“For years it lay in an iron box buried so deep inside me that I was never sure just what it was. I knew it carried slippery, combustible things more secret than sex and more dangerous than any shadow or ghost. … I saw things I knew no little girl should see. Blood and shattered glass. Piles of skeletons and blackened barbed wire with bits of flesh stuck to it…The iron box contained a special room for my mother and father, warm and moist as a greenhouse. They lived there inside me, rare and separate from other beings. … I knew my parents had crossed over a chasm … The box became a vault, collecting in darkness, always collecting; pictures, words, my parent’s glances, becoming loaded with weight. It sank deeper as I grew older, so packed with undigested things that finally it became impossible to ignore.”
-Helen Epstein, Children of the Holocaust

(more…)

Why do so many men sabotage relationships and careers? Current cultural stereotypes of men range from bumbling incompetence to aggressive, macho insensitivity. I’ve worked with men in therapy and personal growth workshops for over 25 years, and I’ve identified a type of adult man I call the LATE Men, Lost, Angry Teens, and they are often stuck in an adolescent level of development – literally, LATE to grow into full adult functioning.

We all have four primary internal parts: An Inner Child, a Teenager, an Inner Critic, and a loving, responsible Adult. The Teenager seeks independence, identity, and acceptance with peers. Teens may also become rebellious, angry, confused and withdrawn. Adjustment problems are more likely to occur in distressed or dysfunctional families, where adolescents do not receive the guidance, emotional support, and other resources necessary for healthy maturation and individuation. (more…)

Experiencing a traumatic life event is horrific and terrifying, but this experience does not have to become your defining moment.

It is possible to grow through a traumatic event, or series of events, and there are loosely-structured phases of healing for that growth to follow. For a moment, stop and reflect on what it means for experts to have identified these patterns of healing: it means that you are not alone in having experienced trauma, and you are not alone on the healing journey.

The healing journey follows three loosely linear stages or phases. The rate of growth through each of the phases, as well as the details of what that growth looks like, will be unique to you. You will develop your own unique pattern of healing, which means that you will enter, exit, and revisit phases at various times in your life.

Always keep in mind that revisiting is not backwards movement. It is like the outer layers of a spiral: you pass by the same issues, but are in a different, deeper state of healing. As you near the end of your healing journey, you will be able to look back and notice an overarching progressive nature to your growth and healing.

[fat_widget_trauma_ptsd_left]This article will look at the first phase of healing, while future articles will address the second and third phases.

Understanding the Safety Phase

As you begin the first phase of healing, safety is both your main concern and the hardest task to achieve. Establishing safety—both within yourself and within your environment—can take days, weeks, or even years. The length of time required to develop genuine safety depends on your unique attributes, such as past life experiences, personality, and pretrauma baseline. The length of this phase also depends on how chronic the trauma. In general, the longer you were exposed to the trauma, the longer it will take to develop a sense of safety.

This is not an easy stage. Establishing safety requires a lot of hard work and may require that you, the survivor, dramatically change your life or lifestyle. While this is a difficult part of the healing journey, absolutely no survivor can skip this stage.

Safety Within

In order to truly have safety, you must establish safety within yourself. Focusing on your physical health lays the foundation for internal safety. Establishing internal safety requires you to tend to any ailments, as well as to eat healthy foods, exercise regularly, and sleep sufficiently. Self-harming behaviors preclude genuine safety, so cutting, burning, or addictions to drugs, alcohol, food, or sex, must be grown through and terminated.

Many self-harming behaviors are efforts at managing emotions or thoughts. Learning how to manage your thoughts and emotional world, including your trauma reactions (especially hyperarousal and intrusive reactions), is fundamental to being safe within yourself. Many people find it difficult to engage in this healing without the assistance, support, and guidance of a trained professional. Do not feel ashamed or hesitant to reach out for help.

Safety in the World

Safety within oneself is only half of the equation. No one can be fully safe unless the environment they live and interact in is also safe. Creating safety within your environment requires safety within your physical and relational spheres.

• Attaining a safe physical space includes your ability to move physically in society with a sense of safety and security. It may help to work on your ability to identify dangerous situations or individuals and, to the best of your ability, to get out of a dangerous situation if at all possible. Consider developing safety plans or learning self defense.

• Assess the physical and emotional safety of your social support network. It may be necessary to remove people from your life who are a potential source of physical or emotional danger, or to increase the number of people who can and do provide emotional support, protection, or practical help.

• For those who experienced trauma at the hands of other people, assess the degree of continuing threat and the potential for re-victimization or revenge, and develop appropriate precautions. Ensuring your safety is not 100% within your authority, since to live means to be vulnerable. But that does not mean it is 0% within your authority either.

Moving Through the First Phase

This phase of growth is gradual. It can have a sometimes halting stop-and-go pattern, and it can take a long time. However, if you continue to work on developing safety, and allow trustworthy others to help you, you will be able to grow through this phase.

Some indicators that you have grown through this phase include no longer feeling utterly vulnerable; having a degree of confidence in your ability to protect yourself physically and emotionally; knowing who to count on for safety and support, and being able to effectively manage most of your trauma reactions, including emotions, thoughts, and behaviors.

If learning about the tasks involved in this first phase of healing feels daunting, don’t give up. Reach out to a trained therapist and harness their skills and abilities in order to engage in this healing work. You have a right to reclaim the quality of life you deserve.

If this first phase of healing sounds like a review of work you have already completed, take a deep breath of congratulations and gratitude. You are on your way to continued and ever-deeper healing and growth.

So, you made it through the hardest part– you made the decision to seek therapy. You asked for recommendations, sorted through therapist profiles and websites, maybe even spoke to a few. Finally, you selected a therapist who you believe can help you, and you are ready to get started. You think you’re on your way to feeling better, but then a strange thing starts to happen; you find yourself feeling worse. How can this be? You’re seeing a therapist and working hard to get through things. How can you be feeling worse, rather than better?

Believe it or not, this is a common phenomenon in the beginning stages of therapy. Taking a deeper look at the situation, it is easier to understand why you might feel worse before you feel better. When you make the decision to enter therapy, it is often because you haven’t been able to work through a particular issue yourself, and your friends and family haven’t been able to help you come to a resolution, so you call on a professional. This probably means a couple of things; the issue is complex and it has been troubling you for some time. Now that you have entered therapy with a trained professional, you are for the first time, exploring this issue and perhaps other issues in a deeper, more meaningful way. Therapy often involves cutting through the defense mechanisms you have used to protect yourself from difficult feelings, and this can be a painful experience.

At this point, you’re probably asking yourself, why should I go to therapy if it is just going to make me feel worse? Good question. And the answer is that while you may experience more pain in the beginning, this process is necessary in order to fully explore your situation in a way that will lead to new insights. These new insights often come with some much needed relief. But wait, it gets even better. Once you’ve made it this far, your therapist will be able to help you parlay your insights into action. Now, you’ve hit the jackpot. You came into therapy feeling lost and overwhelmed and now, with a deeper understanding of your situation, you are actively taking steps towards improving it and moving on to live the life you desire.

Certainly, if therapists began each initial session with new clients by telling them that they should expect to feel a whole lot worse before feeling any better, they probably wouldn’t keep too many clients. However, one of the most critically important elements of therapy is the development of a relationship between the client and the therapist. Skilled therapists can usually establish a solid rapport with clients within a few sessions. Once this rapport is established, therapists should warn clients that the process of psychotherapy can be very painful, especially in the beginning. This conversation may be a difficult one to have, but when a client is really ready to embark on the therapeutic journey, truthful dialogue opens the door to a secure therapist-client relationship– a relationship in which the client knows the therapist will be honest with him or her, even when it is not easy.

One of the most arduous decisions you may ever have to make is whether to stay married to someone who has cheated on you. For many people, the decision to not stay in the marriage is pretty straightforward, most often due to moralistic views about infidelity and the covenant of marriage. More often than not it’s complicated, and deciding whether to divorce or salvage a marriage can be heartbreaking and confusing. Marriage is a huge investment for many people, and as with anything in life, the greater the investment, the greater the loss. Marriage is tied up with many dreams, expectations, and fantasies, so divorce is a hugely difficult decision that should be taken very seriously.

Here are some issues that can get in the way of making a sound decision about whether to divorce:

Fear
Fear is at the core of most bad decisions. When we make choices in life based on fear, we are using the most primitive part of the human brain, a part designed to help us respond to dangerous situations for survival purposes. Human beings are the only species with a more evolved part of the brain that allows us to assess, reflect, and consider a situation before acting on it. This is the part of the brain we want to be using when making decisions about whether to divorce. Slowing things down, not acting hastily, and talking with a professional will help you achieve this goal.

Having Children
Many divorcing couples base their decision to stay in a marriage on their children. While it is extremely important to consider the impact of divorce on your children, it is helpful to not make them the determining factor. Children can easily be used as scapegoats to help parents avoid looking at all the options, even if those choices do not offer the most ideal consequences. There are many divorced households in which the children actually do better, so staying together for the children is not always the only and best solution. Meeting with a child therapist and reading up on the impact of divorce on children will help you make an educated decision.

Low Self-Esteem
Staying in a marriage because you are afraid there is nothing better out there is an issue of low self-esteem. Not feeling worthy of something better leads people to stay in bad marriages at the expense of their own happiness. Working on building your self-esteem and being clear about your value will help you make a proper decision about staying or leaving. Feeling empowered and complete with yourself is a valuable goal regardless of where you are in life, so use this opportunity for personal growth.

Black-and-White Thinking
Thinking in terms of right and wrong is the most obvious form of black-and-white thinking. It is easy to slip into a moralistic or righteous place after an infidelity, but it’s just a way of coping with the painful truth. Black-and-white thinking is very limiting and can lead to making a decision that is not founded on the whole truth. It is important to approach the decision to divorce with flexibility and openness to all options. Staying in the gray, as opposed to rigidly clinging to the black or white, allows for a more efficient and genuine decision.

Anger
Anger, not unlike fear, is not the best state of mind to be in when making a decision about your marital situation. Anger is a defense mechanism we use to gain control in a powerless situation, and it can cause us to make rash decisions that are not based on fact. If you respond to the circumstances of your marital conflict with anger as opposed to a calmness and clarity, you become blind to the possibility of potential solutions or answers. While the anger you feel may be justified and expected, it does not serve you in dealing with this important decision.

Uncertainty
Uncertainty breeds the tendency to cling to what we know. When it comes to the unpredictable future that is inherent in divorce, the first instinct is to hold on to the past because it’s familiar. The decision to stay or leave a marriage can be clouded by the unpredictable nature of your future without your partner, but the truth is that your future is unpredictable whether you are married or not. However, it is important to remember that the best predictor of the future is the past, so use your past experiences, successes, and failures to provide you with an accurate assessment of what you are capable of doing going forward. This will help you make a choice that is founded on the realities of who you are.

Deciding to stay in or leave a marriage can be torturous. Often, the heart and mind are conflicting when it comes to marriage and divorce, so it is normal to feel confused and uncertain about what to do. It can also be confounding to make a decision about something that doesn’t appear to have any positive consequences. Consulting a professional, becoming aware of your thinking and feelings, and taking the proper amount of time and space is integral to making the best possible decision for your future.

Have you ever found yourself in a shopping mall, searching, with a slightly pounding heart, for something? Something to wear tonight, tomorrow, or for that next important meeting, or perhaps it’s something yet to be thought of, but you know you must need something, or at least you feel like you need something. Maybe you just want something new, what is the difference, right? You are just going to get it and then whatever is really going on will go away, maybe it’s not even that something tragic or problematic is happening, but your mind and emotional system has been wired so that you go shopping, and when you get a new object that will, in turn, whether you acknowledge this or not, assist you in getting rid of something, or help you “deal” with your feelings.

People who have found compulsive shopping to be an avenue of distraction use compulsive spending as an emotional regulation system. Compulsive spending is the thread or the glue that holds the emotional regulation system together when a person would typically “fall apart” or fragment.

Take the Compulsive Spending Quiz

If the scenario listed in the first paragraph sounds familiar, you may want to consider whether you tend toward compulsive buying. To do so, answer each of the following questions with “almost always,” “once in a while,” “infrequently,” or “not at all”:

1. Do you buy things you want even if you know at that moment you do not have the money to pay for it?
2. Is it difficult for you to save money?
3. When you have some extra cash that you could save, do you think instead of other things you would like to buy?
4. Do you cheer yourself up or give yourself a reward by going shopping?
5. Does more than a third of your income go to pay credit card bills, not including rent or a mortgage payment?
6. Have you had to move credit lines because you typically don’t have the money to pay off your credit line?
7. Do you pay the minimum balance on your credit card most of the time?
8. Are you inclined to keep buying more of your favorite things—clothes, makeup, CDs, books, computer software, electronic gadgets—even though you do not have a specific need for them?
9. When and if you have to say no to yourself or control yourself from buying something you really want, do you feel intensely deprived, angry, or upset?

If you answered “always” and “once in a while” to at least four of these questions, you may have overspending tendencies. The last question is a particularly potent indicator of a serious problem; if you answered “always” or “once in a while” to question number 9, compulsive spending/shopping should be considered a real concern.

What’s Really Going On?

At the core of many compulsions and addictions lays the untouched, guarded emotional life. A person suffering from a hunger disease such as compulsive spending experiences anxiety because he or she wants something but cannot allow themselves to really know what it is. This knowing would perhaps be too painful to tolerate and hence the compulsion to spend becomes the method of soothing, a frantic race to kill off the thoughts, and acquiring objects of desire with a “magical” credit card, makes the soothing process easy. Then, once the objects are consumed or purchased, a sense of relief surfaces simultaneously along with negative thoughts toward the self for doing something so “stupid.” A repetitious cycle is created because the acquisition provides transient satisfaction, not long-term satiation, and it fuels the compulsion to buy increasingly. The wanting and anticipation of getting the new purse, shoes, or race car contains the most pleasure and is done repeatedly.

In fact, some people buy the same thing over and over, knowingly or not. For example, perhaps a person buys 20 pieces of the same fruit at each grocery store visit whether or not he or she needs them, because the purchase creates a feeling of safety, soothing, and containment over anxiety.

Compulsive spending becomes increasingly severe over time, just like other forms of addiction. Credit cards are maxed out and new cards are obtained until the damage is so severe that serious debt is what leads a person to seek some form of assistance or at least hit rock bottom, and then, get help or start the cycle once again. It is important to understand that the “habit” is not an intellectual problem, but an emotional problem, in the sense that the emotional regulatory system has gone awry and spending is what keeps the system held together.

In his book, Hunger Diseases, Raymond Bettegay defines hunger diseases as the emotional problems a person has based on a lack of self-esteem, so much so that they are driven to possess and consume people and or things in an addictive manner. However, no matter how much they get, it does not feel like enough. The hunger is insatiable. It is thought that these problems derive from childhood when the child’s hunger for closeness, warmth, and stimuli were either inadequately met or inordinately gratified, triggering a recurrent experience of insatiable hunger—a hole or emptiness that must be filled with a constant supply of something. Compulsive spending, too, develops to create homeostasis in an emotional world that seems scary, unstable, and uncertain. The process provides sustenance and recovery requires an intentional transition, just like transitioning a baby from a bottle or from nursing. Recovery requires being attentive to needs, feeling emotions, rather than suppressing them, and responding with insight and care.

Neurobiology and Addiction

Currently, research and clinical experience both indicate that there is no addiction center in the brain and no specific circuits strictly for an addictive purpose. However, the brain systems involved in addiction are among the key organizers and motivators of human emotional life and behavior, which is why addiction has a powerful hold over people. In the book In the Realm of Hungry Ghosts, Gabor Mate designates the three major networks of the brain involved in addictive processes: the opioid apparatus, the brains natural narcotic—the dopamine system, the manager of incentive motivation functions—and the self-regulation system.

The less effective an opioid system is to provide love, pleasure, and pain relief, the more driven a person will be to seek joy or relief through compulsions perceived as rewarding, such as spending money for a new dress or makeup. The dopamine system is triggered during the origination and development of addictive behaviors, such as compulsive spending. The dopamine system is the main strengthener of compulsive spending behavioral patterns because desire, wanting, and craving are all incentive feelings managed by dopamine, while opioids are more responsible for the pleasure-rewards aspect of compulsive spending. Both the opioid circuits and dopamine pathways are important components of the emotional part of the brain. Emotions exist for a very basic purpose, according to Mate, to initiate and maintain activities necessary for survival. So, in essence, they regulate two drives that are essential to human beings: attachment and aversion.

The self-regulation system, technically known as the orbitofrontal cortex (OFC), regulates how a person processes and reacts to emotions. In compulsive spenders, the OFC emotionally overvalues an object of desire or the act of spending, making it the main concern for the compulsive shopper, and sadly, the only concern. The OFC also undervalues other objectives, like making rent, providing for oneself and family members. By becoming triggered even at the thought of a new purse or sunglasses, the OFC encourages craving and neglects its job of impulse control (Mate, 2010).

References:

1. Battegay, Raymond, MD. (1997). Hunger Diseases. New York: Jason Aronson, Inc.
2. Mate, Gabor, MD. (2010). In the Realm of Hungry Ghosts: Close Encounters with Addiction. Berkeley, CA: North Atlantic Books

He called me, as most new clients do, to inquire about me, my practice, and my approach to helping. What made this call unusual was that I had to educate him about Eye Movement Desensitization and Reprocessing (EMDR), not because he was unaware of the treatment, but because what he had heard about it from his current therapist was inaccurate. Unfortunately this happens a lot with all kinds of therapy.

As I tell many folks, finding a therapist is like finding the right pair shoes. Some shoes look good, but they don’t fit. Some don’t appear to be a good fit or style, but they are. Just as many of the choices you make as a consumer are aided by research and experience, becoming an educated therapy consumer is a necessary part of your healing journey. When you contact a new therapist, the therapist, too, will wonder whether he or she is the right therapist for you, whether the type of therapy used will be in your best interest, and whether the therapist can offer the expertise that you seek.

With the potential new client on the phone, I found myself in a bind. On the one hand, I wanted to be respectful of the relationship he had with his therapist, but on the other hand, what he had been told about EMDR was not accurate and could possibly hurt him. I elected to educate him and tell him the truth about it, even though it was different what he had heard from his provider. With this information, he was able to better identify what he needed from a counselor and to determine when or whether to pursue EMDR.

EMDR Is Not a Quick Fix

We often look for a quick fix in this culture. Certainly, EMDR’s way of processing traumatic material can be rapid, intense, and highly effective, but it is no guaranteed quick fix, as the client on the phone had been told. Generally, when I first meet with a client to talk about EMDR, this is one of the first misunderstandings that comes up. EMDR is like a specialized surgery procedure, a laser beam of sorts that hones in on the material that is stuck in the nervous system causing distressing symptoms. I wouldn’t ask my surgeon to rush, nor would you. In fact, rushing may mean missing out on completing the eight phases.

More than Just Eye Movements

The name Eye Movement Desensitization and Reprocessing suggested to the client that the treatment involved little more than eye movements. This is a common misconception. If your EMDR therapist is talking only about eye movements and nothing else, it’s not EMDR. EMDR consists of eight distinct phases, which I will illustrate for you. If you are currently using EMDR therapy, you may already know where you are in the process. If not, I hope to reveal some of the mystery behind the treatment. Though the phases are intended to be completed in a particular order, transitioning between them, in a circular fashion, is not uncommon. We can go back to a phase at any time.

The Eight Phases of EMDR 

1. History Taking
   In this stage, your therapist will learn about you and your history and might conduct the standard assessments that he or she uses. This is the time when you share your story, get to know your therapist’s style, and set up initial treatment goals. The therapist should also be creating a target sequence plan, an overview of what affects you from your past and a template for your future. In this phase you are likely to discuss touchstone events, previous experiences that contribute to your current symptoms. You may be surprised to know that how you think and feel in this moment is linked directly to your past. As you review these events with your therapist, you may be asked to rate how disturbing things are to you on a scale of 0-10.
2. Preparation
   The next three phases are like a traffic light, and phase two is like the red light. At this point, you are learning more about EMDR, as well as identifying and ensuring your readiness to move further through the phases. You may be learning additional grounding skills, stress reduction skills, or state change skills, and your therapist will help create a safe-place image for you. You will also be asked to complete a brief assessment to identify if you experience dissociation. You will learn about bilateral stimulation (BLS), the back-and-forth eye movements, sounds, or tactile sensations that help the right and left hemispheres to process the traumatic material and activate the brain’s Adaptive Information Processing (AIP) system. In this phase, you may also hear your therapist talk about resourcing and using the BLS to help you access more positive experiences, thoughts, and images before moving on through the remaining EMDR phases.
3. Assessment
   This phase is like the yellow light on a traffic signal. In the assessment phase, you and your therapist will look at what you want to target when you move into the processing phase. Your therapist will ask you for an image, a negative cognition, and a positive cognition, and to rate how true your positive cognition feels on a scale of 1-7 and how disturbing the target is on a scale of 0-10, and to describe what you experience in your body.
4. Desensitization
   This phase is the green in our traffic light analogy. This is where the BLS really comes into play. Those who have used EMDR know that this is where what you are working on comes up. All of your senses become involved as you process the disturbance you are targeting. You won’t talk to your therapist during this process; you’ll have a brief check in, and then go back to moving your eyes back and forth, hearing the tones, or feeling the taps. This is where AIP comes into play, and your brain will recycle the material for your nervous system to release it as it did not get to at the time. In between sets of BLS, your therapist may also throw some things in for you to think about; these are called cognitive interweaves. The same 0-10 scale from the assessment phase will be used here to assess your level of disturbance. When the level of disturbance is rated at zero and the target truly feels neutral and not distressing, we move on to phase five.
5. Installation
   Next, we will install the positive cognition that you chose with the BLS, but before we do, we recheck to see if the positive cognition has changed at all. It often does because you have moved further on in your healing. We will also check to see how true that positive cognition feels to you, using the same 1-7 scale from phase three. We then keep using the BLS to see if anything is getting in the way. When you get to a 7, completely true, we move to phase six.
6. Body Scan
   Just as the name suggests, you will be asked to mentally scan your body to find any sensations or tensions that signal that something is still stuck regarding the target. If there are any lingering sensations, your therapist will continue with the BLS.
7. Closure
   This will look and sound different depending on if your session was complete or incomplete. You will close down the material and do a final check. You will also use various methods, including imagery, to contain the material that is still not processed. This may include returning to your safe place or creating a container to hold anything that may become to distressing in between sessions.
8. Reevaluation
   Though it looks like the last step, the reevaluation phase spirals back as if it were the beginning. Your EMDR therapist will do a check in at the beginning of your next session that will include reevaluating your disturbance level regarding the target from the last session. This helps to determine if your disturbance is still neutral and if your positive cognition still rings true. If the previous EMDR session was incomplete, the cycle begins again at phase four.

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.

Sometimes people ask me why they should bother seeing a therapist when they can just talk to their friends. Friends know your history, you’re comfortable together, and you trust and care for each other. Friends don’t expect to get paid either, and you can meet socially instead of making an office appointment. That’s all true and wonderful.

What Can a Therapist Do that a Friend Can’t Do?

First of all, therapy is completely private—you can speak freely, without fear that your story will go where you’d rather it didn’t. Maybe there are things you’re afraid of or that embarrass you or make you feel sad, and you feel a need to talk about them. You can discuss them with friends or family, that’s true, but you might like the confidentiality that a therapist provides.

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Next, a therapist is trained to see your patterns, both good patterns and those that don’t work very well. As a therapist, I can point these patterns out to you, and then together we can employ and enhance the good patterns and identify and avoid the not so good. For example, many people who continue to have the same kinds of relationship problems over and over can learn to make better choices in their behaviors and in finding suitable partners. Other people may have trouble getting along with people at work, difficulty making friends, or feelings of loneliness. Therapy is really good at helping people with all kinds of relationships, because it is a kind of test relationship—you get to receive feedback while trying out new ways of being in a safe environment.

Friends, on the other hand, may not be totally honest with you, because they don’t want to hurt your feelings. I don’t want to hurt your feelings either, but I know how to be straightforward and direct and how to say things in ways that won’t be so painful. And if they are painful, we can slow down, continue at a pace that helps you to feel safe, and use techniques that will help you feel less anxious or depressed.

Can’t a Friend Provide Advice or Help You Figure Things Out?

Certainly, a friend may share ideas of what’s best for you and tell you what to do. I may have ideas about what’s best too, but I will help you figure things out for yourself. A therapist can help you look deep inside to find your own solutions and teach you to remember that pathway so you can find it again when you need it. Therapists encourage self-reflection and empower people to find solutions on their own; these techniques can help people live more rewarding lives.

How Do You Know You’ve Met the Right Therapist?

As with any new person, when you first meet a therapist, you have to get to know and learn to trust the therapist.  Most often, you can feel it in your gut. Do you like each other? Do you think you could get comfortable with this person?

It’s scary to begin treatment, and it’s awkward talking to a stranger about your personal life. All therapists have ways of helping people feel comfortable. As an object relations specialist, I pay close attention to the unspoken feelings revealed in your body language. I’ll let our conversation develop naturally, and I’ll invite you to ask any questions you might have, especially if they seem silly. I’ll probably make a joke, or try to, because therapy can also be playful.

Don’t People Become Too Dependent on Their Therapists?

You might feel dependent for a time, but therapists measure their success by people’s abilities to learn and move on, allowing them to leave therapy with healthier strategies to make better lives for themselves.

When you think it might be time to cease treatment, the best strategy is to talk it over with your therapist and review your original goals. Have you met them? Are there new goals you’d like to work towards?

If you both agree that it’s time to bring your relationship to a close, it can help to set a date for termination, so you can say a full goodbye to each other. Goodbyes are just as important as hellos, you know.