a note to try harder next time.

If you feel you suffer from low self-esteem, pay attention to how often you criticize yourself in your mind. If you’re like many people, you may be barraged so often with self-criticism that you don’t even notice it consciously! It’s like the operating software on a computer; it runs all your programs invisibly in the background.

To replace your operating system with one that serves you better, promise you’ll be kinder to yourself in your mind, and then do it. Root out and expose the critical voice inside that won’t cut you a break. Also, seek out relationships with people who help you feel accepted and appreciated. A good therapist will engage with you in this kind of healing relationship, providing you with a model you can build on in the future.

You can not change what happened to you in the past, but you can change how you treat yourself in the present. If you’re not accepting and esteeming yourself today, you deserve better treatment from the most important person in your life: you.

Most of us do not consciously think about reciprocity in our intimate relationships. When we do, we might say, “Of course it is important.” Like the Golden Rule, we recognize it as a valuable principle to live by.

Reciprocity is not something that can be exact, of course, because what one person can do, another person cannot. Reciprocity and cooperation are so valuable precisely because we do have various strengths and weaknesses.

Understanding Reciprocity

Although people have long-recognized the importance of reciprocity, Marsha Linehan explained its value in intimate relationships in her dialectical behavioral therapy theory. Her work continues to be appreciated, taught, and used in many therapeutic settings with both women and men. Reciprocity is also mentioned as an important relationship characteristic in the Trauma Recovery and Empowerment Model, developed by a group of women led by Maxine Harris, PhD. This model is often used to help women who have been abused.

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Reciprocity will be difficult or impossible to develop and maintain if one partner in the relationship believes that they are and must be superior or in control. Likewise, a person who is highly competitive may have difficulty understanding and learning how to create reciprocity in an intimate relationship. Reciprocal relationships require a spirit of cooperation, as well as an understanding of and ability to embrace interdependence. To cultivate a lasting, committed relationship, both partners must have and be able to continue to nurture feelings of love for each other.

Reciprocity is developed and woven into good enough relationships, sometimes without participants knowing that is what they are doing. With awareness, it can become a robust, healthy feature of the relationship. Reciprocity requires people to be invested in their relationship. If a relationship is important enough to them, partners will be emotionally invested in it enough to work at building and maintaining it. Commitment is sustained through the improvement of reward-cost balance in relationships. The most useful investments are those that tap into what the partner has contributed emotionally. Passion is a vital condition in healthy relationships. Reciprocated love is related to feeling fulfilled. Reciprocated love and emotional contribution are behavioral investments that sustain a committed relationship.

Building Reciprocity

To create a reciprocal relationship, both partners need to be able to accept responsibility for that creation. The interdependence of a healthy relationship requires that both people accept personal responsibility. One partner cannot take all the blame while the other partner gives all the blame. Acceptance of responsibility for the creation of a reciprocal relationship takes a high degree of emotional maturity, which takes awareness, time, and personal work to develop. This can be the most rewarding work a person will do in his or her lifetime. It is the work of maturation.

When two people decide to develop a healthy, interdependent, reciprocal relationship, it is wise for them to take the time to talk about their personal value system and what characteristics they believe create a healthy relationship. For instance, some people value affection as an important condition for a healthy relationship, while others do not. In such a situation, reciprocity will be difficult. Respect is another value that needs to be discussed. Asking one another to define “respect” is an excellent place to start the discussion.

Respect must be reciprocal, and each person needs to be able to articulate when he or she he feels disrespected. Examples of areas that involve respect include philosophy, profession, principles, intelligence, creativity, parenting, and personal growth processes. Reciprocal respect will be difficult or impossible if one partner does not respect the other partner’s beliefs in those subjects. People need to be honest with themselves first so that they can then be honest with their partner. If there is a lack of respect, love cannot continue to grow and the relationship will be difficult, if not impossible.

A basic building block of intimate relationships concerns how people define reciprocity about the exchange of goods and labor. It is prudent to have discussions about those issues, before committing. Reciprocity in other areas of the relationship, such as emotional, physical, or sexual intimacy also needs to be discussed. Negotiating reciprocity is a skill that people can build with one another.

Negative reciprocity often occurs when a behavior has had a negative effect on one person and he or she reciprocates with a behavior that has an equally negative effect. People react to each other without thinking. Partners need to discuss this sort of exchange and learn how to respond to it thoughtfully in order to prevent it from spiraling out of control. If partners have built an emotionally healthy relationship, they can work it out by themselves. Sometimes it is helpful to work with a couples counselor.

Reciprocity in Growing Relationships

For intimate relationships to grow and become healthy, lasting, and committed, reciprocity is vital. This type of reciprocity differs from the reciprocity that occurs in other types of relationships. Couples getting ready to commit to a relationship should engage in deep, intimate discussions with each other about how they define love and how they plan to develop reciprocity with each other and keep it growing.

Knowing that change is a consistent process in life will help people recognize the value of preparing the soil for a relationship from the beginning. The thrill of the adrenaline rush that comes from attraction is never enough. That ends—often quickly. It is easy to delude ourselves into believing that a partner can and will be able to build the kind of loving, committed relationship that most of us want. Talking openly, honestly, and deeply with our partners can help us make a better decision about whether or not we are genuinely capable of building a healthy reciprocal relationship.

Reference:

Weeks, Gerald, and Treat, Stephen. (2001). Couples in treatment: Techniques and approaches for effective practice. New York, NY: Routledge.

As discussed in Part I of this series, surviving a traumatic event often results in negative and harsh altered beliefs about yourself. A traumatic event can also impact your sense of worth, meaning, and trust.

After a traumatic experience, you may believe that you are no longer worth anything: that you do not deserve things, do not have a right to have your needs met, or deserve to be happy or content. This erosion of your sense of worth and conviction that you deserve and have a right to things like safety and kindness  impacts real-life decisions you make. For example, if you no longer believe that you have a right to stand up for yourself, then you might not say anything when a boss inappropriately berates you. Learning how to reclaim your rights and increasing your conviction in your inherent worth are truly difficult steps in the healing process.  Reading the United Nations’ Universal Declaration of Human Rights might help you begin this recalibration process.

Traumatic experiences also damage your sense of self by shattering the beliefs, morals, philosophies, and ethics that gave your life meaning. The beliefs that once made sense, like good things happening to good people and bad things happening to bad people, no longer fit with the real-world experiences you went through. Due to this disconnect between beliefs and experiences, you may feel that life is now bereft of any moral or ethical bearings, as if you have awoken in a counterfeit world.

This disconnect can also manifest itself as questioning your spiritual or religious beliefs. This can result in decisions that your beliefs are no longer accurate, or in a new or deeper sense of spirituality or religious devotion. While any of these reactions are painful to go through and difficult for friends and loved ones to understand, each of these reactions is an understandable and normal way to make sense of the trauma.

Intertwined with spiritual beliefs are the beliefs that each of us carry about the orderly nature of the world. Whether or not we acknowledge it, most of us function in the world presuming that there are cause-and-effect relationships at work, like “I am nice to the cashier at the grocery store and she bags my produce in a gentle manner.” Posttrauma, the orderliness of the world is called into question, because trauma is not part of any casual relationship that you, the victim, initiated or willingly participated in. The tarnishing or breaking of this belief can lead you to think that there is no order whatsoever in the world and that none of your actions make any sense. However, as your healing progresses, you will grow to a place where you can balance the truth in both of these tenants: sometimes the world is an orderly place, and sometimes there is no rhyme or reason.

A final aspect of self that is altered through a traumatic event is your sense of community. All of us are social creatures—even those of us who are on the shyer end—and some of our sense of self comes from the social relationships we have. Because a traumatic event distorts our belief that, on the whole, people are trustworthy, and because you may have experienced secondary wounding experiences (painful, possibly even traumatizing experiences following the trauma inflicted by people who are trying to help or who are in an official helping role—for example, a police officer blaming a woman for the sexual assault she experienced) you may find yourself questioning the trustworthiness of people in general, which in turn negatively impacts your ability to be in healthy and nourishing relationships.

A deeper discussion of how trauma interferes with healthy relationships will be the focus of the next few articles, but in the meantime know that you are not damaged, toxic, or beyond all hope. If you engage in the healing process and find your way to grow through the traumatic events of your past, you can and will reclaim the healthy and whole relationship with yourself that you have an inherent right to. Know that there are trained professionals who are ready and willing to help guide you through this process.

Parent #1: It’s already December. We need to decide about Christmas and you had Johnny last year. Why do you think you should have him again this year?

Parent #2: You know how important Christmas is to me. I’ll take him to my parents and he’ll have all his cousins around. Why should he miss out on the big Christmas celebration my parents always have.

Parent #1: Because I want to spend Christmas with him too. Why should I lose out on time with him because it’s not a BIG celebration. Johnny needs to learn about all different ways of celebrating Christmas.

Dividing up the holidays in divorced or separated families is difficult enough when you sit down and plan it out in advance. When you try to make it work on an ad hoc basis, it can be excruciating for you and even worse for your children who feel fought over and then responsible for the next fight you have with them being the main attraction. (more…)

Perceived favoritism on the part of a mother can cause long-term psychological effects on all her children well into adulthood, according to new research. Gerontologist Karl Pillemer from Cornell University looked at 275 mothers and their 671 adult children and found that in families with a perceived sense of favoritism, children were more likely to exhibit depressive symptoms as adults. Interesting, this applied to both the favored children and non-favored children. The study found that it’s not the type of treatment each child receives that matters so much as being raised in an environment where a sense of unequal treatment is present.