Tag Archives: Marriage

Identifying and addressing competing attachments with couples

By Anabelle Bugatti August 6, 2020

Couples come to counseling for a variety of reasons, and therapists are tasked with understanding the nature of couples’ concerns and offering helpful tools. Sometimes, as therapists, we might hear one partner complain about the things the other partner is doing and, often, these things may seem very trivial. We might also hear clients complain of conflict that centers on a lack of emotional availability on the part of their partner, coupled with their partner escaping or turning elsewhere to de-stress, to get needs met or for emotional sharing.

For example, one person might say, “My partner is always on their phone” or “My husband always takes work calls even during family time” or “My wife shares our fights with her friends” or “My partner would rather play video games than be with me.” Then there are statements that are less trivial, such as, “I think my spouse is having an affair.”

Anything that erodes the security of the bond between partners and creates distress can be seen as a threat to the relationship. The resulting distress must not be viewed as trivial, regardless of how small and harmless the situation may appear on the surface.

A rival to the relationship

A competing attachment is a threat to secure bonding in which one person in a relationship turns away from the relationship and toward someone or something else to get their emotional or attachment needs met. This is often experienced by their partner as a rival to their relationship — someone or something with which they have to compete for their sweetheart’s time
and attention.

Some of these emotional investments or activities on the part of one of the partners may actually be counterfeit attachments. These attachments are an attempt to mimic the fulfillment of comfort, soothing and belonging needs that a secure relationship would typically provide. It is usually the other partner (not the partner engaging in the competing attachment) who initially complains of distress.

The person participating in the competing attachment may or may not be aware that they are turning elsewhere to get their emotional and attachment needs met. This may largely depend on their own attachment style and level of emotional intelligence. Those engaging in the competing attachment are sometimes aware of what they are doing but may try to deny the impact this has on their partner or relationship. 

Depending on the type of competing attachment (what or whom a person turns out to) and the frequency (how often they’re turning out), their partner can be left feeling frustrated, jealous, hurt and disconnected. The more often this occurs, the more distressed the relationship may become. The attachment bond may then start to shift from secure to insecure, or a romantic attachment bond that was already insecure can have that insecurity amplified. Additionally, relationship satisfaction decreases as a relationship becomes distressed by a competing attachment.

Research currently shows a connection between competing attachments and insecure attachment relationships. However, it is unknown whether one causes the other or if an already insecure bond or insecurely attached person might be more vulnerable to developing or experiencing a competing attachment.

While different types of competing attachments tend to pose different levels of threat to a relationship, there is a clear connection between a partner’s concern of competing attachment and their romantic attachment security and relationship satisfaction. In a study conducted for my dissertation research, it was revealed that the more a competing attachment increases, the more the attachment security within the relationship decreases. As attachment security decreases, the more relationship satisfaction also decreases.

Competing attachments constitute a counterfeit attachment in which one partner turns outside of the marriage or relationship and toward something or someone else for escape, soothing, comfort or attention as a substitute for unmet attachment needs. Competing attachments can include addictions, affairs, gaming systems, smart phones, family members or anything else that might lead a spouse or partner to feel it necessary to compete with this “other” for the attachment bond with their partner.

Competing attachments vs. hobbies

It is important to distinguish the difference between a competing attachment and a hobby. Obviously, not everything that someone turns to outside of a relationship will constitute a competing attachment. Clients may have healthy attachments with other people or things that do not violate the boundaries of the romantic attachment relationship between two people and that do not create a feeling of competition for emotional time, attention or affection.

In general, hobbies do not threaten relationships because there are some emotional boundaries involved. Typically, hobbies are engaged in for general enjoyment rather than as an escape or as an alternative to the benefits of their romantic partner. Hobbies do hold the potential of turning into a competing attachment, although this doesn’t usually happen in securely attached people or relationships.

In my clinical practice, I have often heard female partners voice feeling the threat of competing attachment because their partners come home from work most nights and neglect to spend even a little bit of quality time connecting. Instead, they go straight to their gaming systems and play for hours until it’s time to put the children to bed or turn in for the night. Part of what contributes to the sense of a competing attachment is if one partner regularly turns to this “other” before they turn to their own partner or more frequently than they turn to their own partner.

Types of competing attachments

Research has yet to explore every type of competing attachment individually or their respective impact on relationship security and satisfaction, in part because new forms of competing attachment pop up and develop over time. In addition, competing attachments and their impacts can vary culturally. However, a few specific types of competing attachment have been linked to decreases in relationship security and satisfaction.

Addiction

Research on addiction and attachment helps explain how disrupted early life attachment bonds and adaptive mechanisms can, if left untreated, become barriers to emotional flexibility and bonding in adult romantic relationships. When emotional regulation and soothing have not been taught in the context of attachment bonds with a loved one, it can leave the individual more vulnerable to turning to a substance as a means of soothing and escape. On a fundamental level, failed attachment to a primary attachment figure creates alternative attachment to survival mechanisms and defenses. This eventually transitions into attachments to substances or other compulsive behaviors in an attempt to find comfort, soothing, safety, protection and security.

Substances are shown to have analgesic (pain blocking) effects that aid in the numbing out of emotionally painful experiences and situations. Individuals with addiction lack the ability to internally self-regulate their emotions. They frequently turn to substances or compulsions to regulate their feelings of pain or distressing emotional experiences. Nonchemical processes such as pornography and gambling are demonstrated to have similar effects to chemical substances on the brain and can be used by a person to achieve the same effect.

The more frequently someone turns to addictive behaviors to meet their attachment needs, the less often they will seek connection with others. The addiction eventually starts to become a substitute for human connection. Over time, this builds into a false sense of connection, or a counterfeit attachment, because a true and secure attachment bond involves a reciprocal relationship.

In romantic relationships, the consequences for the partner who is not addicted is that they are left emotionally (and, often, physically) alone to deal with emotional distress and the stresses of daily living. Additionally, it is hard to build a secure and satisfying connection with a partner who is not emotionally present, engaged or accessible because of their addiction, especially if the addiction negatively alters the person’s mood. The result is a relationship that is higher in conflict, less emotionally engaged, more unstable or insecure, and less satisfying.

Social media, gaming, smart phones

With the advancement and availability of new technology, the types and frequency of competing attachments have also changed. Internet addiction is a general term used to encompass a wide variety of online behaviors that are problematic for individuals and relationships. For example, addiction to Facebook, Twitter or Instagram has been cited as being intrusive in relationships and is associated with relationship dissatisfaction. Technoference is a term applied to the interference of technology in relationships, including romantic relationships. Another trending term is phubbing, or phone snubbing. This describes when a person turns their attention to a smart phone instead of to their romantic partner or others in a social or personal setting.

As cell phones and gaming systems have morphed from simple electronic devices to devices that encourage participation and interaction online, live human interactions have decreased. Online adult gamers have described sacrificing major aspects of their lives to maintain their online gaming status. Romantic partners report that technologies such as gaming and smart phones frequently interrupt quality time and connection, reduce instances of going to bed together at night, and affect the amount of time spent together on leisure activities. In other words, these partners feel that their relationship has taken a back seat to online gaming activity.

Those who have been phubbed report feeling that their romantic partner favors a virtual world over time and connection with them, thus sending an implicit message about what their partner values most. This has become so problematic in romantic relationships that support groups have been created for “gaming widows” suffering from technoference. Additionally, interviews have revealed that technoference lowers relationship satisfaction and increases conflict between romantic partners.

Pornography

Pornography is unique in that it can encompass two different types of competing attachments: addiction and infidelity (since many romantic partners view pornography as a form of infidelity). Often, the partner who is addicted turns to pornography as a source of stress release or to soothe feelings of shame and disconnection in the romantic relationship.

Research into the experiences of those partners who are not addicted to pornography shows that they often feel in competition with the pornography or the actors in the pornographic material. The turning outside of the relationship to an addiction has also been shown to have a negative effect on the security of the relationship bond and the level of relationship satisfaction.

Affairs and infidelity

Being unfaithful in a romantic relationship (infidelity) is considered one of the most potent threats to romantic attachment security and relationship satisfaction. Infidelity is one of the leading causes of divorce and one of the leading threats of competing attachment.

Unlike other forms of competing attachment, this particular form may need to occur only once for the partner to consider it a competing attachment. What constitutes appropriate or inappropriate behavior with someone outside of the relationship can take on different meanings for different people. For some, a one-time nonsexual encounter in which their partner turns to another may be acceptable, whereas others may find small flirtations that do not result in sexual intercourse unacceptable. For others, finding inappropriate, provocative or sexual pictures or messages exchanged between their partner and someone else may constitute infidelity. The definition of infidelity depends on how the couple delineates the boundaries of their relationship and how they define cheating.

Infidelity, even if only perceived, has the power to undermine the trust, security and satisfaction of the love relationship. Behaviors on social media that violate relational boundaries are also associated with relational insecurity and lower levels of relationship satisfaction.

Factors such as attachment security and satisfaction have been demonstrated to be both consequences and causes of infidelity. Those with secure attachment are less likely to engage in infidelity-related behaviors. There is also a link between attachment avoidance and interest in other partners, as well as strong associations between attachment insecurity and infidelity in relationships. Unmet attachment needs and low levels of relationship satisfaction may contribute to people seeking connection and sex outside of their primary love relationship. 

Rival relationships

Outside or “rival” relationships may not constitute or result in infidelity, but they can still be experienced as competing attachments to the romantic bond. A rival relationship may be any nonromantic relationship that a partner has with another person outside of their love relationship, especially if the outside person is perceived as being attractive. This could be a friend of the opposite sex. Even family members can become competing attachments in some relationships.

In rival relationships, one partner may consistently turn out to a friend or family member to discuss private emotional topics, seek comfort or validation, or share friendly connections that are not shared with their partner or spouse within the love relationship. Another example may be a partner who exchanges text messages, emails or phone calls or engages in private get-togethers with another person outside of the love relationship, particularly if their romantic partner is not invited to take part. The romantic partner may feel like they are being left out of or are on the outside of a friendship or relationship that their partner has.

In therapy, clients might complain about their partner’s closest friend of the opposite gender or an intrusive in-law whom their spouse frequently turns to for advice and emotional support. Rival relationships that involve family members, usually described by clients as “intrusive” family members, are associated with a weaker couple identity and are demonstrated to predict the quality of the couple’s bond.

Interestingly, even in cultures in which men are expected to maintain a strong alliance with their mothers after getting married, wives in these marriages often complain about feeling like they are competing with their mothers-in-law for their place in the family unit. An example might be a husband who frequently puts his mother first by meeting her every need, even after he marries. This type of competing attachment often goes unnoticed. Society tends to dismiss enmeshed mother-son relationships as being potentially problematic, despite the consequences to the son’s marriage or romantic relationship. I am not referring here to a healthy attachment bond between a mother and a son but rather to an unhealthy form of attachment (insecure bonding) that results in the failure of either person to securely and appropriately transition parts of their attachment role when necessary.

Importance to clinical practice

In each of these types of competing attachment, there exists a common link with attachment security (or lack thereof) and relationship satisfaction. As professional therapists, we know that science is clear about the importance of human attachment bonds across the life span. Primary attachment figures were initially considered important for infants and children. However, these roles were later recognized as being important for all humans at all stages, including those with whom we formulate strong romantic attachment relationships as adults.

Each person will have a different attachment style that is classified as either secure or insecure. These attachment strategies are typically stable over time. However, attachment relationship bonds can be defined separately from individuals, also as either secure or insecure. Additionally, there is plasticity in adult attachment relationships. They can shift from secure to insecure and vice versa. In romantic relationships, distress can occur when the security of the attachment relationship is threatened. This is important for therapists to understand as they work with their clients to help them shift from insecure to secure bonding and to build safe and satisfying relationships.

Competing attachments threaten the security and satisfaction of romantic attachment relationships and can become pivotal moments that redefine a couple’s relationship as unsafe. This can additionally create an impasse to relational trust and stability, both of which can negatively affect relational satisfaction. Anything that threatens the stability and satisfaction of an attachment bond is important for clinicians to know about so that they can be prepared to intervene.

Not all things that someone turns to outside of the love relationship qualify as competing attachments. To constitute a competing attachment, it must cross certain boundaries or thresholds that result in distress. If a competing attachment does exist in a relationship and is causing distress, then the relationship satisfaction will start to go down. The less secure the bond becomes between the couple and the less satisfying the relationship is, the more risk exists of the relationship becoming broken. Attachment security is strongly associated with relationship satisfaction. Both attachment security and relationship satisfaction are also important factors in relationship longevity and personal health. Relational satisfaction should remain relatively high and stable over time for most couples in securely attached relationships.

Attachment science offers a guidepost for treatment strategies and interventions for couples who come to therapy reporting the presence of competing attachment.

Treatment recommendations

If a couple comes to your practice complaining of a competing attachment or hinting at the possibility of one, consider asking a few assessment questions. These questions are based off of the Competing Attachment Scale that I created with emotionally focused therapy trainer Rebecca Jorgensen and UCLA professor Rory Reid in 2015 for my dissertation study.

1) Have you experienced in the past or do you currently experience a sense of competition with the activities or relationships in which your partner engages?

2) Do you feel like your partner turns elsewhere outside of the relationship to have their needs met rather than turning to you?

3) Do you feel hurt, bothered or upset by this?

4) Do you feel like this has been a problem in your relationship, created a lot of conflict or affected your ability to get close with or have a healthy bond with your partner?

Also consider the following treatment recommendations for couples reporting distress due to a competing attachment:

  • Clearly identify and understand how the competing attachment is part of a couple’s relational system (their negative interaction pattern or cycle).
  • Identify the competing attachment as an alternative (and ineffective) way of coping with/not dealing with emotional distress or not getting needs met (maladaptive behavior).
  • Help couples turn toward each other as secure bases/safe havens to help co-regulate moments of emotional distress.
  • Help couples find alternative ways of coping with emotional dysregulation that don’t create relational distress or violate relationship boundaries.
  • Help couples identify their emotional/attachment needs and be able to ask for these needs to be met in their relationship.

 

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For more information on adult attachment research, or to find clinical training in your area, visit the websites of the International Center for Excellence in Emotionally Focused Therapy and its founder, Sue Johnson.

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Anabelle Bugatti is a licensed marriage and family therapist with a private practice in Las Vegas. She is a certified emotionally focused supervisor and therapist and is the president of the Southern Nevada Community for Emotionally Focused Therapy. She has a doctorate in marriage and family therapy from Northcentral University. Her new book, Using Relentless Empathy in Therapeutic Relationships: Connecting With Challenging and Resistant Clients, is slated for release at the end of the year. Contact her at anabellebugattimft@gmail.com.

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.

The marital paradox

By Guillermo Cancio-Bello and Jim Rudes July 14, 2020

“In relationship with others, people are free to engage in goal-directed activity, or to lose ‘self’ in the intimacy of a close relationship.” — Murray Bowen

There is no shortage of strained marriages. Two people who were once close can grow distant over time and become entrenched in their own positions, which they come to see as being antithetical to those of their spouse. The things they once cherished or found charming have since faded or become an annoyance. Where there was once agreement, now there is discord. Where there was once calm, now the waters are riled. Comfort has turned to uncertainty, and the house once filled with laughter now pulses with quiet (or not so quiet) tensions.

Rarely do couples come in for counseling until the discomfort of that distance, in whatever form it presents, has exceeded their ability to cope with the difficulty and strain it creates. But how does this happen? How can two people who started out so close with each other become so distant?

People are drawn to the comfort, support, intimacy, affection and validation that marriage can offer. That desire for closeness pulls us together. However, when the harmony of that relationship is disrupted, problems begin in the places where each partner has been using the relationship to prop themselves up or ease their personal anxieties in some way. Where one partner suddenly feels invalidated, the other feels wronged by a disagreement. Where one spouse feels anger over the other’s opinion, the other person retreats from their partner’s criticism. The forms these disruptions can take are endless.

What happened?

In the beginning of a relationship, most of us are more flexible and adaptable in the presence of the other than we otherwise might be. We put on a layer of maturity that doesn’t necessary reflect our true level of functioning. We are able to do this because the nature of the relationship early on has less tension. We listen to the other, we share our opinions openly, we ask questions and engage in conversation, we are curious about our partner and their views, and we are warm, kind and affectionate. Our immaturities somehow become minimized. And thank goodness that is the case, or else we might never get together.

However, that layer of maturity we put on is temporary. It is a reaction to the pull of closeness and harmony with the other. We are not implying that this action is all pretend or fake but rather that part of it does not reflect the reality of our functioning. It is a mechanism that fosters the closeness both individuals desire.

When that maturity slips off, and when our immaturities rear their heads, each individual in the relationship can begin to wonder what happened to the other. Each person begins to assume that the other has changed, and each assumes that the other is the one inhibiting the restoration of intimacy and harmony. This is the distance that pushes apart people who were once so close. Both become entrenched in their position that the other is the problem, and the relationship patterns that maintain the distance become fixed.

This is when people tend to seek counseling. So, what can we do as professional counselors? Working from the framework of Murray Bowen’s family systems theory has helped us acquire and maintain perspective about the relationship between two people. Its systemic underpinnings allow us to conceptualize the relationship without placing blame or seeing fault in one partner or the other. The theory focuses on the processes between people rather than the content of the arguments, which can create a din of noise in which both counselor and clients can easily become entangled and lost.

Focusing on the  ‘other’ as the problem

All marriages have tensions and difficulties because any two-person relationship has instabilities built into it. People want to be together with others, but they also want to maintain their autonomy. When things are working well in a relationship, people feel connected but also free to be themselves. When people feel too close or too distant, it causes a disruption in the individual and, ultimately, in the relationship.

We want attention from our partners, but we can become allergic to too much of it, pushing the other away or distancing ourselves emotionally from them. And when we get the space we think we want, we can feel unappreciated and look for affection and validation to make us feel connected and secure. In this emotional seesaw, each person becomes sensitive to the other and what they do or say and can begin to focus on them as the problem: If only my partner would give me more attention. If only my partner would step up and do their part. If only they would listen to me. If only, if only, if only …

The reality is that both parties contribute to any relationship difficulty. That is the nature of reciprocity, but it is a fact that we all have trouble seeing when we are in the midst of relationship tensions and the emotions and anxiety they produce.

The more that tension and anxiety build, the more reactive people get, and the more they unwittingly contribute to the reciprocity, or mutually influenced pattern, that maintains the “problem.” When people get anxious and reactive, they tend to focus on what is wrong in or with the other rather than looking at what they are doing, how they are contributing to the maintenance of the “problem,” and what their options for changing their own thinking and behavior might be.

Especially in intimate relationships, people can get bogged down in the tensions of feeling misunderstood, neglected or mistreated in one way or another. It can be difficult for individuals in a relationship to see beyond the dust cloud of an argument, a history of small misunderstandings, the minute experiences of neglect that one feels toward the other but has never vocalized, and so on. These histories build because people want stability and harmony in the moment and are willing to sacrifice some autonomy for that without realizing they are contributing to a process that will later result in an eruption.

In our experience, many initial sessions with couples begin with an attempt by both parties to pull the counselor into a he said, she said tug of war. Both want the comfort of togetherness with their counselor, albeit at the expense of their relationship with each other. We believe it is the counselor’s responsibility to stay out of it. The minute that clinicians start seeing one partner or the other as an angel or demon, they have lost their objective footing.

The two overarching and interlocking steps counselors can take to guide people through the process of working on themselves in their relationships are:

1) Help each person increase their perspective of how they relate to their partner.

2) Help each person work on themselves in the present.

As with any idea, the simpler it seems, the more difficult it is.

Increasing perspective: Seeing the reciprocity

Helping people increase perspective begins with the counselor’s ability to maintain a larger perspective. Rather than seeing sides of the relationship, the goal is to focus on the processes and patterns to which both parties contribute, much like a coach looking over the field from above and watching what each player does. If the counselor is able to keep perspective, they can be useful to their clients by helping them gain a larger view of what is going on in their relationship.

Step 1: Decrease anxiety. Nothing can happen until the anxiety in each individual comes down to a level at which they can both work on their part. Often, just talking can help bring down the anxiety. Setting up your expectations (as the counselor) for the session can also help limit the escalation of tensions. One of the biggest factors in decreasing the anxiety when a couple is in the room is the counselor’s ability to remain objective and neutral.

Step 2: Take a step back. Have the couple take a step back from the intensity of the moment by widening the lens they are using to view the problem. Often, each person is hyper-focused on the other, so taking a step back means having each person shift their focus off the other and onto their own functioning. When one person begins talking about what the other is doing, you can help them shift the focus by asking questions about their thinking on their own behavior and thoughts.

For example, if one person begins telling you how the other never says anything, never has an opinion, and is just so limp and passive, you might respond with questions about what they do and think when their partner does those things or what they are doing and thinking before the other partner reacts passively. Conversely, when one partner tells you that the other partner is angry all the time, comes at them with high intensity and is critical, you might question what they do when that happens or how often they anticipate their partner’s intense reactions.

Step 3: Highlight the reciprocity. Continually point out the reciprocity in the “problem” — the fact that each person is contributing in some way to the maintenance of what is going on. Highlighting the reciprocity helps each person begin to recognize that they are an equal participant in what is going on in the relationship, and it furthers the process of each individual shifting their view of the other as the problem to focusing on their own functioning. Using the example above, you might point out to the couple how interesting it is that each time one partner gets intense, the other becomes passive, and how when one becomes more passive, the other gets more intense.

The beauty of this perspective is that it is never up to one person to change the other. There is always something for each person to work on individually, and in doing so, each person is also working on the relationship. There is always a way to move because the processes between two people are constant and ever flowing, even if the participants are locked into automatic and reactive behaviors. A change in one person sets off a change in the process between the two. It is nonsensical for one person to blame the other because they are each contributing, and have contributed, to what is going on between them in the present.

This shift in focus — from off of the other and onto the self — is necessary for each person to move forward effectively. If this shift isn’t made, people tend to either get stuck in conflict or give up more and more of the self to keep the relationship stable. A little conflict is better than a false stability.

Working on self in the present: Working on the reciprocity

Taking a step back and gaining perspective allows people to reenter the tensions of the present moment with more clarity because the focus has shifted from off of the other and onto the self. Once that shift in focus has been made, people can work on managing their emotions and anxieties in the here and now. But these two steps are inextricable because the knowledge gained by looking at and understanding one’s part in relationship patterns is the catalyst for better managing self in the present.

Step 1: Watch the reciprocity. Once each person has begun to see the reciprocity and recognize that they are an equal contributor to the relationship tensions, then they can begin to work on their part. The first step is helping each person become an expert on how they contribute to the reciprocity. What you are doing as a counselor is moving the clients’ thinking from a cause-and-effect framework to a systemic framework in which the rule is reciprocity.

After seeing it, people can begin to be aware of the reciprocity in the present. That awareness might show up in session as one person reflecting on how when their partner got angry, they “retreated again.” In response, their partner increased their intensity, and this person reacted to that increase by shutting down. The client’s focus is now on the process and their part in it.

Step 2: Work on the reciprocity. As each person becomes an expert on their part in the process between the two, they simultaneously begin to work on themselves in the present moment and in the reciprocity that is always ongoing. As the partner from the example above begins to see that their “retreating” and “shutting down” contribute to the other partner’s increasing intensity, they can begin to work on staying engaged in the relationship under pressure. This might begin with noticing their impulse to retreat and staying in the conversation a bit longer than they normally would despite the “feeling.”

In other words, they are tolerating the discomfort of the feeling, but that tolerance is driven by a thoughtful framework regarding the nature of reciprocity and their part in that process. It might mean recognizing that the partner’s intensity is not a critique on them but is rather about their partner’s own functioning. Thus, the first partner may begin to take things less personally. We could go on and on here, but the point is that this person begins to be less caught up in the emotional intensity of the moment. In doing so, the person is able to be less reactive and more thoughtful in what they do and how they do it. The more they work on themselves in the reciprocity, the more options they have in how they function, and the greater the chance for the relationship to improve.

We focused on one partner above, but we could do the same exercise with the other partner. That person would begin by seeing the reciprocity of increased intensity by them and withdrawal by the other partner. They might begin to watch their own functioning, recognizing that the more intense they get, the more their partner retreats. They might notice that when the other retreats, their own intensity automatically increases. They might begin to work on managing that impulse and their facial expressions, tone of voice and so on in the presence of the other. And in working on themselves, they might begin to see that they are working on the relationship.

The challenge as the counselor is to continually bring the focus of the session back to the process of what is going on, or has gone on, and to stay out of the content. Any couple will tend to slide back into content — who said or did what to whom — when tensions and anxieties rise. It is the counselor’s work to stay neutral and objective and to point back to the process of what is going on.

Just as the paradox of marriage is for each individual to manage the self, the paradox of counseling is that the counselor must manage the self rather than try to change whomever is sitting before them. We see the work of the counselor as being no different than the work we perceive as useful to clients. In other words, if the counselor is getting lost in the content of a couple’s argument, then the counselor is not managing their own self, and their anxieties have taken over. But if the counselor can stay focused on the process of how the couple argue, how this contributes to the larger patterns of their relationship, and how that is tied to a history of behavior of which they both are a part, then the counselor is being useful in some way and is managing the self, at least a little bit.

 

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Guillermo Cancio-Bello is director of the November Institute, where he works to bring natural family systems thinking to the lives of individuals, families and organizations in the pursuit of growth through a deeper understanding of human relationships. He is currently undertaking a Ph.D. in counseling at Barry University and lives in Miami with his wife and two dogs. Contact him at thenovemberinstitute@gmail.com or visit thenovemberinstitute.com.

Jim Rudes is an associate professor of counseling in the Adrian Dominican School of Education at Barry University. He has more than 20 years of clinical experience, and for the last several years has devoted most of his professional energy to the study of family systems through the lens of natural family systems theory. His current research interests are concerned with emotional process versus content, and the light at the end of the tunnel. Contact him at jrudes@barry.edu.

 

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.

Recovering from the trauma of infidelity

By Lindsey Phillips April 1, 2020

Most people agree that a sexual affair counts as infidelity, but what about sending a flirty text? What if your partner takes out several loans and acquires a large debt without your knowledge? Does engaging in virtual sex with someone other than your partner, connecting with an ex on social media or maintaining an online dating profile even though you are already in a relationship count as betrayal? The answer depends on how the people in the relationship define infidelity.

A recent study commissioned by Deseret News found conflicting answers when 1,000 people were polled about what constitutes “cheating.” The majority of respondents (71%-76%) said that physical sexual contact with someone outside of the relationship would always meet the threshold for cheating. However, a slimmer majority thought that maintaining an online dating profile (63%) or sending flirtatious messages to someone else (51%) should always be considered cheating. The lines on whether following an ex on social media constituted a betrayal were even more ambiguous: 16% said it was always cheating, 45% thought it was sometimes cheating, and 39% answered that it never was.

As this poll illustrates, how one defines infidelity is subjective. Thus, Talal Alsaleem, a leading expert in the field of infidelity counseling and author of Infidelity: The Best Worst Thing That Could Happen to Your Marriage: The Complete Guide on How to Heal From Affairs, stresses the importance of clearly defining infidelity in session. “A lot of therapists make the mistake of not putting enough attention into defining infidelity,” Alsaleem says. “From the first session, if we don’t agree on what to call it, we cannot go any further” because correctly identifying the problem guides which counseling interventions will be used.

If counselors set the stage poorly from the beginning, they risk alienating one or both parties, he adds. For instance, referring to infidelity as “inappropriate behavior” risks minimizing the betrayal. On the other hand, clients and counselors could exaggerate an issue if they refer to something being infidelity when it really wasn’t.

Alsaleem, a licensed marriage and family therapist in private practice at Happily Ever After Counseling & Coaching in Roseville, California, points out that when defining infidelity, research often relies on heteronormative values, which excludes any relationship that does not fit the “traditional” model (read: a heterosexual, married couple). To account for the various types of relationships that exist and people’s microcultures and macrocultures, Alsaleem developed a flexible definition of infidelity that can work for all of his clients, including those who are LGBTQ+ or polyamorous.

“All relationships should have a contract — whether verbal or written — that stipulates the number of the partners in the relationship … the emotional and sexual needs that are expected to be fulfilled in this relationship, and to what extent those needs are exclusive to the partners in the relationship,” Alsaleem explains. “So, infidelity is a breach of contract of exclusivity that you have with the partner(s) … and it’s outsourcing those needs to others outside the relationship without the consent of the partner(s).”

Although having a relationship contract is helpful, it is much less so if the partners maintain implicit expectations of each other that aren’t covered in the contract or if they allow the contract to become static, says Alsaleem, founder of the Infidelity Counseling Center. “It’s very crucial for people not only to have a clear contract in the beginning but also to continue to have those discussions [about their relationship expectations] on a regular basis,” he says.

Alsaleem believes his definition of infidelity not only works for clients of various backgrounds but also provides counselors with a buffer from their own biases about what infidelity is. When it comes to infidelity counseling, “therapists tend to confuse therapeutic neutrality with thinking that they don’t have a role to play,” he says. He asserts that his definition allows therapists to remain neutral without minimizing accountability.

Cyber-infidelity

Technology has provided new frontiers in infidelity because it offers higher accessibility, greater anonymity and opportunities for cyber-infidelity, says Alsaleem, who presented on this topic at the 2020 conference of the International Association of Marriage and Family Counselors (IAMFC), a division of the American Counseling Association. In fact, technological advancements such as virtual reality pornography and teledildonics — technology that allows people to experience physical tactile sensations virtually — are adding new layers of complexity to infidelity and relationships.

People can use technology to escape real-world problems and reinvent themselves, Alsaleem notes. One of his clients suffered from erectile dysfunction. Because of the shame and stigma associated with his condition, he turned to virtual sex as a way to accommodate for the deficit rather than dealing with the issue with his wife.

“Because [technology] is a new frontier, it’s an unchartered territory. Not too many people can agree on what’s appropriate or what’s inappropriate online infidelity behavior because we don’t have a reference point for it,” Alsaleem says. “That ambiguity makes it easier for people to cross those lines because in their minds, they’re not doing anything bad.”

Alsaleem worked with another couple who were in a happy relationship, but their sexual intimacy had decreased because of common life stressors such as work and parenting. Rather than talk to his wife about it, the husband started watching pornography, which evolved into virtual sex. When the wife discovered this, she felt betrayed, but the husband didn’t think his actions constituted an affair because it wasn’t happening in the real world. He considered virtual sex to be an acceptable alternative to “real cheating.”

Situations such as this one further emphasize the need to clearly define infidelity and establish a relationship contract, says Alsaleem, who points out that the good thing about his definition of infidelity is that it applies to both real world and virtual world affairs. Using his definition, counselors could work with a couple to help a partner realize that virtual sex is a form of infidelity by asking, “Was there an agreement between you and your partner that all your sexual needs would be fulfilled by them only?” If the partner acknowledges that this agreement was in place, then the counselor could ask, “Is what you did derivative of sexual needs? If so, did you outsource this need to someone else?” This form of questioning would help the partner realize that he or she did in fact breach the contract of exclusivity.

Transcending relationship dissatisfaction

Relationship dissatisfaction is a common cause of infidelity, but it is far from the only cause. Alsaleem recommends that counselors consider three categories when working with infidelity.

The first is dyadic factors, which are any relationship issues that lead to the couple not having their sexual or emotional needs met by each other.

The second category is individual factors — each partner’s personal history and overall mental health. Counselors should ask about clients’ family history and previous mental health issues, not just their relationship history, Alsaleem advises. He points out that some mental health issues, such as bipolar disorder and narcissistic, antisocial and borderline personality disorders, may increase the likelihood of infidelity.

People who experienced sexual trauma at an early age are also more likely to engage in infidelity as adults because the trauma may have affected their attachment, sexual identity and the type of relationships they have in adulthood, Alsaleem adds.

The third category is sociocultural factors, including a person’s job, culture, family, friends, lifestyle, environmental stressors, etc. Survey data taken from Ashley Madison, a website that helps married people have affairs, reveal that certain careers and occupations are more correlated with infidelity. These careers typically involve frequent travel; expose people to trauma; feature long, stressful hours; or offer unhealthy work environments (among the examples provided were military personnel, first responders, nurses, police officers and people in sales). This finding illustrates how one’s sociocultural factors can facilitate infidelity behavior, Alsaleem notes.

Treating the trauma

Sometimes clients who experience a partner’s infidelity meet the criteria for posttraumatic stress disorder (PTSD), says Gabrielle Usatynski, a licensed professional counselor (LPC) and founder of Power Couples Counseling in Boulder and Louisville, Colorado. In fact, because the emotional response to infidelity (e.g., ruminating thoughts, sleep problems, erratic behaviors and moods, health problems, depression) can mirror responses to other traumatic events, some therapists have started using the term post-infidelity stress disorder to describe this parallel.

“If you pull up the DSM-5 and look up the PTSD criteria and change the word traumatic event to infidelity, it’s almost going to be picture perfect in terms of the symptom criteria,” Alsaleem points out. “There will be triggers, flashbacks, hypervigilance, avoidance behavior, and manifestations related to the knowledge about the affair and everything related to the affair.”

The fallout from infidelity can also spill over into other roles that people occupy, such as being a parent or a professional. This can lead to guilt and shame if they are not performing well in another area because they are preoccupied with the trauma of the betrayal, he says.

Despite having worked for a while with couples in crisis, Alsaleem found that none of the counseling tools he had acquired over the years adequately dealt with infidelity. If counselors use a generic trauma-informed approach with infidelity, they may have a strategy to handle the sensitivity of the issue, but they won’t have a clear understanding of the obstacles and the steps needed to overcome them, he says.

Alsaleem started jotting down observations of his clients dealing with infidelity and discovered several struggles that these clients shared regardless of the type of relationships they had, the length of their relationships, or their cultural or religious backgrounds. These shared struggles included defining infidelity, handling the emotional impact of infidelity, and navigating the significance of the affair narrative. Alsaleem’s observations led him to develop systematic affair recovery therapy (SART), which provides counselors with a treatment method for helping couples process and heal from the trauma of sexual and emotional infidelity.

SART describes seven milestones clients go through as they heal from infidelity:

  • Setting the stage for healing
  • Getting the story
  • Acknowledging the impact
  • Choosing a path
  • Creating a plan of action
  • Implementation and healing pains
  • Sustainability

“Your role [as a counselor] is to help them process what happened, to make sense of it, so this trauma does not define the rest of their lives, whether as a dyad who are rebuilding the relationship or as individuals who have decided to separate and move on to other relationships,” Alsaleem says.

He warns that the process isn’t easy because clients often come in with knee-jerk reactions about what they want to do. Counselors must help clients resist making impulsive decisions and instead encourage them to make up their minds after completing the proper steps and understanding why they are making their decision, Alsaleem says.

With affair recovery, Jennifer Meyer, an LPC in private practice in Fort Collins, Colorado, finds it helpful to have couples write down their feelings and emotions, which can be intense. From the beginning, she asks couples to share a journal and write their feelings back and forth to each other.

After the couple has had time to identify and process the cause of the infidelity, Meyer asks the partner who has been unfaithful to write an apology letter and to read it to the injured partner in session. In this letter, the offending party conveys that they understand the pain they have caused and feel remorse for their actions. Even if the couple decides not to stay together, the letter helps repair the damage caused by the infidelity, and the partners can move forward (and, eventually, into new relationships) without carrying the pain and trauma with them, Meyer says.

Navigating the affair narrative

Some therapists avoid having clients share details about the infidelity because they fear it will create more harm or retraumatize clients, Alsaleem says. He argues that narrating the affair is a painful yet crucial part of recovery that can help facilitate healing if done with the right level of disclosure.

Alsaleem dedicates an entire day in his SART training program to teaching counselors how to help clients share their affair stories without retraumatizing both parties (by sharing too much or too little information) and without minimizing or exaggerating what happened. With infidelity counseling, “every mistake counts,” he says. “When people are coming in after the discovery of infidelity, whether it’s recent or from the past, they are very fragile, so that’s when you need to be strategic and adaptive and plan each intervention and how to respond to the outcome of the intervention.”

Meyer, a member of both ACA and IAMFC, often finds that clients want to ask the offending partner multiple detailed questions about the intricacies of the affair. Meyer is aware that the answers to these questions have the potential to create even more hurt and trauma for her clients, so she is honest with couples about this possibility and guides them through the process.

Alsaleem provides a brief example of how counselors can determine the appropriate level of disclosure when clients share their affair stories (but he advises clinicians to seek further training before trying this approach). He first asks the offending partner to be proactively transparent when sharing the affair story. They shouldn’t hide anything, he says, and they should go out of their way to show the injured partner(s) the unpleasant truths that led to the affair. This is done not to traumatize, he emphasizes, but to show the offending partner’s capacity to be open and honest.

Alsaleem also tells injured clients that they can ask anything they want about the affair. But before they ask, he helps them determine whether the question will help them understand what type of affair it was or why the affair happened. If so, then it is a fair question, he says.

For example, a client dealing with a partner’s sexual infidelity may want to ask, “What specific sexual activities did you engage in?” If the partner who was unfaithful is dealing with a sexual addiction (an individual issue), then the specific sexual activity is not important to understanding the motivation or what went wrong in the relationship, Alsaleem says. However, if the infidelity occurred because of a compatibility issue (a dyadic issue), then that would be a fair question because the betrayed would discover in what ways they are no longer fulfilling their partner’s sexual needs, he explains. 

“The need behind the question [can be] healthy and appropriate, but sometimes [clients are] not asking the right question because they don’t know how to address that need,” Alsaleem adds. He advises counselors to ask clients what they are trying to learn about the story with their questions and help them figure out if these questions are the best way to obtain that information while avoiding further traumatization.   

Affairs can evoke intense emotions in session, especially when discussing the affair story. To ensure that emotions don’t escalate to an unproductive level, Meyer uses a preframe such as “You seem calm at the moment, but this is difficult, and I want to ensure you can both talk without being interrupted. If things get out of hand, I’m going to ask for a timeout. You can both ask for a timeout as well.”

Meyer also uses her own body language — such as scooting up in her chair or standing up — if clients start yelling uncontrollably, or she physically separates them for a few minutes by having them take turns going to the restroom or getting a glass of water. These subtle changes help clients calm down and not get stuck in fighting, she explains.

Creating an imbalance to facilitate healing

Usatynski, an ACA member who specializes in couples therapy, approaches infidelity counseling differently from couples therapy where betrayal is not the presenting issue. In ordinary couples therapy, she strives to keep therapy as balanced as possible, focusing equally on the complaints of both partners and the unresolved issues that each brings to the relationship. But when infidelity is involved, she intentionally creates an imbalance of power and initially allows the injured party to have all of the power. The offending party, on the other hand, does not get to bring any of their complaints about their partner or their relationship to the table until they have successfully addressed the injured partner’s distress. This treatment works only if the offending party expresses true regret for the harm they have caused their partner and expresses a genuine desire to rebuild the relationship, Usatynski adds.

Usatynski’s approach comes from a psychobiological approach to couple therapy (PACT), which is a fusion of attachment theory, developmental neuroscience and arousal regulation developed by Stan Tatkin. When betrayal is the presenting issue, this method requires that clients move through three phases as they process and attempt to repair their relationship.

The first phase addresses the trauma the injured client has experienced by allowing them to express all of their emotions about the betrayal. “It’s when people feel like they have to hold back [emotions] or they can’t get angry or there’s nobody there to listen to them that actually creates trauma or at least makes it worse,” Usatynski says.

The partner who was betrayed can also ask any question they want about the affair during this phase, and the offending partner has to answer honestly. Many therapists who work with betrayal are concerned about the injured partner being traumatized by finding out the truth, Usatynski says. She admits this is a valid concern, so therapists should support the injured partner throughout the process. However, she advises that therapists not shy away from the truth coming out because, as she explains, the only way to repair the relationship or build something new is with total transparency.

If clients are hesitant to ask about the affair, therapists need to explore this hesitation with them. The injured partner may say that they don’t want to know what happened out of an inability to deal with feelings of loss and the practical implications of the relationship ending, Usatynski adds.

During this initial phase, the offending partner has no power to negotiate. They must simply sit and endure the rage and inquiry of the person whom they betrayed, Usatynski explains.

The second phase of PACT involves the offending partner providing the betrayed with whatever support is needed to correct the injury to the attachment bond between them, Usatynski says. This phase could involve declarations of commitment, appreciation or praise, as well as loving actions on the part of the offending partner. However, only the injured partner can decide what behaviors are reparative, she explains. The goal of this phase is resolution.

During the third phase, the injured partner lets the offending partner out of the “doghouse” and, together, the couple decide the new rules and new relationship contract they will have going forward, Usatynski says.

According to PACT, the dysregulation of one’s nervous system (such as during states of hyperarousal or hypoarousal) may lead to discord between the couple, Usatynski says. Thus, counselors should not only track clients for signs of dysregulation but also teach couples how to track each other’s nervous systems.

When Usatynski notices a client showing signs of dysregulation (e.g., changes in skin color, posture or vocal tone), she will ask the other partner if they recognize the change. For example, she might say, “Did you see how your partner’s skin color just changed when he or she said that? What do you think is going on with him or her right now?”

The goal is interactive regulation — the couple learning the specific strategies that soothe, regulate and excite each other, Usatynski notes. “These tracking skills are particularly important in the aftermath of betrayal because … [they help the offending partner] develop a greater awareness of how their behavior affects their partner. These skills also boost sensitivity and empathy,” she explains.

A silver lining?

Alsaleem compares infidelity to a heart attack for the relationship. “It’s a critical wake-up call,” he explains. “It forces [clients] to really lay all the cards on the table and make an informed decision.” Do they commit to fixing all of the deficits and work toward having a better, stronger relationship, or do they end their relationship and find new, healthier relationships?

Alsaleem says several of his clients began therapy devastated by the trauma of infidelity, but by the end, they admitted they were almost glad it had happened because it ultimately led them to having the relationship they always wanted with their partner. For some people, infidelity is the catalyst that ultimately allows them to get unstuck, he explains.

When clients decide to repair their relationship, Meyer helps them develop a new, explicitly stated contract regarding the rules in their relationship moving forward. She asks them to write down their agreement about these new relationship rules (including how quickly they would inform their partner that they experienced a compromising situation and what constitutes infidelity going forward) and ways they could be vulnerable to future affairs.

“As counselors, we can’t assume every couple wants or needs strict monogamy,” Meyer adds. So, this new agreement can take many forms depending on the relationship. For example, partners in a committed relationship may agree that being involved with another person sexually is OK as long as they discuss it first with their partner or keep everything in the open.

Of course, clients in infidelity counseling may also decide to end their relationship. Even so, by showing up to counseling, clients have taken the first step toward ensuring that infidelity does not define the rest of their lives, Alsaleem notes.

“Infidelity is an awful event, but it doesn’t have to be devastating. It actually has a silver lining. Infidelity — as awful as it is to experience, as awful as it is to happen — can actually be a good thing to help people change their lives,” Alsaleem says. “If treated appropriately, it can actually enrich people’s lives and make them more resilient and make them better in the long run.”

 

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Related reading: An online companion article to this feature, “Helping clients rebuild after separation or divorce,” provides strategies for helping clients to process their grief and start over.

 

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

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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.

Helping clients rebuild after separation or divorce

By Lindsey Phillips March 25, 2020

Jennifer Meyer, a licensed professional counselor (LPC) in private practice in Fort Collins, Colorado, had a client who, after 30-plus years of marriage, discovered that her husband had been embezzling money from their joint business. This infidelity, along with his recent verbal abuse, prompted the woman to get a divorce. The client was hurt, shattered, ashamed, lost and confused about her future, Meyer says. For the previous 30 years, she had shared friends, children, family and a business all with the same partner. How would she be able to start all over again now?

Clients such as this one often find that they have to rebuild their lives because, in some ways, divorce is the “death” of a relationship. Meyer tries to help clients accept that divorce is a big loss — one often accompanied by feelings of betrayal and trauma. To overcome this loss, she works with clients on processing their emotions (which often include anger, shame and blame), communicating their needs, establishing healthy boundaries with their ex-partner and rebuilding their lives.

The stages of divorce

Meyer, a member of the American Counseling Association and the International Association of Marriage and Family Counselors (an ACA division), specializes in divorce coaching and recovery. She has noticed that her clients often exhibit signs of grief, such as feeling unmotivated and having trouble sleeping. In fact, going through a divorce can be similar to going through grief, but it can be further complicated by layers of legal issues, financial strain, individual mental health challenges, the experience of parental alienation, the challenges of co-parenting, and the realities of dividing assets, Meyer says.

Meyer gives clients a handout of the seven stages of divorce, created by Jamie Williamson, a family mediator certified by the Florida Supreme Court. Williamson draws on the well-known “stages” of grief, but her model ends with rebuilding — a stage when a person’s acceptance deepens, they let go of the past and they find a way forward.

Meyer, who presents on the emotional journey of divorce at an ongoing national women’s workshop in northern Colorado, adapted Williamson’s model to illustrate the complexities of grieving a divorce, which she likens to climbing Mount Everest — a climb they didn’t sign up for. In this metaphor, she pairs six stages of divorce with sample thoughts of what clients may be feeling:

  • Denial: “This climb is a complete waste of time. I should be home trying to save my marriage”
  • Anger: “This divorce is expensive. Why is this happening to me? I didn’t plan for this.”
  • Bargaining: “I would do anything to turn back and make things right with my spouse. What if I don’t make it? Will my kids be OK?”
  • Depression: “I’ve lost my spouse and some mutual friends. I can’t sleep. I feel so lonely.”
  • Acceptance: “I no longer idealize my past. This process taught me how strong I am.”
  • Rebuilding: “I’m excited to close this chapter and begin creating a happy future.”

In between these stages, she says, clients are growing and learning. They start to learn who their true friends are, and they learn more about themselves, their boundaries and their expectations.

Meyer’s metaphor also highlights that the stages of divorce are not sequential. For example, someone might move from being angry at the financial cost of divorcing to wondering if they should get back together with their ex out of a fear that their kids won’t be OK to being angry again that this experience is happening to them.

Processing emotions

Meyer uses emotionally focused therapies to help clients turn inward to process their feelings about the separation or divorce. One of Meyer’s clients was frustrated because she felt her ex-spouse was never emotionally available. So, Meyer had the client close her eyes and picture the ex’s face. Then, she asked the client, “What would you say to your ex from an angry perspective? What would you say to your ex from a hurt perspective? And what do you imagine your ex would say back to you?”

This role-play exercise helps clients not only process their feelings and find a way to move forward from their hurt and anger, but also recognize their own part in the marital problems, Meyer explains. She cautions counselors not to focus on the self-responsibility part too early but says that as clients move through the stages of divorce, counselors can gently encourage them to look at what part might have been theirs.

Meyer has also noticed that women often want to take all of the responsibility for a relationship ending, so she tries to help them realize that both partners played a role. To do this, she might say, “There’s 100 percent blame out there. What percentage of that would you claim, and what percentage is your ex-partner’s?”

Owning their responsibility can also be empowering for clients, Meyer adds. They often feel like everything was done to them, so realizing the role they played and how they would handle that differently in the future helps them move forward, she explains.

Meyer also has clients write goodbye letters to their exes (or any family members or friends they have lost in the divorce). In the letters, they name all the things they will miss (e.g., “I will miss your hugs,” “I will miss your excitement to go to concerts”) and the things they won’t miss (e.g., “Goodbye to your smelly socks on the floor all the time,” “Goodbye to the fact that you never prioritized me”). This exercise allows clients to express their hurt, anger and sadness and helps them let go of the relationship, she says.

Developing healthy communication and boundaries

Some of Meyer’s clients also have a difficult time knowing how to act around the other partner after deciding to divorce. They may feel guilty for setting boundaries on someone who used to be their partner, but Meyer reminds them that the relationship has changed. “The communication that you wanted and needed while you were married or together is … very different, so you’re going to need to each have boundaries around your communication,” Meyer says.

Meyer helps clients figure out the source of their distress with their ex-partner and guides them in establishing better boundaries. For instance, if a client was upset because their ex-partner kept showing up to their child’s soccer games and hounding them about renegotiating a part of the divorce, Meyer would help the client communicate new boundaries by coming up with phrases such as “Let’s talk about this in mediation” or “If you call me names or raise your voice, I’m going to end this conversation.”

Gabrielle Usatynski, an LPC and the founder of Power Couples Counseling (a private practice with offices in Boulder and Louisville, Colorado), also focuses on the way the couple communicate and behave around each other. “One of the points [of divorce counseling] is to help them develop the capacities they need in order to engage in fruitful conversations that do not get scary and dangerous,” Usatynski explains. To do this, she teaches couples about the value of treating each other with fairness, justice and sensitivity, even in the midst of divorce. She also helps couples learn to negotiate and bargain with each other so they can create win-win solutions for divorce and co-parenting.

A psychobiological approach to couple therapy (PACT), developed by Stan Tatkin, acknowledges that there is a difference between what people say they do and what they actually do, Usatynski says. People’s narratives are subject to inaccuracies that can throw the therapist off track in terms of understanding what is really happening with the couple, she explains.

A couple’s attitudes and problems, as well as their ability to engage with one another, are largely driven by the state of their autonomic nervous systems, Usatynski continues. “Therapists should facilitate these nervous system states in session and intervene while the couple is in those particular states,” she says. “The goal is to collect and bring to bear as much raw, unedited information [as possible] from the body, brainstem and limbic brain.”

For this reason, Usatynski uses a technique called staging, which targets the body and deep brain structures. Couples act out problematic moments in their relationship in front of the therapist. Because people have different perspectives, finding out exactly what happened is not Usatynski’s goal. Instead, she wants to find situations that created distress for the couple and see for herself the mistakes the couple made in their interaction.

So, if a couple going through a divorce had a heated exchanged when the father dropped the children off at the mother’s house, Usatynski would ask for them to act out that exchange in her office. When the father says, “Your music is way too loud. The kids don’t need to hear the music that loud,” the mother responds, “Stop yelling at me in front of the kids, and don’t tell me what to do.”

Usatynski notices this is a point of distress for the couple, so when they finish acting out the scenario, she discusses this misstep with them. For example, to help the father understand that he came across as demanding and made his wife look bad in front of the kids, Usatynski might ask him, “Did you say, ‘Please turn down the radio?’”

After discussing each of the missteps, Usatynski has the clients re-enact the scenario. This time, however, they have to come up with ways of relating to one another that are nonthreatening, fair and sensitive. “When we allow our clients to stumble along, the solutions they find on their own are going to be way more powerful, creative and effective than anything we could offer them,” Usatynski says. “The process of discovering their own solutions also gives them a greater sense of empowerment and competency that they really can do this on their own.” That is ultimately the goal of counseling, she adds. Only when a couple is really struggling to come up with viable solutions on their own will Usatynski provide suggestions.

Acting out the scenario in the brain state they were in at the time of conflict and then learning a better way to handle the situation helps clients react differently the next time they find themselves in a heated exchange, Usatynski notes.

Starting over

After clients have gone through the emotional journey of divorce, they need to start rebuilding their lives and hoping for a better future. To help clients start this process, Meyer returns to the letter writing exercise, but this time she has them write a “hello” letter to their new life and the aspects they will enjoy most. For example, clients could write, “Hello to traveling by myself without someone who gets impatient,” “Hello to being able to decorate my bedroom the way I want to,” “Hello to time with friends again” or “Hello to the stronger, more confident me.”

One of Meyer’s clients brought in items that represented her divorce, including the goodbye letter she had written in a previous session. She then went outside with Meyer and burned it all. This act symbolized her letting go of that relationship and taking a step forward.

Meyer has also had clients go outside and use nature as a metaphor for their progress and healing. For example, one client said that an old tree that had been chopped down represented her at the beginning of her divorce, but by the end of it, she identified with a stronger, healthier tree.

Divorce is a devastating event that no one wants to experience. In fact, according to the Social Readjustment Rating Scale developed in 1967 by psychiatrists Thomas Holmes and Richard Rahe, divorce is the second most stressful life event for adults (behind only the death of a spouse). But clients can rebuild their lives and have a hopeful future.

“When you work on [what happened in the relationship] and you figure out what your part was and what was going on with the partner that you didn’t think was healthy, you can really find the good part of you and salvage the rest of this to the point where you’re in better spot than you ever were,” Meyer asserts.

Meyer watched her client who divorced after 30-plus years of marriage undergo an incredible transformation throughout their sessions. The client realized how often she had done what was asked of her (by her ex-spouse, her kids and her employers) without considering her own needs. She began to slow down, set boundaries and say “no.” She realized what she deserved in a relationship, and she learned how to select and be a better partner in the future.

By processing her emotions about the divorce and betrayal and letting go of the blame, shame and anger that had become such a heavy burden for her, the client began to feel younger in her body and make healthier life choices. And with Meyer’s guidance, she realized she didn’t have to be afraid to start over.

 

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For more on this topic, look for an in-depth feature article on helping clients cope with divorce or infidelity in the April issue of Counseling Today.

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. 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.

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.