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Friday, July 29, 2011

Keys to a Positive Marriage--Weaving Your Lives Together

Let me begin with what may seem to be an outrageous statement and then try to explain myself.

There is nothing more natural than two people, married or otherwise, growing apart.  The goal of marriage is to prevent that from happening.

Why do I believe this?  I believe it is true because in the past, in a more rural society, people shared common goals and interests.  Both often worked on a farm or similar setting.  Meals were shared in common.  Topics of conversation were  the crops, the animals, the children, and so on.  (Please understand that I have never lived on a farm, but I think the logic still holds.)

Now consider a modern urbanized family.  In many cases, both partners have jobs.  It is highly unlikely that they work at the same place.  They do not know the same people.  They have somewhat different stresses and somewhat different focuses to their lives.  Each person is brought into contact with other people.  These are people who have a similar interest and focus to them individually (banking, law, sports, etc.) but not necessarily for them as a couple.  This may make them feel closer to co-workers than to their spouse or partner.  I am quite fortunate in that my spouse is also a counselor.  So our outlooks are quite similar.  Our values are.  Our intellectual interests are.  But this would make us somewhat of an exception.

When two people originally bond through marriage or long term commitment, there is usually some degree of commonality of interest.  But whatever the original common interest, it can change over time.  It might be their university, a sport, or the social circle they are in.

As we mature and grow older, we change.  Our brains change in ways that science has not yet fully figured out.  And our environment (read, job) changes us. 

But we can take the time to continue to weave our lives together.  If we put the time and energy into it, we can keep things in common.  Here are some things which couples might have in common:

  • a circle of friends
  • going to university events such as football games
  • going to church together
  • having a hobby together (sailing, bowling, etc.)
  • going to children's sporting events together
  • participating in extended family get togethers
  • traveling together to see and share experiences in common
  • discussing events in the news and sharing ideas
  • tackling home improvement together (although this can also be stressful on a marriage)
  • making plans for the future together
You may have your own ways of weaving your lives togehter.  The how is not so important here. What is important is to realize that it takes effort to stay within each other's worlds. 

Be a part of who the other person is and what they are interested in.  You can still have your own interests and individuality.  You can still have spaces in your togetherness, as Kahlil Gibran put it.  But find ways of weaving your lives togehter. Don't assume that the initial good feelings of love and romance will link the two of you together forever without any further work on your part.

Keys to a Positive Marriage--Understanding and Preventing Escalation

I am fascinated by how arguments escalate in marriages--both in my own and in others.  Being married allows me to study this first hand, and I think I understand a few things about it.

First, I understand how easily it can happen.  It can happen more quickly than either partner expects and sometimes out of the clear blue sky.

Secondly, I understand that often feelings and arguments can escalate inside our own heads before we ever say anything out loud to our partner.  We can talk ourselves into an emotionally upset state to the point that we are unlikely  to be able speak calmly and rationally.  This makes it easy for the external escalation (i.e., what we actually say out loud to our partner) to occur.  It can occur quite rapidly because we have been thinking things in our head that we haven't yet said; but with a slight provocation, these things then spill right out.

Thirdly, I understand that most of the time escalation can be prevented.  It can be stopped early in the process. I believe that for most couples, escalation can be a decision rather than an uncontrollable chain reaction, if we have an awareness of ourselves, what we are doing, and why we are doing it.  We can decide whether we are going to escalate a discussion into an argument or not.

Fourth, I understand that many couples practically lose their heads in arguing.  (Translation: by "lose their heads" I mean give themselves over to emotional thinking rather than using the rational and logical thinking that their brains are capable of.) They often end up arguing over something very unrelated to the original issue.  In marital counseling sessions following a major argument or fight, they often can't tell me how the argument started or how it transformed from the original discussion topic to what they were fighting about at the end.  They don't remember.

Now, before going further, I need to clarify my terms.  I will talk more about this later, but in a nutshell are some words and phrases about marital communication and what I mean by them:
     talking--logical sharing of information
     arguing--heated sharing of thoughts and feelings; a debate; defensiveness; not really interested in hearing what the other person has to say, wanting to vent to the other person and to defend oneself against what they are saying.  Arguing is not helpful but is inevitable at times in any marrige.
     fighting--Fighting means that we want to hurt the other person with our words or hurt them physically.  We don't just want to win an argument, we want to batter them into submission and hurt them.

Talking can escalate into arguing, and arguing can escalate into fighting.  The arguing is inevitable, I think.  Every couple will argue at some point in their marriage, but I don't believe that it accomplishes anything.  Fighting is not inevitable.  It might be possible for a couple to go through 20 years of marriage and never intentionally hurt the other person just to hurt them.  (We might need to elevate them to sainthood, but I think it is possible.)  It is different to hurt someone accidentally because you are arguing and to hurt them on purpose.

Here is my suggestion, based on 35 years of my own marriage.  Don't escalate.  It can be hard, but it can be done.  How?

1.  Be determined not to escalate.  First you have to have a reason in our own minds not to pursue escalation.  We have to decide as individuals and as couples that escalation is not what we want and that it will not help us achieve our goals. That there is no reason to escalate things 99% of the time.  (Maybe 0.1% of the time there is such  an important principle at stake that you need to be willing to go "all the way" with the argument--arguments over child abuse, spousal abuse, illegal behavior, etc. come to mind)   We cannot ultimately win anything important through argument.  We can maybe win the argument about what type of car to buy.  But if winning causes resentment in the other person, then we haven't really won anything important.  My philosophy in my marriage is that I can't change my spouse through arguing.  And rarely, if ever, have I felt that I saw examples of one spouse change another.  That doesn't mean that people don't change; it just means that one person cannot directly change another through arguing and escalation.  I believe that I can suggest change.  I can give positive reinforcement for change.  But if I try to coerce change through escalation, nothing good comes of it.  And I believe most marriages are this way.

So, if we can't change our spouse for the better, then why escalate?  Probably most of us at one time or another just feel the need to vent our emotions.  And that is not all bad.  We are human beings after all; we are not saints.  Some emotional venting is necessary.

But escalation often brings with it damaging statements that we weren't planning on saying, things which can never be taken back.

Secondly, realize that one partner cannot escalate an argument all by themselves.  They can explode or become abusive, but an escalation of an argument requires two people.   Just like a comedian "funny guy" needs a straight man, and vice versa, for the act to work, true escalation needs both people to cooperate.  So either person has the power to stop it.  Keep that in mind.

Thirdly, if you are in a situation which can escalation, keep track of the back and forth comments.  I suggest using the "rule of two."  First, state your beef, what's bothering you.  Now, let's assume that your spouse becomes defensive.  They argue with what you said.  Perhaps they didn't understand what you said.  Perhaps it has become distorted in their minds.  Restate your point more clearly. 
And then,
And then,
shut up.

If they are starting to argue or escalate, don't follow up right then.  You have said what you have to say.  If they are upset, escalation can occur at this point.  If they are not upset, let the information roll around in their head for awhile.  Or if they are in a reasonable mood, then a good discussion can occur.  But if they wanting make it into an argument that would escalate, there is really no need to say anything else.  If there is going to be an argument, then they are not really likely to hear what you are going to say next, so why say it right then?  Say it at another time when they are calmer.

There are some interesting findings in learning research that suggest that if you want to learn something and want to transfer it from short term memory to long term memory, close your eyes after you read it or see it.  This prevents new information from crowding into working memory and competing with the first information.  the first information can be better consolidated and stored for the long term.

Similarly, if you follow up an initial important point with an escalating argument, the important intiial information can be crowded out by the subsequent arguing so that they other person does not end up remembering what you first said, which was what you really wanted them to hear. 

But what if your spouse wants to argue and wants to escalate?  That doesn't mean that you have to participate.  You can say that you have really already made your point.  You can clarify it as long as the discussion stays on topic and as long as you feel that you are staying in the talking stage, not proceeding to the arguing/debate/defensiveness stage.

Rember that you don't need to have the last word.  This may seem to contradict what I just said about the last thing seen or heard is what is remembered.  But in learning theory, people remember is most likely to be the first thing in a series or the last in a series.  While it was be advantageous for us to have the last word, that doesn't work in most arguments, because each person is struggling to have that last final comment.  That is what leads to escalation and even to getting sidetracked.  If we insist on having the last word, we are more likely to have escalation.  Both persons want the last word, and because each may be talking over the other, neither may really get that clear opportunity.  Moreover, since walls of defensiveness go up during arguments, getting the last word in a marital argument may not have that same advantage of being the last thing learned in a calm college list learning experiment.  So instead, settle on having the first word.  Bring up the issue calmly.  Then don't escalate.  It's easier when you have already decided that you are not going to try to have the last word.

Making Marriages Work--Things I Don't Really Need to Say

In my next few blogs, I am going to be writing about what I think makes a marriage work.  I am not going to bother to state the obvious.  I won't be writing about not abusing your wife, not coming home drunk, and not having affairs.  If you need to be told not to do these things, then consider yourself told. But maybe some of my upcoming blogs on marriage will touch on things that you haven't thought of.

Here are some things which I won't be touching on though.  I hope they are obvious enough.

Do not select a spouse on the basis that they have a "kick ass" tatoo.
Do not select a spouse because they are a great drinking buddy and can drink everyone else under the table.
Do not select a spouse because they are a good "fixer upper."
Do not select a spouse on the basis that they are in prison for multiple felonies but deep down really "have a good heart."
Do not select a spouse on the basis that they have been married five times to "no good bums," but now you will have the opportunity to rescue them and show them what a real man or woman is like.

All tongue in cheek comments aside, maybe someone needs to write a list of statements like the above for people who need it.  But I think that has already been covered by Jerry Springer and Dr. Phil.

So it is time to move on to more serious blog postings on marriage.

Saturday, July 09, 2011

Understanding Psychotherapy Research and Evidence Based Practice

A recent trend in psychotherapy due to the abundance of psychotherapy research has been a call for "evidence based practice."

Let's take a look at what that means and what may be in store for us in the future.

First of all, this movement means that there is a desire to protect the public from quackery.  If, as a psychotherapist, I am constrained or compelled to only use empircally validated techniques, I cannot just use whatever comes to mind at that moment.  I cannot tell my patients to wear copper bracelets to get better.  I cannot simply smile and be pleasant.

Secondly, it means that some traditionally accepted treatments may not make the cut either.  For some disorders, psychoanalysis may not have been shown to work.  Hypnotherapy may not have been shown to work.  Transactional Analysis or Gestalt Therapy may not have, either.

Thirdly, it means that patients have a fighting chance of getting better.  No therapy is perfect.  No therapy has been shown to work 100% of the time.  And even when therapy works, it often does not work 100% effectively for an individual.  But the patient has a fighting chance because people have been shown to get better with that therapy.

Now let's look at some drawbacks to movement.  First, just because a treatment has been shown to be effective doesn't mean that my patient may be ready to accept it.  Exposure to a feared stimulus (phobia) has been shown to be an effective treatment for that type of anxiety disorder.  However, patients may not want to use that treatment because it means that they have to confront the feared stimulus first.

Secondly, while research has shown certain treatments to be effective for certain disorders, it is important to understand what that means.  It means that there is a statistically significant difference between the beginning and end of treatment or between two groups--a treatment group and a control group. It does not mean that people receiving that treatment get "well."

Thirdly, just because a treatment has not been shown to be effective does not mean that it isn't.  It may only mean that no research group has devoted the time and monetary resources to test the treatment.  A treatment rejected today because of lack of evidence could well be supported by research next year.

Fourthly, when a patient walks into my office, they often do not want to be treated as a disorder.  They often do not want to be known as a case of "agoraphobia."  And so they may not want a packaged treatment for that disorder.  They may want more than anything for someone to just listen to them.  What if the empirically verfied treatment does not call for "listening" as a primary therapeutic ingredient?

Fifth, the patient may not tell me why they are there at first.  Shame may keep them from revealing the true nature of their issues until they get to know me better.  What if I start treating them for the symptom picture they present with, but then six sessions later they tell me a rather different issue that really what is bothering them the most?

Sixth, patients are complex.  They are rarely just a single symptom picture.   They often have several different symptom issues, such as ADHD, mild depression, and anger issues.  Which of the three guides me in determining the empirically verfied treatment?

The above problems are not to say that we cannot or should not use empircally verfiied treatments.  We need to.  The history of psychotherapy research (only about fifty years) has been productive in testing out some treatments and helping us understand what works.  It also has pointed to the importance of the therapeutic alliance in therapy outcome.  Psychotherapy has to be scientific to the extent that it is possible.  It is not mumbo jumbo. Or if it is, then it needs to be taken out of the field of medicine.

But psychotherapy is somewhat unique in the field of medicine.  If a person needs a shot, or an MRI, or an antibiotic, then the doctor's pleasant demeanor is a nice bonus.  But it is not totally necessary.  The relationship is of utmost importance in psychotherapy.  The patient is not an object.  They are a person.  And that is why the who issue of evidence based practice has to be approached very carefully.