Tag Archives: Marriage

The invisibility of infertility grief

By Tristan D. McBain September 30, 2019

In my work as an outpatient mental health counselor, I have encountered numerous clients over the years with stories about reproductive loss. Not only were these stories fraught with sadness and grief, but some of the individuals were still experiencing acute grief even several years later.

As I branched out into my role as a researcher during my doctoral study, these stories stayed with me. So, I began a line of inquiry on reproductive loss that started with infertility and the accompanying grief. Since then, my research on infertility and miscarriage grief has resulted in numerous professional conference presentations and guest lectures. The purpose of this article is to share information that I have learned about those with infertility and to provide methods for best practice in counseling with these clients.

Infertility is generally defined as a condition of the reproductive system that inhibits or prevents conception after at least one year of unprotected sexual intercourse. To account for the natural decline of fertility with age, the time frame is reduced to six months for women 35 and older. According to the Centers for Disease Control and Prevention (CDC), about 12% of women between the ages of 15 and 44 have “difficulty getting pregnant or carrying a pregnancy to term.” Infertility can affect both men and women, despite a common misconception that infertility is a woman’s condition. Infertility in men may be caused by testicular or ejaculatory dysfunction, hormonal disorders, or genetic disorders. In women, infertility may be caused by disrupted functioning of the ovaries (such as with polycystic ovary syndrome, a condition that prevents consistent ovulation), blocked fallopian tubes, or any uterine abnormalities (such as the presence of fibroids).

Infertility can be categorized into one of two subtypes. Primary infertility refers to when a woman has never birthed a child and thus has no biological children. Secondary infertility refers to when a woman experiences the inability to birth a child following the birth of at least one other child. Both forms of infertility produce a cyclical pattern of strong emotion that is often referred to as a “roller coaster.”

Medical interventions

A number of available interventions may be used to increase the chances of becoming pregnant. The best course of treatment will be different for each couple and may depend on considerations such as whether the infertility is male factor or female factor, the cost and availability of insurance coverage, and cultural customs or beliefs. Some couples decide that pursuing any kind of medical treatment is not the right course of action for them. For others, medical treatment may include any of the following interventions.

  • Medication may be prescribed to stimulate ovulation or follicle growth in the ovaries, increase the number of mature eggs produced by the ovaries, prevent premature ovulation, or prepare the uterus for an embryo transfer.
  • Surgery may be necessary, perhaps to clear out blocked fallopian tubes or to remove uterine fibroids.
  • Intrauterine insemination (IUI), also known as artificial insemination, is a procedure in which sperm are inserted directly into the woman’s uterus. The woman may or may not be taking medications to stimulate ovulation before the procedure.
  • Assisted reproductive technology (ART) refers to fertility treatments in which eggs and embryos are handled outside of the body. This excludes procedures in which only sperm are handled (e.g., IUI). The most common and effective ART procedure is in vitro fertilization (IVF).

Undergoing IVF treatment requires a strong physical, emotional and financial commitment. Generally, medications are prescribed to stimulate egg production and may include a series of self-administered injections. Eggs are removed from the ovary using a hollow needle, and the male partner is asked to produce a sperm sample (or a sperm donor may be used). The eggs and sperm are combined in a laboratory, and once fertilization has been confirmed, the fertilized eggs are considered embryos. About three to five days after fertilization, the embryos are placed into the woman’s uterus via a catheter in hopes of implantation. The CDC reports that women under the age of 35 have a 31% chance of conceiving and birthing a child with the use of ART; the chances are closer to 3% for women ages 43 and over.

The IVF process can be a highly emotional time for the woman and the couple, marked by moments of excitement, hope, disappointment or uncertainty. The IVF cycle may be canceled if certain problems develop along the way, such as having too few or no eggs to retrieve, the eggs failing to fertilize, or the embryos not developing normally. Any of these situations may produce a sense of loss for the woman or the couple. After the embryo transfer, it is generally recommended to wait 10-14 days before testing for pregnancy. In some circumstances, a chemical pregnancy takes place. This is when implantation happens that results in an initial positive result, but then the pregnancy does not progress. In other words, a very early miscarriage occurs.

This section on medical interventions is important to include because these interventions are part of the infertility experience and may affect the emotional or mental health of the client. This is true even for women and couples who choose to not pursue treatment; at the end of the day, a decision was made and they must cope with the implications of that choice. Professional clinical counselors who are knowledgeable about the available medical interventions will have better context for recognizing the myriad decisions that these clients face and the potential losses that may occur throughout the process.

The invisibility factor

Take a moment to think about the grief that occurred for you after the death of a loved one. The relationship you had with your loved one was probably clearly defined, and you have memories of that person to look back on. The loss is easily identified and articulated, not only by you but by others who were aware of the death. You most likely had many people express sympathy and give you their condolences, perhaps verbally or by sending flowers. You may have taken time off work for bereavement and attended a ritual such as a visitation ceremony, wake or funeral that helped to facilitate your grief. Your loss was likely recognized, acknowledged, validated and supported in a multitude of ways.

Now think about the losses associated with infertility. One of the major losses is that of the imagined or expected family. Women with primary infertility, who do not have biological children, face the loss of the entire life stage of parenting. This may include pregnancy, passing on family or holiday traditions, and passing on the genetic legacy or surname, plus the eventual loss of other life stages such as grandparenthood. Counselors should recognize that meaning is often attached to these losses which further compounds the pain. For example, not being able to experience pregnancy means that the woman is also excluded from cultural pregnancy milestones such as going to the first ultrasound visit, thinking of fun and exciting ways to announce the news to family and friends, participating in a baby shower, and throwing a gender reveal party. With infertility, the loss comes from an absence of something that has never been rather than the absence of something that used to be.

The stigmatization surrounding infertility contributes to an atmosphere of silence and invisibility. Infertility and its accompanying losses are not as outwardly visible and may not be well known or understood by others unless the woman discloses them herself. Many women who experience infertility feel a sense of failure or self-blame toward their bodies, and some may withdraw socially, isolate, or struggle with their identity and sense of self. The stigma surrounding infertility can make it difficult for women to reach out for support. As a result, they find themselves navigating the experience alone.

When a woman does talk openly about her infertility, other people may not respond in ways that are validating or compassionate, which may make the situation worse than if she hadn’t disclosed at all. For example, comments such as, “Just relax,” and, “Give it time,” minimize the woman’s pain and invalidate her grief. Asking, “Have you tried (fill in the blank)?” or “Have you considered adoption?” implies that the woman is not trying hard enough to find a solution or that what she has tried already is inadequate. Most of the women with infertility I have encountered over the years acknowledge that people generally mean well and offer such comments in an attempt to provide hope or to decrease their own feelings of discomfort when talking about infertility.

Facilitating the grieving process

Professional counselors have a responsibility to provide compassionate and competent mental health treatment. Each infertility journey is unique, and counseling interventions should be tailored to fit the individual needs of every client. Taking clients’ cultural, religious or spiritual backgrounds into consideration, several interventions may be used to effectively assist these clients through their grief.

  • Counselors, first and foremost, can be present and listen. Typically, this is what is missing when family members, friends, co-workers, doctors or strangers offer comments that end up being hurtful or invalidating to the person or couple experiencing infertility. We do not have to have the answers — even as counselors. Just be there.
  • Counselors can assist clients in articulating what they need from others around them. This may also incorporate methods for helping clients increase their assertiveness or self-confidence.
  • Counselors can help clients redefine their life expectations and conceptualizations of womanhood, family and mothering. This may also include processing how clients perceive lost embryos, chemical pregnancies or miscarriages to fit within the family unit.
  • Counselors can help clients manage the roller coaster of emotions and ongoing stress as they are trying to conceive, rather than focusing on finding closure. Closure usually implies resolution, which may not be possible with the prolonged nature of infertility and the treatment process.
  • Counselors can assist clients in developing their own rituals while trying to conceive, undergoing fertility treatment, or after making the decision to stop treatment. For example, a woman once told me that she threw a party after she and her husband decided to stop IVF treatments. The party signified taking control over their decision to remain child-free and served as a celebration of the effort it had taken to come that far. 
  • Counselors can explore appropriate methods of client self-care, including engaging in hobbies, participating in creative or social activities, and even taking breaks (as needed) from trying to conceive or pursuing medical treatment.
  • Counselors can connect clients with appropriate resources. It may be necessary to provide clients referrals to group counseling if they wish to connect with others who have similar stories, or to couples counseling if they are struggling in their relationships. In addition, location or cost can be barriers to clients obtaining the services that would work best for them, so counselors who are knowledgeable about online resources can provide these options. Collaborating with other health care professionals with whom the client is working can also provide more comprehensive treatment.

This is not, of course, an exhaustive list. Grief is a personal experience. Which methods are the best fit for your client should be explored in a therapeutic setting that considers both individual and cultural contexts.

What do counselors need to remember?

Imagine that you are working in a private practice when you meet a new client experiencing infertility. You are a master’s-level clinician and are fully licensed in your state. You have taken one class in your graduate program on grief and loss but have no further specialization or experience with infertility. The client has heard numerous comments, questions and suggestions throughout the years regarding her infertility. She is unsure of how counseling might help, but she feels the need to seek support.

This scenario, while general, is a realistic picture of a possible situation that any clinician could experience. As such, I will provide thoughts on what every counselor should keep in mind when it comes to the areas of infertility grief. I am not attempting to reinvent the wheel when it comes to essential counseling tools; rather, I am striving to provide context for effectively using these tools with clients affected by infertility.

>> Convey empathy and understanding. If I could share only one thing I have learned in my work with women affected by infertility, it would be that so many of them feel and believe that you cannot possibly understand what infertility is truly like unless you have been through it yourself. Many women have asserted to me that they just need someone willing to sit with them through the anguish. Counselors who are attempting to provide encouragement and hope may instead end up inadvertently dismissing their clients’ pain or minimizing their grief. It is also possible that counselors end up avoiding a deeper exploration of the experience completely because they do not know what to say. Do not underestimate your basic counseling skills when working with these clients. Acknowledge, reflect and empathize.

One way that counselors can suggest understanding is through the careful use of language. For instance, matching the client’s chosen language of “baby” or “child” is more appropriate (and accepting) than using the more medically correct terms of “embryo” or “fetus.” Language can also offer a reframe from a label of “an infertile woman” to “a woman affected by infertility.” This choice of words depersonalizes the condition and acknowledges that her identity is separate from the condition.

>> Become familiar with client issues related to infertility. Clients who talk about their infertility journey will use a variety of terms and acronyms. For example, you may have clients talk about the time they were “TTC,” which stands for trying to conceive. They may also mention medications, medical procedures or basic biological functions with the assumption that the counselor is generally informed on these topics. Although asking clarifying questions of clients can help paint a clearer picture of their experience, it is not the client’s job to educate the counselor. Take the initiative early in the working relationship with a new client to learn about infertility in areas in which you are deficient. That way, you will be able to understand the client’s journey and experience in greater context.

>> Validate the loss. The invisibility of infertility may cause some women to wonder whether their losses are real or valid. For example, I met a woman during my research who had elected to try IVF after three years of actively trying to conceive, and she gave birth to a healthy baby after just one round. Still, she felt a sense of loss over the fact that her memories of the conception did not entail a moment of passion and love, but rather recollections of shame and fear. She referred to her husband having to masturbate in isolation to provide the needed sperm sample and her experience of lying on a cold table waiting for the doctor to transfer the embryo. She did not feel that she could verbalize this sense of loss to others, however, because it might make her sound ungrateful. A counselor could validate the loss of the ideal conception story and help her articulate feeling both sad for that loss and grateful for her baby at the same time.

The invisibility of infertility also means that some women may not have the vocabulary to identify and articulate their losses. Women with primary infertility endure the losses of pregnancy, delivery, parenthood and eventual grandparenthood but may not be able to understand for themselves that they are mourning the loss of an anticipated and desired life stage. Counselors can assist clients with developing language for their losses if they are struggling to verbalize their grief.

>> Get comfortable. Discussions about infertility may overlap with other taboo topics such as sex, masturbation, miscarriage and abortion. Many of the women I have met who have been affected by infertility have had miscarriages along the way. This brings about an additional — but connected — situation of grief and loss. Talking about miscarriage can be difficult to do without also bringing up abortion, given overlapping language (e.g., spontaneous abortion) and medical procedures (e.g., dilation and curettage). These topics can be slippery territory for personal bias, but counselors should regulate their own reactions and practice reflection to maintain appropriate neutrality and support. Engaging in self-care can be particularly important when counseling those affected by infertility.

Challenging infertility stigma

More and more, childbearing is being viewed as a choice rather than a societal or marital expectation, yet not having children is still considered to be somewhat taboo. Women are socialized from a young age to prepare for eventual motherhood through childhood play that often fosters a nurturing and caretaking role. Other cultural narratives suggest that women have an ability and responsibility to control their fertility. This contributes to self-blame and shame when they are unable to conceive. Infertility is infrequently discussed publicly and thus carries a sort of social stigmatization. Counselors can contribute to destigmatizing infertility by normalizing conversations about infertility, challenges to conception, fertility treatments, and miscarriage.

Stories related to infertility gained widespread media attention throughout 2018. That March, a fertility clinic in Ohio experienced a technical malfunction that caused the destruction of more than 4,000 eggs and embryos, a loss that most certainly had potentially devastating implications for the affected families. Then, in August, a rare visual of the emotional and physical struggle of trying to conceive was captured in a photograph that went viral of a newborn baby surrounded by the 1,616 IVF needles that it took to conceive her. In the months that followed, actress Gabrielle Union opened up about her emotional fertility journey that included numerous miscarriages and surrogacy, and former first lady Michelle Obama revealed her story that included miscarriage and IVF to conceive her two daughters.

These stories bring visibility to infertility and normalize conversations about the challenges that can come with attempting to get pregnant. Counselors can contribute to destigmatization by engaging in discussions and posing curious but sensitive questions about how resources and support can be bolstered for affected women and couples.

Conclusion

Each infertility story is unique, and no one-size-fits-all solution exists when it comes to helping women and couples work through their infertility grief. Whereas an obvious loss from the death of a loved one usually includes rituals and social support, the invisibility of infertility makes it difficult to identify the losses, often leaving women affected by these losses to deal with them in silence and isolation. Counselors can help clients find the vocabulary to articulate the losses they are grieving, give voice to what they need from the people around them, and create ways to process their grief in a warm, nonjudgmental atmosphere.

 

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Tristan McBain is a licensed professional counselor and licensed marriage and family therapist. She is a recent graduate from the Counselor Education and Counseling Psychology Department at Western Michigan University in Kalamazoo. Contact her at tristanmcbain@gmail.com.

 

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Letters to the editor: ct@counseling.org

 

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Related reading on this topic, from the Counseling Today archives: “Empty crib, broken heart

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The miscommunication model and the WDEP system

By Barbara A. Mahaffey June 4, 2019

Helping clients keep or revitalize loving relationships are long-term goals for those who specialize in couples counseling. Those goals get derailed when one or both clients storm out of the room during the middle of a heated debate during an intake session. Therapeutic ruptures and divorces can happen if counselors fail to quickly mediate couples’ arguments, especially if the counselor has not yet established credibility and an alliance with the clients.

Success in couples counseling sometimes depends upon gaining a therapeutic alliance with both partners while simultaneously preventing or resolving emotional outbursts. However, simply teaching couples polite ways to communicate will not keep them together, according to John Gottman. Another technique or approach is warranted. Couples who come to counseling are seeking relief from anger, tension and communication breakdowns, so it makes sense for us to offer them a new way of relating to each other.

I developed a technique to help couples communicate and self-disclose in a nonthreatening way and used this technique as my intake in private practice starting in 1996. What is different about this creative technique? The secret may be the miscommunication model. I found the missing key to helping couples alter communication patterns was engaging them in creating a drawing that contained the reasons they struggled to keep calm and communicate their needs and wants. While completing this drawing, people gained insight into the ways they had been miscommunicating.

What is lacking for many couples is the ability to debate, relate and communicate without blame, shame and anger. While drawing the miscommunication model, each person recognizes that communication is difficult and that everyone struggles with multiple barriers. For most, the drawing is a cathartic exercise that can shift the common blame-game conflicts to goal setting and nonthreatening communication opportunities.

Most people come to counseling with the expectation of a tell-all session focused on disclosing problem after problem, or they complete a checklist of problems before a session begins. Unfortunately, intervention strategies specific to preventing or defusing negative or emotionally charged situations is a skill gap in counselor education. This raises an important question: How do counselors gain trust simultaneously with two strangers, provide tools to promote their affective connection, and prevent outbursts and ruptures during a volatile first session?

Establishing multiple therapeutic alliances

As is the case with individual counseling, a therapeutic alliance is the most important factor in successful couples counseling. Gaining a therapeutic alliance with two people simultaneously is a multifaceted challenge, however, especially when these individuals are trying to describe relationship concerns and upsets to a stranger.

Conflict resolution for couples begins after a counselor establishes ground rules and structure during the intake session. The first important rule is to establish how clients can have a calm session. If a first session is filled with anger and centered on problems, counselors will find it more difficult to form a bond with these individuals. Establishing a nonthreatening review of couple challenges is one way to provide catharsis, encourage openness and set ground rules. Sessions should also end with goal setting to keep a calm home environment in between sessions.

I developed the miscommunication model during years of intake assessments to deescalate anger and promote a working relationship among all people in the counseling room. As part of the effort to establish an alliance with both people simultaneously, the model provides counselors with a way to demonstrate barriers to a satisfying relationship while establishing nonthreatening goals and tasks. The first tasks are to provide the mechanism through which each client will participate in counseling, learn about barriers to healthy communication, and gain awareness of ways that relationships can be derailed. In demonstrating the miscommunication model, counselors can then help couples learn to express what they want.

Clients may not come to counseling with a set of rules for governing appropriate self-disclosure. Therefore, counselors can introduce the tenets of choice theory’s WDEP (want, do, evaluate, plan) system concurrently with the miscommunication model to add a directive structure to counseling sessions, according to internationally known choice theorist Robert Wubbolding. The purpose of combining the WDEP system and the miscommunication model is to first outline how common traits, past experiences, barriers, learned patterns, language and its meanings, emotional reactions, life interference and family rules contribute to a breakdown in couple communication, and then to introduce a way to build a happier relationship.

The miscommunication model approach to intake interviews

The miscommunication model was developed to help clients understand and conquer the many barriers to an improved relationship. One potential helpful insight is that people can and often do have different “wants” or needs in a relationship. Choice theory’s WDEP system provides structure when integrated in this model.

In some cultures, relationship conflict begins when one of the partners in a couple believes that both partners should share common wants. Counselors can provide conflict-resolution templates to help couples thwart power struggles (for example, by getting the couple to focus on helping each other attain goals rather than focusing on whose wants are more important). Guiding couples to learn aspects of negotiation and acceptance are additional ways that this model promotes a healthy relationship.

What has been missing in previous approaches to couples counseling is engaging couples in a conversation about the ways that anyone can be misunderstood when trying to communicate. One way to engage clients in intake sessions is to draw a diagram denoting two people communicating and then to explain the common barriers to and complexities of relationships. Framing this information in a way that suggests that interpersonal communication can be improved adds hope for couples with relationship ruptures.

Miscommunication barriers vary, and the model illustration on page 39 shows only a small sampling of these barriers. Clients can be encouraged to come up with more examples that fall under headings such as personal characteristics, past experiences, brain lies, family rule books, rate of talking versus rate of thinking, life event disruptions, and words and definitions. Counselors who draw a miscommunication model — with clients’ input — can integrate the goal-setting WDEP system tenets of “what are our wants,” “what will we do,” “evaluate” and “plan for and create a quality world.” This is a refreshing new way to engage clients in a nonthreatening conversation.

People who come for couples counseling typically have not been able to resolve their differences and are seeking assistance to do so. Learning that people miscommunicate many times a day helps to remove some of the blame, shame, guilt and anger that are often present in these relationships. These negative emotions can be the underlying cause of a ruptured relationship. Learning about the many ways that miscommunication has disrupted their relationship also serves to add skills to the couple’s toolbox. It is important for counselors to normalize the frequency of miscommunication by pointing out that everyone differs in some way and that disagreements are commonplace, not the exception.

Personal characteristics

Discussing the barriers that hinder relationships can be tricky business. People depend on counselors to lead conversations about problem-solving though, and the place to begin is by talking about the “elephants in the room.”

The first barrier to communication in the miscommunication model is each person’s differing characteristics. Each person has different traits, cultural influences, coping and defense mechanisms, learned behaviors, circumstances and life predicaments that can hinder relationship harmony. Some clients can easily list other attributes that differ, including age, race, religion, education, interests, abilities, sibling status, and work or military experience. Others may note differences in body language, personalities, parental influences, relationship histories, likes and dislikes, communication habits and health issues. A few clients might disclose traumatic experiences, medical histories and pre-existing thoughts about counselors or the counseling process.

This extensive list can be developed over several sessions if warranted. Counselors can explain that many of the barriers will be unspoken and unconscious. It is sometimes appropriate for counselors to note that barriers can be kept secret to protect the emotional safety of the clients. One example of this is that clients are not pressured to disclose childhood abuse. Significant others or spouses may not realize that certain topics are “off limits” for the other person in the room.

Preventing session blowups and engaging clients in a calm conversation about what has changed in their relationship involves helping couples gain insights into their communication skills. At some point in their couplehood, their ability to discuss what they want/need and how to share problems changed.

Sometimes the differences or discrepancies in how people relate to one another are obvious and sometimes not. When discussing relationship barriers, it is wise to point out how a person’s past or lived experiences can create a block to understanding another person’s actions, decision-making, problem-solving abilities, and likes or dislikes. For example, a couple might argue about going to a certain restaurant without being able to talk about a past negative experience that is influencing the thinking, emotions or actions of one of the partners. The miscommunication model would focus attention on this important discussion topic by adding it as a conversation bubble for one of the communicators in the drawing.

Talk about family rules

One way to introduce the “family rules” miscommunication barrier is to discuss the family-learned communication styles that Virginia Satir wrote about in Peoplemaking. Her communication styles and “family rule books” of placater, distractor, computer, blamer and open communicator can be added between the two people in the miscommunication model drawing. This is the counselor’s judgment call and depends on how volatile the couple’s relationship can be.

Another Satir concept, “can of worms,” illustrates the complicated communication patterns in families and can be added in a future session should it become a hot button issue. If a client points out that the other person’s family has a rule book of open warfare and verbal onslaughts, I recommend noting this as a topic for a future session.

Another family rule book example that can be noted for future discussion is the concept of “life expectations.” Many times, derailed personal goals connected to children, work, education or bill paying can be hidden aspects behind relationship dissatisfaction. Although understanding a client’s values, morals and beliefs is an important part of establishing trust and a therapeutic alliance, an intense discussion around these topics can derail the focus on issues during the first session. It may be beneficial for counselors to be directive and to suggest that such topics be developed in future sessions, after the therapeutic alliance has been well-established among everyone involved.

Normalize individual differences

Yet another barrier to communication is our personal brain differences. Part of the benefit of the miscommunication model drawing is the catharsis clients feel when they realize that many other people have struggled to keep a relationship thriving. Counselors might point out the many possible differences between people in learning styles, intelligences, interests, values/morals and perceptual acuities/filters. Also, people “screen” in and retain information differently, yet they may not realize these differences.

In the miscommunication model, these differences can be demonstrated by drawing two brains and pointing out the different ways, speeds and processing pathways for each person. For example, Person A may process and filter by using cognitions or thoughts first. Person B may process by filtering feelings first. Yet another person can believe that they verbalized a thought even when they didn’t because we think faster as humans than we speak. Drawing the two brains can aid in emphasizing that each person in the relationship has unique qualities. Note that people have different processing speeds and rates of speech too. This provides clients with an opportunity to gain awareness and new insights.

Some counselors who draw the miscommunication model use the phrase “our brain lies to us” to describe another barrier: conceptualizations. To help clients grasp the concept that the brain sometimes “lies,” counselors can offer the examples of optical illusions or mistaken perceptions by witnesses. Some clients may resist the notion that their brain isn’t always a dependable source of accurate perceptions. The knowledge that information is not always perceived, interpreted, processed and retained correctly can be unsettling. Counselors may wish to ask permission to point out inconsistent communication to highlight instances when the “brain lies.”

When drawing the miscommunication model, counselors can also add the ways that people differ genetically, developmentally and stage/age wise, and then discuss those aspects.

The miscommunication model next leads to introduction of the Do tenet from the WDEP system. This helps clients shift to a discussion about how to resolve or respect individual differences.

Daily life barriers

Daily life disruptions are constant sources of miscommunication. Any number of new or co-occurring outside events can affect a person’s relationship and communication quality. Family, work, environment, health issues, money issues and other stressors can add to a person’s strife and grief. In the miscommunication model, the importance of these variables could be added or symbolized as a conversation bubble that is drawn or attached to the second person in the couple interaction. The risks involved in second marriages, deaths in the family, and child rearing are common topics within this barrier. During this discussion, counselors may engage clients in ideas about evaluating their situations, establishing their plans and setting goals.   

Words and language as relationship barriers

Words are one of the biggest hindrances to successful couple communication. How a person defines a word or phrase can cause grave misunderstandings, especially when there is a lack of clear definition related to emotions. I would caution counselors not to ask clients, “What is your definition of love?” because that query can result in a storm-filled diatribe in session. Conversely, pointing out that emotion-laden words such as love may be defined in many ways can be a healing approach.

Miscommunication also happens in cultural and historical contexts. Newly created terms used in texting, social media and alternative forms of communication (such as meta communication) only sometimes have shared meanings. For example, one couple split their household over the phrase, “I am done.” One spouse interpreted this as the intent to divorce, whereas the other spouse interpreted it as meaning their conversation had ended.

Another couple’s rupture was healed after talking about how one of them expressed love through behaviors rather than verbally. The husband realized he had learned about love from watching John Wayne movies and had internalized a belief that “I don’t have to say I love you, I just do.” He also learned an important evaluation skill — that challenging a learned reaction and confronting a prior belief could benefit both him and his wife. His wife benefited from learning that he was not intentionally dismissing the words that would typically be used to express an affective connection. She also started observing the favors and actions he did to show his caring for her between counseling sessions. This problem resolution happened because of her request to “receive the gift of a verbal love commitment — the statement of ‘I love you.’”

I have seen couples benefit from discussing throughout the counseling process words that have different meanings or definitions. Some examples of words that often have different contexts or descriptors include committed relationship, separation, affective connection, friendship, change and going steady.

Integrating WDEP’s problem-solving steps

The final aspect of the miscommunication model and the integrated WDEP system is the creation of a plan. (While the evaluation aspect of WDEP is not elaborated on in the model, it is part of the ongoing discussion orchestrated by the counselor in the room.) The plan can have three goal sections — one for each member of the couple and one for the couple as a unit. Each person is given a chance to state one goal that will facilitate the creation of their “quality world.” This is an important aspect to goal attainment and success, according to Wubbolding and his associate, John Brickell.

Typically, the couple goal is a fun and easy task or set of tasks. One of these might be to plan an activity in which both individuals create a new interest together and then report back to the counselor about what was accomplished. The plan should include a timeline and should feature positive, mutually agreed upon and doable activities, according to Mark Young, a counselor educator at the University of Central Florida.

One of the skills that counselors can model during the session termination phase is to frame plan changes in positive ways. For instance, instead of wording a goal with terms such as “unmet expectations,” counselors can help clients set goals that are “gifts for each other” that lead to relationship improvement.

Drawing the miscommunication model and integrating the WDEP system on a piece of paper that the couple can take home is a great way to assist them in recalling homework, goals and barriers to future interpersonal communication. It also is an unexpected presentation method. One benefit to drawing the dynamics of interpersonal communication is that couples can come to future sessions better prepared to diagram their miscommunications. This paves the way to increased insights about their conflicts and arguments.

When counselors try to teach clients different or accepted ways to communicate without first gaining their trust and, more importantly, their insights into barriers to communication, they often fail to help couples improve and stay in committed relationships. Relationships can improve, but it involves a process of learning how communication can go in a wrong direction. People can more easily change their attitudes and opinions about each other if they are given information that empowers positive change. The miscommunication model is a tool that couples can use to discuss their individual wants, intentions, behaviors and plans.

Simultaneously conducting an intake assessment and providing education about how to navigate relationships has been successful in helping me prevent couples counseling ruptures and storm-filled counseling sessions. Counselors can combine the miscommunication model with the WDEP system for a directive approach that leads to problem resolution.

 

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Helpful resources

  • “Applying reality therapy’s WDEP tenets to assist couples in creating new communication strategies,” by Barbara A. Mahaffey and Robert Wubbolding, The Family Journal, 2016
  • “Couples counseling directive technique: A (mis)communication model to promote insight, catharsis, disclosure and problem resolution,” by Barbara A. Mahaffey, The Family Journal, 2010
  • “Therapeutic alliance: A review of sampling strategies reported in marital and family therapy studies,” by Barbara A. Mahaffey and Paul F. Granello, The Family Journal, 2007

 

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Barbara A. Mahaffey is the executive director of the Scioto Paint Valley Mental Health Center, an agency that serves clients in five counties in Ohio with outpatient and residential facilities. Contact her at bmahaffey@spvmhc.org.

 

 

Letters to the editor:  ct@counseling.org

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Stepping up to the challenge

By Lindsey Phillips May 29, 2019

Stepfamilies are complex and feature unique differences, yet on the surface, there may be little to distinguish them from “traditional” families. In fact, as Joshua Gold, a professor in the counseling education program at the University of South Carolina, points out, some counselors don’t necessarily think to ask if they are working with a stepfamily or blended family.

But perhaps they should. According to a 2010 Pew Research Center report, more than 40% of American adults have at least one step relative — a stepparent, a step- or half-sibling or a stepchild — in their family. Gold points out that of the eight most recent U.S. presidents, four (Obama, Clinton, Reagan and Ford) were part of stepfamilies.

“Often for counselors, it gets overwhelming to think about working with stepfamilies because it does look like so many moving parts,” says Jayna Haney, a licensed professional counselor (LPC) in private practice at the Wellness Collective and at Red Dun Ranch in Texas. “But what is also true is that stepfamilies [tend to] have similar problems.”

According to Institute for Stepfamily Education Director Patricia Papernow in her 2017 Family Process article “Clinical Guidelines for Working With Stepfamilies,” stepfamilies face five
major challenges:

1) Insider/outsider positions

2) Children struggling with losses, loyalty binds and change

3) Parenting issues and discipline

4) Building a new family culture while navigating previously established family cultures

5) Dealing with ex-spouses and other parents outside the household

Normalizing stepfamily dynamics

Stepfamilies often assume that something is wrong with them if the family isn’t working well, so counselors should reassure these clients that crisis and change are normal in stepfamily life, says Haney, the founder of the Bridge Across for Single Parents and Stepfamilies. She will often tell clients, “It’s not you. It’s your situation.”

One tool that Haney uses to educate clients about the challenges of stepfamily dynamics is called the stepfamily triangle. She draws a triangle, and at the top she writes in the name of the biological parent. She adds the name of the stepparent in the bottom right corner of the triangle and the name of the biological children in the bottom left corner. Then she explains how the biological parent and biological children have three bonds — emotional, biological and legal — and each bond is as old as the children are. Haney draws three lines to represent these bonds on the side of the triangle that connects the biological parent and biological children. The biological parent and stepparent have an emotional bond and a legal bond (if they are married), so Haney adds the lines connecting them. The stepparent and stepchildren have only an emotional bond (one that is only as old as their relationship) connecting them, which Haney illustrates with one line at the bottom of the triangle.

“So, when stepfamily couples are confused or frustrated because it feels like the family dynamics aren’t squaring up, it’s because they’re not,” says Haney, a member of the American Counseling Association. To illustrate her point, she’ll often put her hands together in the shape of a triangle and tip it over to the left because all of the weight is with the biological parent and child. She has found this visual helps families understand the dynamics and challenges that stepfamilies often face. 

Gold, author of Stepping In, Stepping Out: Creating Stepfamily Rhythm and editor of the newly released book Intervening for Stepfamily Success: One Case, Multiple Perspectives (both published by ACA), also uses education as a means of normalizing stepfamilies’ experiences. Rather than directly asking stepfamilies whether a specific issue affects them, he provides general information about challenges that stepfamilies often face to see if anything resonates with them. He often starts counseling sessions by drawing two large circles — one for the clients’ lived experiences and the other for common stepfamily issues based on his professional knowledge. For example, in his circle, Gold may write that some stepfamilies deal with gendered expectations, such as assuming the stepmother will automatically be nurturing with the children or expecting the stepfather to be the disciplinarian. If the clients say they have experienced that issue, Gold will add it to their circle. 

Both Gold and Pat Skinner, an LPC in private practice in Denver, agree that the schools offer one effective avenue for easily reaching stepfamilies and helping normalize their experiences. Gold recommends that school counselors hold stepfamily groups. These groups can be promoted in the school handbook given to parents at the beginning of the year.

Skinner, an ACA member who specializes in working with stepfamilies, thinks that holding stepfamily groups or classes at schools helps address some of the time and financial obstacles that these families might otherwise face in getting assistance. She also says that groups allow stepfamilies to hear stories similar to their own, helping them realize that they are not alone in their experiences.

Integrating multiple perspectives 

Working with stepfamilies means having multiple voices and perspectives in each counseling session, which can further complicate the process. “The more complex the situation, the more flexible you need to be,” says Gold, a member of ACA and the International Association of Marriage and Family Counselors (IAMFC), a division of ACA. “If I’m dealing with one client, I’m trying to meet one client’s expectations. If I’m dealing with five, I now have five sets of expectations.”

“It takes more skill and more orientation as a clinician to figure out how to integrate all these different voices,” he continues. “Most conflict is founded in the notion that it’s an either/or situation. Either you’re right or I’m right.”

Gold, a contributing editorial board member of IAMFC’s The Family Journal, advises counselors to help stepfamilies switch to a both/and mindset so that situations won’t become win-or-lose propositions. For example, rather than focusing on how the kids from one family ate yogurt and cereal for breakfast and the other family ate eggs, the new stepfamily could include both breakfast options.

Haney, who specializes in high-conflict situations, parental alienation and stepfamilies, has developed an integrated family protocol in which she spends three to four family sessions discussing how to convert high-conflict tendencies into something productive. High conflict involves rigid thinking, unmanaged emotions, extreme behaviors and blaming others. She advises stepfamilies to do the opposite: engage in flexible thinking, manage their emotions, moderate their behaviors and own their actions.

In the first session, Haney always discusses flexible thinking. She puts eight or nine items with various textures (such as slime, play dough, Kinetic Sand, putty and therapy dough) on trays and passes them around. Each family member plays with the items and discusses how the items feel. Haney then asks what all the materials have in common. Someone typically responds that all the items can be mushed or smashed. Haney points out that no matter what the family members do to the items, the materials remain flexible. To emphasize this point, she asks the stepfamily to consider what would happen if they punched slime versus punching a wooden box. The answer: Only the wooden box would break.

Haney connects this exercise to the importance of being flexible in one’s thinking and explains that all people and situations have some good and some not so good features. With this new perspective, she asks each family member to tell her one thing that they like about their other family members.

Next, they take turns telling Haney one thing that drives them a little crazy about their family. For example, a family member may say that they don’t like it when everyone is yelling or how one of the parents is constantly asking the children how they are doing. Haney purposely uses the phrase “drives you a little crazy” because she finds it helps clients think of small problems, not big ones. She also advises counselors against asking clients what they wish were different because that is often counterproductive, she says.

When a stepfamily walks into Darrick Tovar-Murray’s office, he observes where each family member sits and how they communicate with each other. Take for example a session with Jim (the custodial parent), Jeff (the stepparent) and James (the child). Tovar-Murray will call attention to the way the family is arranged in the room: “James, why did you sit closer to Jim than to Jeff? Help me to understand what you make of the way … the family is sitting in the room right now.”

Tovar-Murray, an associate professor of counseling at DePaul University, also points out subtle verbal and nonverbal communication: “Jim, when you said James is not doing well in school, your voice went up, and at that moment, James turned his back to you. Can you tell me what James may be feeling right now?” Teaching stepfamilies effective communication skills helps them to understand one another’s experiences and emotions, says Tovar-Murray, a member of ACA.

Haney encourages clients to explore the narratives they are telling themselves about certain situations while simultaneously accepting that everyone has their own perspective on those situations. For example, if a stepmother says that her husband is always looking at his phone and waiting for his ex-wife to call, the counselor can say, “I understand that bothers you. What’s the story you are telling yourself?”

The stepmother might say she feels like the ex-wife is still more important to her husband than she is. The husband says he’s simply concerned that he’ll miss a phone call from his children. To which the stepmother responds, “I don’t want you to miss a phone call from your children. I just feel like you’re always looking at your phone when we’re out at dinner.” The couple can then make an agreement for the husband to either put his phone away for an hour or call his children before going out to dinner.

Recently, Haney had a stepmother come in by herself because her 25-year-old stepdaughter was constantly fighting with or upset with her and her husband. Haney worked with the stepmother to help her understand that she could not control the adult child’s behavior — but she could control how she reframed the situation and responded to the stepdaughter. With Haney’s guidance, the stepmother changed her perspective and learned new skills so she would no longer get surprised, upset or disappointed when the stepdaughter turned argumentative.

“The hardest part in relationships is to realize the amount of power you have or don’t have to make change,” Gold says. “You have endless power to make change in self. You have less power to make change in others. And, sometimes, part of being in a relationship means you accept things you don’t really like.”

Establishing stepfamily structure

Haney often begins counseling with the stepcouple first because she believes the partnering piece needs to be in place before other issues can be addressed effectively. “If the stepfamily couple can create the structure within their relationship and they can get on the same page with some of these issues, the kids fall into line,” she says.

Stepcouples often face challenges with establishing and maintaining clear parenting roles. In fact, a primary area of conflict for stepfamilies is the parent–child relationship, Haney notes.

The stepcouple need to agree on what they want to teach their children and what the family rules are in the home, she continues. For instance, if the stepmother thinks the children should stop using their smartphones at night and tries to enforce the rule without the biological father’s support, it will cause problems. In such situations, Haney often finds that the biological parent agrees with the overarching rule; the disagreement is in the details. Perhaps the father thinks that 8 is too early to restrict phone use and that 10 would be a better time.

“The moment that you allow the biology to divide, then the house is really two different houses,” Gold says. “So, there’s got to be a set of rules for the house.”

Haney suggests that stepfamilies establish basic rules about bedtime, homework and family dinners. Every family member should also have his or her own space in the house, she says. For example, one person shouldn’t sleep on the couch while the others have their own bed.

Haney believes that the biological parent needs to parent, and the stepparent needs to let that happen. Gold agrees. The stepcouple should figure out the household rules, and then the biological parent should present those rules to the family, he says. Then, both parents can enforce those rules.

If a couple disagree on this point, Haney draws the stepfamily triangle so they can visualize the dynamics. This can help the stepparent realize that he or she may have been overstepping. Haney then asks, “What does the family need to do to make the triangle stay upright?”

First, the partners must be on the same page and create a supportive relationship in which they respect each other’s experiences and perspectives, Haney says. Sometimes, stepparents will need to take a step back, she adds. Haney tells stepparents, “When you assert yourself as a biological parent when you are not … you’re putting a target on your chest because you will always be the bad guy. You will never win.” The biological parent’s job is to protect the stepparent by doing the parenting, she stresses.

Second, Haney says, stepparents have to strengthen their relationship with the stepchildren, but they must also accept that it will take time. One activity she uses to help with this is the emotional bank account. When stepparents marry or move in with the biological parent, they assume a parenting role, she explains. Because biological parents already have a strong emotional, legal and biological bond with their children, they can discipline, set boundaries for, and offer advice and make comments to their children, Haney says. However, stepparents don’t have this emotional connection yet, so with every negative action (e.g., punishing, yelling, making comments, rolling eyes), they make a withdrawal from the emotional bank account with the child, she continues. “It’s not one deposit and one withdrawal,” she points out. “It’s one deposit, but for every negative nonverbal or negative interaction, it’s five withdrawals.”

Haney often helps stepparents realize that they are depleting this emotional bank account faster than they recognize. In such cases, they need to stop making withdrawals and start making deposits. Recently, one of Haney’s clients, a stepfather, was having a difficult time with his 14-year-old stepdaughter. He expected a lot of her and often critiqued what she did. For example, he would point out that he often needed to remind her to take out the trash and even made comments about the way she tied the garbage bag rather than thanking her for her efforts. Haney encouraged him to start making deposits in his stepdaughter’s emotional bank account by giving her compliments, texting that he was proud of her, or saying that he noticed how hard she had been working. When he followed through, their relationship took a 180-degree turn within a week’s time, Haney says.   

When a biological parent finds a new partner, the children are often expected to show love and respect for that new partner right away, Skinner says. However, it’s important to remind stepfamilies that neither children nor adults love immediately. It takes time.

In addition, the child’s developmental stage can affect the degree to which the stepfamily bonds. If children are approaching or into adolescence when the stepfamily forms, they may never feel connected to the stepfamily unit because they are focused on forming their
own separate identities at that point, Gold notes.

In her stepfamily, Haney and her husband developed a plan to handle the stresses and problems they faced. She encourages couples to follow a similar plan, which includes:

  • Talking to and reassuring each other that things will be OK
  • Creating daily habits that provide a sense of connection and support
  • Going out on dates
  • Limiting how much time they discuss children, stepchildren and exes

Haney also reminds clients to laugh. She and her husband found watching a daily episode of Seinfeld helpful during the difficult early part of their stepfamily’s life.

“A lot of times with stepfamilies, you’re sacrificing the me for the we,” Haney says. “If the couple … is willing to make these changes for each other, then it can be a really powerful experience.” In addition, the behavior of asking for help, finding solutions and making changes serves as a powerful model for the children, she says.

Focus on the solution, not the problem

“I think the big mistake that counselors make is they try to start with the problem,” Haney says about counseling stepfamilies. Often, stepfamily couples come in experiencing so much angst, frustration and confusion, they don’t know where to begin. If the counselor asks the couple to talk about their problems and feelings, the couple and the counselor all become problem saturated and risk becoming overwhelmed, she says. 

To avoid this, Haney starts sessions with a basic genogram, which provides her with all the names and connections between the family members. She uses colored markers and construction paper, drawing a circle for each woman and a square for each man in the family, including the stepfamily couple, the ex-partners and the children. Haney then asks the stepcouple’s ages and living arrangements, when the couple first met and when they started dating, and she adds that information to the genogram. For those who are married, she will also ask if they lived together before they got married, when they got married and how long they have been married. Finally, she asks about the most serious relationship that each of the partners had before they got involved with each other.

Next, she draws smaller circles and squares for the ex-spouses or ex-partners and asks similar questions such as age, length of time together, when they separated and if they have children together. If they do have children together, Haney connects the ex and adds in the children’s names and ages, as well as how the parents split their time with the children and how involved each one is with the children.

Haney always ends this exercise by asking, “Is there anybody else that we’re going to be talking about today or who is creating challenges in your stepfamily life?” By asking this question, she often discovers other people, such as one of the partner’s siblings, a grandparent or even the ex-spouse’s new partner, who are adding to the stepfamily’s problems.

In addition to serving as a reference tool that counselors can use throughout their work with the stepfamily, the genogram provides structure to the session. “Structure is a big part of doing a successful stepfamily session,” Haney says. “[It’s] knowing what you’re going to do and how you’re going to do it so that you don’t allow [the session] to become problem saturated.”

Tovar-Murray uses a narrative approach to separate the family from the problem. For example, if a child feels divided between family members, he would have the family name the problem and then ask, “When did the sense of divided loyalty enter your family system? How has it caused you to think you are not a family who can be a cohesive unit? What would your future look like if divided loyalty were no longer present and you were operating as a family unit?” This approach encourages the family to fight together against the problem rather than letting it divide them, he explains.

To strengthen stepfamily cohesion, counselors can also ask family members to describe activities that might make them feel more connected and then encourage them to carve out time over the next week to engage in those activities, Tovar-Murray suggests. “We’re always looking for those unique outcomes, and those are the times in which the stepfamilies are not being saturated and influenced by whatever the problem is,” he says.

Separating the family from the problem is also helpful when there is resistance to the new family structure, such as when one of the partners resists embracing or blending two racial or ethnic identities. For example, in a household with a Latinx stepfather and an African American biological father, the biological father might say, “Maintaining my African American identity is extremely important, and I’m not giving that up. I’m going to see this as an African American family.”

“That resistance piece is just showing [the counselor] how important that identity is,” Tovar-Murray says. With this situation, the counselor could attempt to separate the family system from the resistance piece and reframe it. For example, the counselor could respond, “I can see that you have a strong sense of pride in being African American. Now, I also wonder how you can have that same sense of pride in the relationship that you just formed.”

The counselor can help the family reframe this racial pride and create pride in the new structure the family is developing. Otherwise, the stepfather may feel isolated, which makes cohesion and integration almost impossible, Tovar-Murray says.

Take a step forward

Both Gold and Skinner acknowledge that busy schedules and finances can be big issues for many stepfamilies. As a result, these families often are not looking to engage in long-term counseling.

Gold says that any counseling approach that is more “present-focused” works well with stepfamilies. He often relies on a brief therapy model — six to eight sessions — and finds that most clients will make a commitment to therapy if they know how long it will take. This model also works well with family schedules, he adds.

Counselors “need to remember that a stepfamily couple is going to be less likely to come once a week, every week, for six months,” Haney points out. “So, when [counselors] work with stepfamily couples, [they’re] really doing that solution-focused piece.”

In fact, Haney finds that when stepfamilies come to see her, they have already thought and talked a lot among themselves about the issues they are struggling with, so they want to know what to do. “They know where they are and they know where they want to be, but they do not know how to get there,” she says. Haney doesn’t direct stepfamilies on what to do, but she does help them figure out different paths for getting where they want to be.

After Haney finishes the genogram, she asks the stepcouple directly, “How can I help you today?” Some couples may get to the heart of the matter, whereas others may not have an answer. In those cases, Haney provides the stepfamily with information on the importance of partnering together, the stepfamily triangle and the emotional bank account.

Haney also asks the stepfamily, “What are the two or three things you want to accomplish or work on while you are in counseling?” The family’s answers must be something they have control over, she says. “You don’t have any control over the ex or the stepchild,” she explains. “You do have control over how you respond to the ex. … You do have control over how you respond to the stepchild, how you talk to your partner about the child, and what kind of stepparent or parent you want to be.”

In part because stepfamilies may attend only a few counseling sessions, Haney often spends a longer amount of time in the initial session getting to know the family members, figuring out why they came to counseling and making sure they leave with an action plan. In the initial session, which often lasts up to two hours, she spends approximately 15 minutes on the genogram and 15 minutes educating clients about common stepfamily issues. For the remaining time, she helps families determine two or three things that they want to accomplish.

By the time the family leaves, each family member “need[s] to have something that they’re going to do that’s doable and that they can work on,” Haney says. “Then they leave empowered because they know what to do. [They] leave … educated because you’ve shared with them some insights that help them change their perspective and reframe how it’s working. And … it helps them see their story and their family differently.”

 

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Invisible stepfamilies

The concept of stepfamilies can challenge traditional assumptions of the word family, which often evokes an image of a married father and mother with their biological children. But as Darrick Tovar-Murray, an associate professor of counseling at DePaul University, points out, this image doesn’t account for the diversity found within stepfamilies. In fact, because this assumption doesn’t recognize other types of partnerships or unions, it renders them “invisible,” he says. That’s particularly the case when these families include a noncustodial and custodial parent with at least one child from a previous relationship and encompass multiple racial, ethnic and sexual orientation identities — which he refers to as invisible stepfamilies of color.

“When you look at invisible stepfamilies of color, they tend to come from cohabitating relationships where there isn’t a marriage or legal contract,” Tovar-Murray says. “That legal contract should not be what defines a family.”

As society continues to grow more diverse, counselors will encounter more invisible stepfamilies of color and thus may need to challenge their own views of what family means, Tovar-Murray argues. Counselors also shouldn’t assume that a couple is married, he continues. In addition, asking “How long have you been dating?” implies that the couple’s relationship may not be as close or as integrated as a couple who is married, and that may not match the perspective the clients have of their relationship.

Tovar-Murray also advises counselors not to make assumptions such as thinking that a stepcouple’s decision not to hold hands is related to their lack of affection for each other. Based on their experience of racial/ethnic or sexual orientation microaggressions, many of these couples may engage in this or similar displays of affection only in spaces they consider to be safe. “As counselors, we cannot assume that invisible stepfamilies of color are going to be out in all spaces that they walk in,” he says.

For this reason, Tovar-Murray, an ACA member and co-author of a chapter on blended families of color in the book Intervening for Stepfamily Success, advises counselors to be open and direct about microaggressions. He will often tell clients, “I want to talk about something I think is important. We know that racism exists and sexual orientation microaggressions exists, and I’m wondering if you as a couple or if this family has ever experienced those things.” He also suggests saying, “I know biases exist, and some of the things that may affect a family system like this may even be biases within your own cultural groups. Have you experienced any of those? How have you successfully dealt with those things?”

“The assumption that [counselors] make sometimes is that [they’re] not going to bring [these issues] up because the client didn’t bring it up,” Tovar-Murray says. “But sometimes clients, couples and families may not know that [counseling is] the space [where they] can talk about those things.”

— Lindsey Phillips

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

How can we truly help clients in a relationship?

By Chris Warren-Dickins April 4, 2019

Couples therapy has been around for years, so it is easy to believe that we know everything we need to know about its underlying principles. Assumptions can lead to an overly narrow perspective, however, so I’d like to offer 10 ideas on which to reflect when it comes to couples therapy.

 

1) “Couples” are actually “relationships”: Perhaps the first way to truly help couples is to stop using that very term — couples. That’s because the term assumes a monogamous relationship between only two people and therefore excludes polyamorous relationships and any other type of romantic relationship. It might be argued that the term leaks something about our personal values, much like an assumption that a “marriage” can be between only a man and a woman. For that reason, I prefer to use “relationships” instead of “couples work,” and I refer to “clients in the relationship” rather than the “couple.”

2) Leakages of personal values: Of course, there is a risk that as counselors, we also leak our personal values in individual work. But it seems to me that the greater the number of clients sitting in the room with us, the greater the chance for this leaking to occur. When we work with relationships, we often see the interaction between the different members of that relationship. In real time, we bear witness to the dynamics of that relationship, and it can be challenging to have that played out before our very eyes. 

In our training, we are encouraged to intervene a great deal more in our work with relationships than we might if we were working with an individual client. We are told that there are more opportunities to offer alternative ways of relating to each other, and if we do not seize these opportunities, then the relationship may end up following the same patterns and learning nothing from therapy.

The question is, what is informing our intervention? Is it what we are actually witnessing in the relationship, or is it our own personal values and assumptions? For example, if we are witnessing a male and female client in a relationship, are we inclined to assume that the male client will be more domineering than the female client? I have worked with a number of professionals who made assumptions about domestic abuse, sexual violence and domineering behavior in general. They often leaked their assumptions that the only possible victims in these scenarios were female and that the only possible perpetrators were male.

The ACA Code of Ethics is clear. Standard A.11.b. says that a counselor should not refer a client to another counselor simply because there is a conflict in “personally held values” between the counselor and the client. Instead, counselors should “respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.” I would imagine that this can prove extremely difficult for some counselors, particularly if their personal (for example, religious) values conflict with the client’s goals. However, as we have seen from cases such as Ward v. Wilbanks and Keeton v. Anderson-Wiley, this does not give a counselor the right to refuse to work with that client. 

3) Formed alliances: If our own personal values are more in line with one of the clients than the other member(s) of the relationship, we could easily get dragged into an alliance with that client. For example, the counselor might share with one of the members of the relationship the personal value that a relationship must be preserved at great cost when there are children involved. But if this does not reflect the personal values of all members of the relationship, the counselor’s role is to remain focused on the goals agreed to by all the members of the relationship. To help with this, we can remind ourselves that the dilemma is not ours to resolve. We can work hard to help the members of the relationship resolve the dilemma, but we do not have to resolve it for ourselves.

Individual client work requires us to monitor the boundary between us and the client. But when we work with a relationship, the boundaries are multiplied. Yes, we monitor the boundary between ourselves and each client who forms that relationship, but we also monitor the boundary between each member of the relationship. Stephen Karpman’s drama triangle can take on an interestingly multidimensional feel to it because we can be one client’s Rescuer while simultaneously being another client’s Persecutor.

4) The blame game: Linked to the drama triangle, we also need to tread carefully as counselors so that we avoid the blame game. All relationships engage in the blame game to some degree, no matter how hard its members try to avoid it. To reduce the frequency, however, we should keep returning the relationship’s focus back to the present moment. The focus should be more on what is happening rather than on why — and who may or may not have caused it. Frequently, an opportunity exists to work together to resolve things, and the collaborative nature often can form a new bond.

One big step toward this is to adopt a relative perspective: There are no absolute rights and wrongs, there is only perspective. If each member of the relationship can show the other member(s) that they are willing to adopt this approach, it can allow for disagreement.

5) Commitment issues: I have often worked with relationships in which one individual was more committed to therapy than was the other(s). The shadow side of this is that sometimes the committed member of the relationship really wanted proscribed therapy for their “problematic” partner(s). They were not interested in looking at how each member of the relationship might have caused problems for the relationship and how that all interacted. This needs to be tackled early on if the work is going to continue. The party who appears “committed” to therapy needs to understand that all members of the relationship are clients, and all members need to examine how their processes may impact on the relationship.

6) Fine-tuning rather than replacing: Our job as counselors is to observe the relationship, witness reports by the clients in the relationship about interactions, create hypotheses about where things might be going wrong, and then help the relationship to establish a revised approach to these issues.

Often, members of a relationship will assume that the relationship is fundamentally flawed. After all, clients rarely seek help unless things have started to go seriously wrong. At this point of crisis, it is hard for them to see how different things could be with a simple fine-tuning instead of a complete replacement. Our job is to support them as they try this fine-tuning. We need to emphasize the strengths and resources that exist in the relationship.

7) Building foundations, not fighting fires: As we emphasize their strengths, we will help the members of the relationship look to the future by developing strategies to resolve their issues. To do this, to really build the foundations of a sustainable relationship, we need to avoid the temptation of looking to the present or the past and trying to fight every issue that erupts.

Instead, we can teach members of the relationship about assertive communication. Often, people don’t really understand the difference between assertive, aggressive and passive (or manipulative) behavior. Counselors should monitor their work for assumptions made about assertiveness, including gender assumptions. For example, I have worked with male clients who have reported quite damaging experiences with therapists who jumped to conclusions about the male member of the relationship, forming an alliance with the female member of the relationship and overlooking (or remaining unaware of) her bullying behavior.

Empathic listening is another key skill to teach the members of the relationship. When I focus on this, I really stress the words “understanding” and “support.” It can be transformative for members of a relationship to see that their partners are willing to try and see the other person’s perspective. It can also help because they are showing their partners that they are willing to support them and help them work it out as a union. The worst feeling is when someone is struggling and they feel they are struggling alone because no one is willing to try to understand and support them.

8) The whole is greater than the sum of its parts: Our clients bring their histories into the relationships they form, no matter how much they try to avoid this. There are parts of them that are made fragile — broken even — because of people from their past. The other members of the relationship might not even know this until they come across that part of their loved one and there is a subsequent explosion, withdrawal or threat of an end to the relationship. Our job as counselors is to help each member of the relationship gain perspective on this. Each member needs help in seeing that this wound is from the past and that agreement may need to be formed about how members of the relationship will approach this in the future.

One example is the wound of discrimination. Counselors should not underestimate the impact that the experience of discrimination has on a person’s ability to trust and form relationships. With members of the relationship who are ethnic or religious minorities or part of the LGBTQ+ community, counselors need to assess not only how much this discrimination affects their relationship now but also what experiences of discrimination each member of the relationship has endured in the past. For example, if one of the members of the relationship grew up as gay in the 1970s, they would have a vastly different outlook on their sexual identity and their relationship than would someone who grew up as gay in the ’90s.

When I worked at an LGBTQ+ organization in London, we encountered a number of Muslim asylum seekers who were fleeing homophobia in countries such as Uganda, Pakistan and Bangladesh. The wounds they brought to a relationship were vastly different from those experienced by their partners who had grown up as Christian gay men, or even Muslims, in London. 

9) Basic structuring: As I have outlined, there are additional complexities to working with relationships. There are multiple layers of boundaries to manage; there are in-person, live playouts of the dynamics within the relationship; there are greater opportunities for our personal values to be leaked; and there are greater opportunities to unintentionally form an alliance with one member of the relationship over the other(s). As a result, the basic structure of a therapy session with a relationship should be different. Sessions will tend to be longer than the typical “therapeutic hour,” and counselors should offer to see each member of the relationship separately as part of the assessment process. 

10) The healing power of play: To help the relationship develop open channels of communication, counselors might consider offering clients an exercise or two to try outside of session. There are a wide range of exercises available, including the Johari window (developed by Joseph Luft and Harry Ingham) and the various exercises (even card games) available via the Gottman Institute. Games and exercises can loosen things up a bit, opening the possibility for people to release the roles they may have been adopting in the relationship. The Johari window helps people discover their own, and other people’s, blind spots. With greater self-awareness, and greater awareness of the other people in the relationship, it is easier to communicate feelings and needs. Without open communication, mistrust is inevitable, and a relationship without trust is like trying to grow a flower without light.

 

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Chris Warren-Dickins is a licensed professional counselor in Ridgewood, New Jersey. Before becoming a counselor, he practiced as a lawyer and taught law at the postgraduate level in the United Kingdom. Contact him at chris@exploretransform.com or through his website at exploretransform.com.

 

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Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The dismissal of divorce advice

By David L. Prucha August 2, 2018

It’s a distressing reality, but advice for the newly divorced might be as common as advice for the newly married. Advice for the newly divorced often centers around protecting any children who might be involved because although parents get divorced from each other, children become divorced from the only life they have ever known.

Parents are advised to keep the child-parent relationship as normal as possible:

  • “Don’t put your child in the middle.”
  • “Encourage your child to have a relationship with their second parent.”
  • “Don’t speak poorly of your former spouse in front of your child.”

Although this guidance seems relatively straightforward, it is difficult for many parents to follow. Why is this? Is it simply unreasonable to hope for wise parenting when anger is running high and hurt is running deep?

To understand how a counselor might help a parent follow divorce advice, let’s first explore the context in which many parents speak poorly about their former spouse with their child.

 

The background for badmouth

One common scenario that leads parents to dismiss divorce advice is when one parent becomes convinced that he or she is on the losing end of the divorce. They have lost friendships and are spending more time alone. The house feels empty.

With this loneliness settling in, eventually the parent is faced with a tempting situation when the child shares feelings of frustration or sadness about the other parent. In many cases, the parent mistakes the child’s complaint as validation for his or her own grievances. In the marriage, they have been on the receiving end of their former spouse’s dysfunctional behavior, and now the parent suspects those same dysfunctional behavior patterns are harming their child. The parent seizes the opportunity to teach the child about how the second parent operates. They convince themselves that they have to share their own experiences to support the child, but in reality, it has become an opening to express their own feelings of hurt. It is catharsis, but camouflaged as compassion for the child.

A second scenario that leads to dismissing divorce advice occurs when a parent suspects that his or her child is aligning against them with the second parent. They start to hear the words of their former spouse spoken through the mouth of the child. The parent believes they are being disparaged and that this is shaping the child’s view regarding who is at fault for the divorce. The parent has tried to take the high road, but the former spouse has taken the low road, and now their relationship with their child is suffering as a result.

This can lead the parent to feeling wronged again by their former partner, and they decide that they need to clear their name in the eyes of their child. They proceed to share their version of the divorce because they think they need to provide a balanced perspective. Unfortunately, this often sets off an escalating arms race between the two parents to compete for the heart and mind of their child.

With these scenarios in mind, how can a counselor help hurting parents to help their hurting child? What new understanding can parents gain that might reduce the likelihood of them oversharing with the child?

 

The child healer

In the first scenario, the parent speaks poorly about their former spouse because they mistake their child’s grievances for their own. In this case, it can be helpful for parents to learn that sometimes children overstate their concern about their second parent in an attempt to help the grieving parent.

In the child healer dynamic, the child notices that his or her parent is in pain. By exaggerating their complaints about the second parent, the child opens the door to allow the grieving parent to emote. The child creates a conversation to say to the isolated parent, “You’re not alone.” The hurting parent thinks that he or she is healing the wounds of the child by sharing their own experiences about the former spouse, but they have it backward; instead, it is the child who is attempting to heal the wounds of the hurting parent.

By inflating their concerns about their second parent, the child reassures the isolated parent that their bond is special, and this reduces the parent’s fear of losing the child to their former spouse. For the child, this has simply become a strategy to calm the parent’s anxiety and to create stability in the home.

How can counselors help parents interact with their child in moments when the child healer dynamic might be present? When the child is sharing difficult feelings about the other parent, how can parents be helpful without falling into the child’s attempt to help them?

One way to help parents is to teach them how to empathize with the emotions of their child without validating the child’s interpretation of the second parent’s motivations. Although it can be helpful for the parent to tend to the child’s emotional experience, this doesn’t require the parent to explain their own experiences with the former spouse. The parent can learn to validate the difficulty of the child’s feelings without speculating about the intentions of the former spouse. The parent can say, “It’s really hard to feel as angry as you do” without saying, “I experienced that same selfishness, and it made me angry too.”

By attending to the emotions of the child without confirming the child’s interpretation of the second parent’s motivations, the first parent avoids falling into the child healer dynamic. By refraining from sharing his or her own experiences about the former spouse, the parent keeps the focus on the emotions of the child. And in cases in which the child is expressing sincere concerns about the second parent, the first parent is still able to effectively empathize with the child’s feelings.

 

Swinging pendulums

In the second scenario, the parent doesn’t bite their tongue because they think they need to set the record straight. The former spouse is speaking poorly about them, and they think the relationship with their child is suffering as a result. The parent overshares because they want to provide a balanced perspective for the child. Essentially, the parent wants to clear his or her name.

In these circumstances, it can be helpful to remind parents that children of divorce commonly bounce from one parent to the other, and at different times, they will feel closer to one parent than the other. Children of divorce are swinging pendulums: Sometimes they swing toward the first parent, and sometimes they swing toward the second parent. The question then becomes how a parent should respond when the child is swinging away from them so that when the child is ready, he or she feels comfortable to swing back.

It is helpful to remind parents who feel distant from their child that trying to clear their name won’t increase the odds of the child swinging back to them. Parents hope that setting the record straight will return their child back into their arms, but this strategy is rarely effective. Instead, it often backfires because the child thinks that in order to swing back, he or she will have to agree with that parent’s version of the divorce. Or at least the child will have to lie and pretend to agree. This makes swinging back more complicated.

It can also be helpful to remind parents that it is better to think of the relationship with their child as a long-term endeavor and to expect changes in the relationship. Indeed, it’s highly unlikely that their future relationship with their child will exactly mimic their current relationship.

When parents don’t feel that the relationship with their child has to be perfect in the present, they realize that nothing needs to be desperately forced. If normal periods of emotional distance are expected and accepted, this can remove pressure from the interactions that parents have with the child, and this mindset can create more room for calm parenting. As a result, a less complicated relationship with the child can emerge, increasing the child’s comfort in swinging back into the relationship.

Going through a divorce can be one of the greatest challenges of a lifetime, and it’s made even harder when a child is involved. It is not realistic to expect that parents will hold their tongue every time they should, but perhaps teaching parents about the dynamics of divorce will create a moment of hesitation where once there was only the urge to overshare. In this window of hesitation, there might be enough room for parental wisdom to grow. Hopefully this new wisdom will contribute to the healing of divorced parents and the healing of their children.

 

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David L. Prucha is an adjunct professor of counseling psychology at Johnson and Wales University in Denver. He is also a licensed professional counselor who maintains an independent practice that specializes in depressive disorders, anxiety disorders, and trauma and stressor-related disorders. Contact him at contact@pruchacounseling.com.

 

More from this author, from the Counseling Today archives: The wise support system in domestic violence rescue efforts

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.