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Pragmatic/Experiential Therapy for
Couples
Brent J. Atkinson, Ph.D. |
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Published in the Journal of Systemic Therapies, vol. 17, pp.
18-35, 1998
In this paper, I describe a treatment
approach which combines an emphasis on concrete changes in couple
interaction with experiential methods for helping clients (1) influence
emotional states which block needed changes in thinking and behavior,
and (2) come into contact with emotional states which facilitate change.
Pragmatic/experiential therapy can be used with individuals, couples or
families. This paper describes the application of pragmatic/experiential
therapy with couples.
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My interest in working with emotion
in the context of systemic therapy began in the mid 1980's when I was
investigating current thinking among neurological and biological
scientists regarding how the brain creates the realities we experience (Maturana
& Varela, 1987; von Foerster, 1984). I discovered a number of
studies suggesting that emotion plays a crucial role in organizing how
we see the world. Particularly interesting were studies suggesting that,
in terms of neural architecture, structures which generate emotion have
a privileged position, and are situated with the ability to exert
enormous influence on the rest of the brain (Ornstein, 1986, 1991).
Throughout the past decade, studies have continued to emerge suggesting
the centrality of emotion in organizing thought and behavior. For
example, Antonio Damasio's studies of patients with frontal lobe damage
suggest that emotion is an integral part in all practical
decision-making, and that those who are without it demonstrate a record
of disastrous decisions (Damasio, 1994). Joseph LeDoux (1996) has
located separate neural pathways that allow the emotional system to
bypass the neocortex, and has identified the amygdala as a central
emotional decision-maker, capable of making split-second emotional
choices, equipped with the neural connections to influence the rest the
entire brain as well as activate every physiological response related to
emotion. Jack Panksepp's (1982, 1985, 1986, 1989, 1992a, 1992b) studies
suggest that there are separate neural pathways for each emotion, and
these neural circuits function as special-purpose systems. When a
specific emotional circuit is activated, there are certain types of
actions that come easily, and other types that are nearly impossible to
do unless you switch emotional command circuits.
My investigations into the neurophysiology of emotion (Atkinson, 1996,
1998) led me to consider the possibility that often, cognitive and
behavioral changes are difficult to achieve because they are somehow
incompatible with emotional states activated in various life situations.
I further reasoned that perhaps if people could learn to interact
directly with and shift their emotional states, then behaviors and
cognitions might change more easily. At that point I began paying
attention to my own emotional states, experimenting with different
methods for influencing them. I naturally integrated this work into my
therapy with couples and families. The result is the clinical approach
described in this paper.
Theoretical Influences
It would be somewhat misleading to say that pragmatic/experiential
therapy has its origins in specific theoretical perspectives, because
this clinical approach evolved primarily out of my own experience
working with individuals, couples and families over the years. However,
my experience has been influenced by various perspectives, and among the
chief of these are: brief, problem-oriented systemic therapies (Fisch,
Weakland & Segal, 1982; Watzlawick, Weakland & Fisch, 1974),
Bowen Family Systems Theory (Bowen, 1978; Kerr & Bowen, 1988),
postmodern philosophy1 (Bernstein, 1983, 1992; Rorty, 1991),
and experiential psychotherapies (Gendlin, 1981, 1996; Greenberg &
Johnson, 1988; Greenberg, Rice & Elliot, 1993; Greenberg &
Safran, 1987; Johnson & Greenberg, 1994; Mahrer, 1996; Kurtz, 1990;
Safran & Greenberg, 1991; Schwartz, 1995).
While elements of each of these influences can be found in a number of
my other papers (Atkinson, 1992, 1993a, 1993b, 1997a, 1997b, 1997c,
1998; Atkinson & Bailey, 1987; Atkinson & Heath, 1987, 1990a,
1990b, 1990c; Atkinson, Heath & Chenail, 1991; Atkinson &
McKenzie, 1987, Heath & Atkinson, 1989), this is the first paper
which describes the integrated clinical approach I am calling
pragmatic/experiential therapy. This approach can be used with
individuals, couples or families. Assumptions about emotional states
which inform this approach are also applicable in supervision of
therapists (Atkinson, 1997a, 1997b, 1997c). In this paper, I will
attempt to sketch the basic features of the approach as applied in
couples therapy, and illustrate them with a case description.
Overview of the Approach
Couples entering therapy usually have evolved into distressing,
redundant patterns involving mutually reinforcing reactions to
reactions. In these cycles, the behavior of partner A fuels the very
behavior in partner B which partner A finds upsetting, and the behavior
of partner B fuels the behavior in partner A which partner B finds
upsetting. The most common forms of these patterns are: pursue/withdraw,
demand/accommodate, underfunction/overfunction, withdraw/withdraw, and
(for limited periods of time) attack/attack.
Pragmatic/experiential therapy for couples seeks to help each partner
focus on changing his or her contributions to these mutual escalations.
This approach assumes that the behavioral contributions of each partner
to mutual escalations are embedded in more encompassing emotional states
which become triggered during couple interaction. The therapist assists
each partner in altering his/her behavioral contributions to the
distressing interactional patterns by helping each partner (1) identify
and influence specific emotional states which block needed interactional
changes, and (2) come into contact with emotional states which
facilitate change.
Throughout this paper, the term emotional state is used to denote a
goal-directed emotive system that includes a physiological experience of
emotion, accompanying cognitions, and a tendency toward particular kinds
of action. In terms of neurophysiology, I am referring to what Panksepp
(1992, 1989, 1986, 1985) calls emotive command circuits which organize
behavior by activating or inhibiting behavioral subroutines that have
proved adaptive in the face of challenging stimuli during the history of
the individual. Brain studies suggest that there are many different
emotional command circuits in the brain, each having a separate neural
pathway which allows them to act semi-independently. Once activated,
each of these response systems function as if they had a mind of their
own, producing a predictable network of emotions, thoughts and
behaviors. When a specific emotional circuit is engaged, there are
certain types of actions that come easily, and other types that are
nearly impossible to do unless you switch emotional command circuits
(Atkinson, 1998). Translated into non-scientific language, Ornstein
(1991) calls these states simpletons. I believe that Greenberg, Rice and
Elliot (1993) address something similar with their concept of emotion
scheme. Gendlin's (1981, 1996) concept of the felt sense and Schwartz'
(1995) notion of the internal part are also related. While I have chosen
the term "emotional state," the reader should keep in mind
that the states I am referring to are actually
cognitive/affective/behavioral states, whose activation is signaled by
the experience of emotion.
Emotional states block needed cognitive and behavioral changes in one of
two ways:
1. Needed change in thinking/acting is incompatible with emotional
states which are regularly triggered in important situations. Example: A
wife may realize that her usual angry, demanding, attacking behavior
when her husband is inattentive only makes things worse, and she may
plan to respond differently in the future. However, when the situation
actually arises, an angry emotional state is automatically triggered,
including a strong tendency to attack, along with thoughts that tend to
fuel her attack, and her rehearsed ways of thinking and acting go out
the window.
2. The anticipation of an uncomfortable emotional state that would
likely be triggered by implementing new thinking/acting prevents the new
thinking/acting from occurring. Example: A husband may realize that his
placating, patronizing behavior in reaction to his wife's anger only
makes her angrier in the long run, but he won't assert himself because
he knows in advance that her angry response to his assertiveness will
trigger the intolerably anxious state that prompted his placating
behavior in the first place, and that he will end up placating again.
In pragmatic/experiential therapy for couples, the therapist helps each
partner identify specific emotional states which block needed changes
and fuel escalations, assists each partner in developing the ability to
influence these states, and assists each partner in accessing other
emotional states which facilitate interpersonal change. Therapy occurs
in three overlapping phases. In the first phase, the therapist helps
each client see how their reactions to the behaviors they find most
objectionable in their partner actually tend to reinforce these
behaviors, and the therapist elicits the commitment of each partner to
work on changing their own reactions. In the second phase, the therapist
helps each client work directly with emotional states. In the third
phase, clients translate this experiential work into concrete changes in
the ways they interact with each other.
Phase One: Establishing Self-Focus
The first phase of therapy focuses on identifying each partner's
contribution to the problematic interactional patterns in their
relationship. A major goal is to help each partner focus on what they
can do to change their relationship, rather than on what their partner
should do. The therapist helps each partner see how their own reactions
to the behaviors they find most upsetting in their partner actually fuel
these behaviors. Using details learned about the mutually reinforcing
patterns evident in the couple's relationship, the therapist provides a
compelling explanation for why this is so. The therapist suggests to
each partner that the odds are much greater that their partner will
change in the desired ways if s/he can change her/his usual ways of
responding to the partner's distressing behavior.
This approach assumes that the relationship will improve if only one
partner changes the part s/he plays in significant interactions (Bowen,
1978; Kerr & Bowen, 1988; Fisch, et. al., 1982; Watzlawick et. al,
1974). However, if both partners are willing, the therapist attempts to
obtain a commitment from each partner to "work their own
program" in the interest of improving the relationship.
The first phase of therapy typically involves a combination of conjoint
sessions and individual sessions, and is not complete until each partner
is committed to working on changing their own reactions to the behaviors
they find objectionable in the other.
Phase Two: Working Directly With Emotional States
In phase two, the therapist helps each partner identify his/her own
emotional states which contribute to the distressing, mutually
reinforcing interactional patterns in their relationship. Through
individual sessions, the therapist helps each partner come directly into
contact with these emotional states during the therapy hour, and develop
the ability to decrease the intensity of the states by interacting with
them. This ability is indispensible for phase three, in which the
therapist helps partners identify and shift their emotional states
during ongoing interaction with each other.
An important distinction is made between self-protective emotional
states (characterized by feelings such as anger, defensiveness,
resentment, etc.), and vulnerable emotional states (characterized by
feelings such as fear, insecurity, loneliness, sadness, etc.). The
specific behaviors that each partner contributes to the distressing
mutual escalations in the relationship are usually embedded in
protective emotional states.2 Thus, a major goal of phase two
involves helping each partner develop the ability to decrease the
intensity and frequency of self-protective emotional states.3
Self-protective emotional states often seem to serve the function of
protecting partners in distressed relationships from the intensely
uncomfortable feelings that accompany vulnerable states, and
self-protective states often prevail until an individual either feels
less threatened by their partner or becomes more able to decrease the
intensity of the feelings that occur when his/her own vulnerable states
are active. Thus, another goal phase two involves helping partners
activate and interact with their own vulnerable states in a way which
results in a moderation of the intensity of the uncomfortable feelings
that accompany such states. As clients develop this ability, the
excessiveness of self-protective states often lessens spontaneously.
There are at least two methods one can use to decrease the intensely
uncomfortable aspects of one's own vulnerable emotional states. One
method is to detach or distract oneself from the vulnerable state,
possibly through the activation of an alternative state, or through
involvement in an engrossing activity. Another way is to pay close
attention to the state, and to find ways to moderate the intensity of
the state through directly interacting with it. Each of these methods
can be helpful in responding to emotional states, depending upon the
particular circumstances involved when the state is activated.
Distraction often gives temporary relief from the uncomfortable
(sometimes paralyzing) feelings that can arise with vulnerable states,
but the state may be easily triggered again, or remain active at a
certain level, coloring the thoughts and actions of the host individual.
Direct contact and interaction with the state is necessary if the state
is to become less extreme and more balanced over time. Most clients
entering therapy have experience with the first method, but limited
ability in the second approach. In phase two of this approach to
therapy, the therapist helps each partner come into meaningful contact
with their own vulnerable states, and to interact with these states in a
way that promotes a balancing and lessening of the uncomfortable
feelings associated with the vulnerable states.
A comprehensive review of methods for working directly with emotional
states is not possible here. Readers are referred to techniques
described by Gendlin (1981, 1996), Greenberg & Johnson (1988),
Greenberg, Rice & Elliot (1993), Johnson & Greenberg (1994),
Mahrer (1996) Kurtz (1990), and Schwartz (1995). Some specific
techniques will be illustrated in the case description that follows.
Four general principles guide my work with emotional states (Atkinson,
1998):
Treat emotional states as if they had minds of their own.
Brain researchers tell us that it's possible for emotional states to
become activated for reasons we may not at first be aware of, and
emotional command circuits may be carrying out pre-programmed agendas
without our full awareness. Accordingly, when clients approach emotional
states with a "not-knowing" attitude, willing to listen to
what may be going on inside of them, they often come away with a greater
sense of understanding and satisfaction, and they are more able to calm
emotional states, or help them shift. It's helpful to approach an
emotional state with the curiosity and respectfulness with which you
might approach another person whom you wanted to know more about.
Focus on the stance individuals take toward their emotional
states.
People vary considerably with regard to how they react to various
emotional states (both their own emotional states and the states of
others). Those who are most able to get cooperation from their emotions
as well as intimacy with others learn to approach their emotional states
in a way that promotes good contact with the states, but some
separateness as well. Learning how to accept emotional states as they
are is the first step toward helping the states become less intense, or
become easier to be with. There is something similar about learning how
to relate to difficult emotions and learning how to relate to difficult
people. Both kinds of learning involve attentiveness to one's own
reactions in relation to another, regardless of whether the
"other" is inside one's skin or outside.
Work with emotional states when they are active.
An individual's stance toward an emotional state is most amenable to
change when the person is actually experiencing the emotional state, not
just talking about times when the state was active. Thus, the therapist
must develop attentiveness to emotional states that naturally occur in
therapy, as well as skill in helping clients come into contact with
certain states.
Seek cooperation from, not control over emotional states.
There is an important difference between attempting to control one's
emotions and seeking cooperation from them. If approached in a
respectful, accepting way, troubling emotional states generally become
less intense or distressing, and/or yield to other states that are
needed. Such shifts are usually achieved by gentle and compassionate
exploration of inner states rather than the force of conscious
willpower.
Phase Three: Facilitating pragmatic/experiential change between
partners
When the second phase of therapy is successful, partners have furthered
their ability to maintain meaningful contact with emotional states, and
to influence them or help them decrease in intensity and/or frequency.
This ability is tested in phase three, when partners come together for
conjoint sessions, and begin interacting with each other in ways that
trigger the usual self-protective emotional states in each other. Each
partner enters conjoint sessions in phase three with an explicit
understanding that the goal of these sessions is to give them an
opportunity to change their own reactions to their partner. They are
cautioned that they will have a tendency to digress into focusing on the
objectionable behavior of their partner, and assured that the therapist
will assist them in maintaining self-focus.
During conjoint sessions, the therapist assists partners in recognizing
how and when their own emotional states are influencing interaction, and
helps them influence these states. The therapist generally begins by
attending to protective states, then, through gentle probing questions
and observations, helps access more vulnerable states in each partner,
and assists partners in responding to each other's vulnerability.
Greenberg and Johnson (1988) describe many useful methods for assisting
couples in making such shifts in conjoint sessions.
As conjoint sessions progress, partners develop facility in recognizing,
without the assistance of the therapist, when self-protective states
have been triggered, and they develop abilities to (1) know if and when
it is wise to attempt to decrease the intensity of a self-protective
state, (2) decrease the intensity of a self-protective state while in
ongoing interactions, (3) avoid triggering self-protective emotional
states in each other, (4) say things that help their partner shift out
of a defensive/self-protective state, (5) take breaks when needed to
calm or shift their own emotional states, (6) give their partner space
to work with his/her emotional state, and (7) practice interacting ways
that were previously blocked by the activation of self-protective
emotional states.
If the shift to conjoint sessions occurs too early, partners tend to
digress into a focus on the objectionable behavior of the other, and
more individual sessions may be necessary. However, once clients have
experienced success in influencing their emotional states in individual
sessions, they can usually be refocused toward their own experience by
the therapist in conjoint sessions.
Case Description
Anne called to schedule marital therapy for she and her husband, Ron.
Ron was 33 years old, soft-spoken, and professionally successful. In
addition to his responsibilities as a manager with a large firm, he had
started his own consulting business. Ron had several hobbies which
included restoration of antique bicycles and sky-diving. Because of his
"poker-face," I had some difficulty in reading his reactions
to me in the initial sessions. Anne, 32, worked out of the home as a
free-lance editor, and juggled professional work with care for their 2
year old daughter, Sophia. Anne was friendly, straight-forward and
outspoken. Unlike Ron, Anne wore her reactions all over her face.
Anne was very upset and vocal about Ron's insensitivity. According to
Anne, Ron's mind was always elsewhere. He would frequently forget
promises he made to her regarding the family schedule, household
projects, and romantic plans the couple had made. She said he cared only
about himself and his own hobbies and projects, and accused him of not
wanting to put forth the effort and responsibility necessary to have a
wife and family.
Ron said that his performance was never to Anne's satisfaction. He said
that Anne was a good wife and mother, but that her expectations of him
were unreasonable, and that she was always upset about something. In an
individual session, Ron told me that he saw Anne as immature, like a
two-year old throwing a tantrum when she couldn't have her own way. He
said he knew it was probably wrong to give in to her childish demands,
but he said that on the few occasions when he hadn't, Anne had
"gone through the roof" and stayed there until he backed down
and apologized.
Each partner believed that they were a victim of the other's
unreasonable behaviors. Ron saw Anne as controlling and emotionally
punishing, and lamented that her caring for him was contingent upon
whether or not he was a "good boy" and did all the things she
wanted. Ron believed that the only option he had when attacked by Anne
was to defend himself, point out the errors in her thinking, and
ultimately accommodate. His accommodations were enacted with an air of
disgust, resentment, and condescension.
Anne saw Ron as irresponsible and uncaring, and believed that the only
way she could get a minimal level of involvement from him was to keep
trying to convince him that he was acting like a jerk. Her arguments
were generally launched from an emotional state characterized by anger
and contempt.
Phase One
My goal in the first phase of therapy was to convince each partner that
their own reactions to the unreasonable behavior of their spouse were
blocking the very changes they were hoping their spouse would make. This
was accomplished through individual sessions with Anne and Ron,
respectively.
I suggested to Ron that, from my sessions with Anne, I sensed that her
worst fear was to be discounted or ignored. She felt insignificant in
the family she grew up in, and worried constantly that Ron would not
take her seriously. I shared my hypothesis that, when Ron pointed out
the errors in her thinking, then accommodated her, she felt discounted,
sensing Ron's thinly veiled disgust. I suggested that what she wanted
most from Ron was not his cooperation, but his emotional responsiveness.
I suggested to Ron that Anne would likely drop her angry attacks if she
felt that she was able to "get through" to him emotionally.
Ron was skeptical, but admitted that things couldn't get much worse, and
agreed to spend some sessions exploring his emotional reactions to her.
I suggested to Anne that Ron's worst fear was that she wanted him only
for what he could do for her, and I noted that this fear grew out of his
experience in the family he grew up in where his only affirmation or
recognition came when he did what he was told to do. I suggested to Anne
that, even when she expressed genuine affection for Ron, he believed
that these moments only came when he had sufficiently jumped through
enough hoops for her to be pleased with him. I suggested that Ron's
resentment and emotional distance were directly related to his belief
that, if he doesn't jump through Anne's hoops, he will be punished by
her anger. I shared with Anne my belief that, if she could show Ron that
she would love him even when he disappointed her, he would genuinely
want to please her, and to be close to her emotionally. Anne thought
that this made sense, but said she wouldn't be able to fake like she
wasn't upset when Ron was insensitive. I assured her that I wouldn't ask
her to fake anything, and that she could actually learn how to influence
how she felt toward Ron if she wanted to. She agreed that she had
nothing to lose in trying.
Phase Two
In the second phase of therapy I continued to meet with Anne and Ron for
individual sessions. The goal of individual sessions was to help each
partner (1) recognize the self-protective emotional states that were
habitually triggered in him/herself (Ron's distant resentment/disgust
and Anne's intense anger) when confronted with displeasing behavior in
the other, and (2) develop a greater ability to influence these
emotional states.
Each partner was encouraged to think about their own respective
emotional reaction to the displeasing behavior of their partner, discuss
the impact their reaction had on their partner, and recognize how easily
their partner could pick up on the presence of their emotional state in
nonverbal ways. (Ron said he thought that Anne could smell his
resentment and disgust, even when he tried to veil it). As our
discussions progressed, each partner was able to see how their
self-protective emotional state brought out the worst in the other, and
they each became curious, although skeptical, as to what their partner
would do if s/he didn't respond with the usual emotional reaction.
Gradually, a shift occurred from talking about emotional states to
helping Anne and Ron interact directly with their emotional states --
first with self-protective states, then with vulnerable states. To
interact with an emotional state, the state must be actively "up
and running," so the first task of therapy sessions involved
helping Ron and Anne each activate the self-protective states that were
regularly triggered in interaction with each other.
Anne focused on her anger, which was easily activated by going through a
list of Ron's most recent shortcomings. I encouraged her to think of
this angry state as being "a part of her" with agendas and
reasons for being angry she might not know fully about (Schwartz, 1995).
My goal in these sessions with Anne was to help her develop a
relationship with this angry part of her, to learn from it, and to learn
how to help it calm or shift when needed. I promoted this through a
number of methods, such as helping her (1) recognize that, although she
spent a lot of time in an angry state, she hadn't actually stopped to
give direct attention to it. (2) voluntarily allow the anger to surface
(although the anger was often active, she couldn't remember ever having
tried to access it in the interest of getting to know it better), (3)
formally acknowledge the presence of the angry part of her when she felt
its presence, (4) try to make it feel welcome for a few minutes, (5)
study how the angry state felt in her body, (6) see if she could allow
it to occupy the place it wanted in her body without pushing it away,
(7) notice how she felt toward it, (8) notice the thoughts that tended
to come to her when the angry part of her was present, (9) ask it,
"what is it, specifically, about the situation right now that is
making you so angry?", (10) ask it if it would like to show her
anything from her past that it was still angry about, (11) ask it what
it would like to say to her now, (12) decide what she would like to say
to it, then say it (internally, or out loud), (13) notice its reaction
to what she said to it, and (14) notice how the feeling in her body
shifted as she interacted with it.
It helped Anne to think of the anger as being a part of her, rather than
being central to who she was. She began to visualize the angry state as
a female version of the Tasmanian Devil, and found that it helped to
greet "Taz" with a internal "hello" whenever
"she" became active. Although initially she felt angry at Taz
for "taking over" and making her look crazy, with some
practice she developed the ability to feel both welcoming and respectful
toward this angry part of herself, and found that through internal
dialogue, she could calm Taz down. During one session, as Anne was
focusing on how the angry state was occupying her body, she realized
that she was angry with herself for becoming so dependent upon Ron. This
realization prompted her to explore alternatives for getting some of her
needs met that didn't involve dependence upon Ron. For example, she
hired a decorator to wallpaper several rooms, a job that Ron had
repeatedly promised, but failed to do.
Early in her work with the angry state, Anne found that when she
sustained her attention on the anger for even a few moments, the anger
would yield to a more vulnerable state, characterized by feelings of
loneliness, rejection, and undesirability. At first, she was embarrassed
by her tears, and disgusted with her inability to control herself, but
with my encouragement, she was able to give the vulnerable state a
welcoming. She acknowledged that this vulnerable part of herself was
always around, just beneath the surface, and that she tried in various
ways to keep it from surfacing, especially in the presence of others. As
she became able to tolerate and sustain the presence of this vulnerable
state, she learned that she could also comfort it. A visual person, Anne
was able to "see" this part of her when she felt it's
presence, and she could interact with it, asking it questions, listen
for responses, offering words of comfort, accompanying it while it
reminded her about painful experiences that had occurred in the past.
In his sessions, Ron practiced coming into contact with the detached,
resentful, condescending feeling state he had whenever Anne became
unreasonable. With Ron, I used many of the same methods I used to
facilitate Anne's relationship with her angry and vulnerable states.
However, unlike Anne's anger which was fully and openly expressed, Ron's
self-protective resentment simmered beneath the surface. In fact, when
he first began to explore his emotional reaction to Anne, he said he
felt nothing at all. As I helped him explore the physical quality of
this "nothing," he became aware of resentful and condescending
feelings. He was reluctant to sustain contact with the resentful state,
but with my help, he was able to keep it active for minutes at a time,
and he reported feeling a good deal of relief each time he was able to
acknowledge it and give it a good, welcome hearing.
On one occasion when he was in contact with the resentful feeling, I
suggested to Ron that he ask this part of himself, "What is it
about Anne's anger that is most upsetting to you?" After listening
to himself for a minute or so, he said, "Anne doesn't believe in me
anymore." As he said this his eyes filled with tears, but he
quickly shifted back to his matter-of-fact tone. I said, "who was
that guy just then -- the one who feels so deeply? Ron responded,
"He doesn't come around much any more... " His eyes filled
again, and I responded, "Let him know that he's welcome here...in
fact, I think we need him." I proceeded to assist Ron as he allowed
himself to experience the depth of sadness and loneliness he felt about
losing Anne's faith in him and her sustaining support. He confessed that
Anne had never experienced this side of him, and seemed heartened by my
statement that she needed contact with this part of him very much.
In each of the sessions that followed, Ron spent some time with
vulnerable feeling states, sometimes in relation to Anne, other times in
relation to events that occurred at work or thoughts or memories he had
of his family. After ten individual sessions, Ron was clearly more
comfortable being in contact with his vulnerability, and less worried
about being able to handle the intense feelings that sometimes came with
it.4
Phase Three
Phase three had already begun by the time I reconvened Ron and Anne for
conjoint sessions. Anne had found some alternative ways to meet her
needs and was considerably less angry with Ron, and Ron had stopped
defending himself, had stopped trying to show Anne that she was being
unreasonable, had begun simply standing his ground on some issues, and
was feeling considerably less resentful toward Anne.
Early in the conjoint sessions, Ron and Anne enacted their usual pattern
(Anne became angry and began accusing Ron, and Ron defended himself with
a condescending tone). On these occasions I was able to stop each of
them and help each recognize the emotional state that had become
activated, decrease the intensity of these states, then facilitate a
shift to more vulnerable states, as I had helped them do in individual
sessions. Ron was able to allow Anne to come into contact with the part
of him who felt lonely, abandoned by her, and who once thrived on her
support. Anne was able to respond with tenderness, assuring Ron that she
missed how he used to need her. Anne was able to allow Ron to come into
contact with the part of her who felt insignificant and worried that he
wouldn't take her seriously, and Ron also offered reassurance.
Its important to note that Ron and Anne didn't just talk about their
vulnerable feelings to one another. Rather, they actually allowed these
feelings to surface during the sessions. This usually occurred after one
partner triggered a self-protective reaction in the other. For example,
on one occasion, Anne became angry toward Ron and he responded with a
disgusted look and pointed out how unreasonable she was being. When Ron
said, "you just don't get it, Anne!", I noticed a hurt look
flash across Anne's face. I asked questions about what was happening
with her at that instant, and Anne was able to access the insecure
feeling she always gets when Ron becomes disgusted with her. As she did
this, Ron apologized, reaching out to touch her hand.
Toward the end of therapy, the couple spent time giving and receiving
suggestions regarding how they could avoid tripping each other's
emotional triggers in the first place. For example, Anne suggested that,
if Ron would assure her that he wasn't blowing her off each time he
changed plans, it would help her stay calmer. Likewise, Ron let Anne
know that it would help if, when she had a complaint, she would preface
it by saying "I'm trying not get angry, Ron."
Therapy with Anne and Ron lasted 31 sessions over a span of 5 months. In
my most recent conversation with them, five months after the last
session, Anne had just given birth to their second child, and reported
that their relationship was going well.
Discussion
Pragmatic/experiential therapy for couples facilitates two levels of
systemic change, each of which can be seen in Anne and Ron's therapy.
First, a change can be seen in Anne and Ron's interpersonal relationship
system which, prior to therapy, was characterized by a mutually
reinforcing interactional pattern involving Anne's angry pursuit/demands
and Ron's distant withdrawal/accommodations. Over time, Anne's angry
pursuit and demands became less intense, and she focused less on
changing Ron and more focused on organizing her own life for greater
satisfaction. Ron became less withdrawn and began asserting himself more
in the relationship. As he came to feel more of an equal with Anne, he
became much more engaged in planning the direction and activities of
their lives together.
Ron and Anne each came to realize that the objectionable behavior of the
other was fueled by their own reactions to it, and that their own
reactions were part of a pre-programmed emotional response system that
was triggered at pivotal times. Each partner became more able to
recognize signs indicating that his/her self-protective state was
"up and running," more able to recognize if and when it was a
good idea to attempt to decrease the intensity of the state, and more
willing to explore methods for accomplishing this.
A second level of change was facilitated in the system of emotional
states operating within each partner. Internal systems operate according
to similar processes as do interpersonal systems (Schwartz, 1995). In
the internal system of an individual experiencing relationship distress,
self-protective states are usually reciprocally organized in relation to
vulnerable states, so that the more vulnerable such a person becomes,
the more self-protective the person will be, and the more
self-protective the person is, the more vulnerable the person will feel
when not protecting him/herself. In highly distressed couples,
self-protective states are often triggered every time a partner feels
vulnerable in the relationship. For each partner, self-protective states
give immediate relief from the uncomfortable feelings associated with
their own vulnerable states. However, if self-protection becomes
chronic, it can facilitate an intensification of vulnerability, because
the individual who habitually distances from his/her own vulnerable
feelings through self-protective states loses the opportunity to become
skilled in interacting directly with the vulnerable states in a way that
decreases the intensity of the states. Lacking this ability, such
individuals go to extreme lengths to avoid vulnerable emotional states,
and self-protective states are one means for accomplishing this. The
result is an internal systemic escalation and polarization in which both
vulnerable and self-protective states become more extreme in relation to
one another.
As Anne and Ron's therapy progressed, the polarization between
self-protective and vulnerable states became less intense as each
partner developed more of an ability to sustain contact, interact with,
and lessen the uncomfortable feelings associated with their own
vulnerable states. Correspondingly, each partner was more able to
recognize and avoid triggering self-protective states, and thus avoid
his/her behavioral contributions to the to the distressing interpersonal
escalations that characterized their relationship when they entered
therapy. For example, as Anne became more able to calm the sense of
insecurity and loneliness that was triggered in her when Ron became
distant, she became more able to refrain from her usual angry/demanding
response. She developed more of an ability to share her loneliness with
Ron in a non-imposing way, and calmly set limits with him when she felt
taken advantage of. Similarly, as Ron became more able to calm the
anxiety and fear that was triggered in him when Anne became angry, he
was more able to refrain from his usual detached, condescending and/or
placating response. He began to stand his ground without activating the
detached/condescending self-protective state, and more able to share
honestly his fear of her rejection when he did stand his ground.
Ron and Anne's therapy was typical of the pragmatic/experiential
approach. In the first phase, each of them became clear about their own
contributions to the distressing mutual escalations which drove them
into therapy. In the second phase, they developed abilities they would
later use to change their respective contributions to the escalations,
and in the third phase, they used the abilities they had acquired in
phase two to change their usual ways of interacting with each other.
While all couples progress through each of the phases in this approach,
a limited number do not require conjoint sessions in phase three,
because once each partner realizes that his/her own reactions are
fueling the behavior they want their partner to change (in phase one),
and they begin developing the ability to change their own reactions to
their partner, (in phase two, individual sessions), they begin altering
their own contributions to problematic escalating interactions with
their partner, spontaneously.
Phase two of this approach is pivotal, and requires a few words of
explanation. In this phase, each partner develops the ability to come
into meaningful contact with emotional states, usually beginning with
self-protective states and then moving toward vulnerable states. An
attempt is made to bring partners into contact with the emotional states
that have been repeatedly triggered in response to distressing behaviors
of their partner. However, the focus of therapy often shifts to other
emotional states, either because, as the original state is being
explored, a second state emerges, or because the client comes to a
session with another state "active" to some degree. In this
approach, the therapist encourages clients to come into contact with
whatever state is present, not just the states that are triggered in
interaction with their partners. It makes little difference, because the
ability to be in meaningful contact with emotional states generalizes.
Once developed, the ability can be applied to any state, including
states that are triggered in interaction with one's partner.
When I speak of "influencing" emotional states, it is
important to clarify that the kind of influence I am speaking of is
earned rather than imposed. This is an important distinction, arising
from my observation that, when a client becomes a compassionate presence
to their own emotional experience, emotional states tend to balance and
moderate themselves (becoming more "cooperative," if you
will). Helpful contact with "live" emotional states involves a
kind of self-accompaniment, a gentle attentiveness and curiosity about
the physical quality of the emotional state, and about the thoughts and
desires that come with the emotional state. A shift in emotional state
arises from an exploration and acceptance of one's feelings, rather than
from a willful attempt to change what one is feeling.
Finally, since this approach to therapy involves activating and working
directly with vulnerable emotions of clients, it is vital that the
therapist is able to be a compassionate presence to each client's
emotional experience. In order to do this, therapists must have
developed the ability to be a compassionate presence to their own
emotional experience, especially vulnerable emotional states. Therapists
must be able to recognize when their own emotional states are triggered
in the context of therapy, and be able to help them shift if they might
interfere with the therapy process. Accordingly, training in
pragmatic/experiential therapy should encourage attention to the
trainee's own emotional experience (Atkinson, 1997a, 1997b, 1997c).
References
Atkinson, B. (1992). Aesthetics and pragmatics of family therapy
revisited. Journal of Marital and Family Therapy. 18, 389-393.
Atkinson, B. (1993a). Knowledge within a human ecology paradigm.
Constructed Realities: Therapy, Theory and Research. Svolvaer/Kabelvag,
Norway, June, 1993.
Atkinson, B. (1993b). Hierarchy: The imbalance of risk. Family Process,
32, 167-170.
Atkinson, B. (1996). Embodied Mind: Implications of Recent Brain
Research for Clinical Practice. Paper presented at the 8th World
Congress of the International Family Therapy Association. Athens,
Greece, July 7, 1996.
Atkinson, B. (1997a). Informed consent form. In C. Storm and T. Todd
(Eds.), The reasonably complete systemic supervisor resource guide.
Boston: Allyn & Bacon Publisher.
Atkinson, B. (1997b). What is the difference between personal therapy
and person-of-the-therapist supervision? In C. Storm & T. Todd
(Eds.), The reasonably complete systemic supervisor resource guide.
Boston: Allyn & Bacon Publisher.
Atkinson, B. (1997c). Risks and safeguards in person-of-the-therapist
supervision. The Supervision Bulletin, 9(3), 4-5.
Atkinson, B. (1998). At the mind/body interface: The relevance of recent
studies in the neurophysiology of emotion for clinical practice.
Unpublished Manuscript.
Atkinson, B., & Bailey, A. (1987). Family physician as strategic
consultant. Journal of Strategic and Systemic Therapies, 6(2), 74-75.
Atkinson, B., & Heath, A. (1987). Beyond objectivism and relativism:
Implications for family therapy research. Journal of Strategic and
Systemic Therapies, 6(1), 8-18.
Atkinson, B., & Heath, A. (1990a). Disadvantages of problem
resolution: An extended conversation in therapy. Journal of Strategic
and Systemic Therapies, 9(4), 34-46.
Atkinson, B., & Heath, A. (1990b). Further thoughts on second-order
family therapy (This time it's personal). Family Process, 29(2),
145-155.
Atkinson, B., & Heath, A. (1990c). The limits of explanation and
evaluation. Family Process, 29(2), 164-167.
Atkinson, B., Heath, A., & Chenail, R. (1991). Qualitative research
and the legitimization of knowledge. Journal of Marital and Family
Therapy, 17(2), 161-166.
Atkinson, B., & McKenzie, P. (1987). Family therapy with adolescent
offenders: A collaborative treatment strategy. American Journal of
Family Therapy, 15(4), 303-312.
Bernstein, R. (1983). Beyond objectivism and relativism. Philadelphia:
University of Pennsylvania Press.
Bernstein, R. (1992). The new constellation. Cambridge, Massachusetts:
MIT press.
Bowen, M. (1978). Family therapy in clinical practice. New York: Jason
Aronson.
Damasio, A. (1994). Descarte's error: Emotion, reason and the human
brain. New York: Grosset/Putnam.
Fisch, R., Weakland, J., & Segal, L . (1982). The tactics of change.
San Francisco: Jossey-Bass.
Gendlin, E. (1981). Focusing. New York: Bantam.
Gendlin, E. (1996). Focusing-Oriented Psychotherapy. New York: Guilford.
Greenberg, L., & Johnson, S. (1988). Emotionally focused therapy for
couples. New York: Guilford Press.
Greenberg, L., Rice, L., & Elliot, R. (1993). Facilitating emotional
change: The moment-by-moment process. New York: Guilford Press.
Greenberg, L., & Safran, J. (1987). Emotion in psychotherapy. New
York: Guilford Press.
Heath, A., & Atkinson, B. (1989). Solutions attempted and
considered: Broadening assessment in brief therapy. Journal of Strategic
and Systemic Therapies, 8(3), 56-57.
Johnson, S., & Greenberg, L. (Eds). (1994). The heart of the matter:
Perspectives on emotion in marital Therapy. New York: Brunner/Mazel.
Kerr, M., & Bowen, M. (1988). Family evaluation. New York: W.W.
Norton.
Kurtz, R. (1990). Body-centered psychotherapy: The Hakomi method.
Mendocino, CA: LifeRythm.
LeDoux, J. (1996). The emotional brain. New York: Simon & Schuster.
Mahrer, A. (1996). The complete guide to experiential psychotherapy. New
York: John Wiley & Sons.
Maturana, H., & Varela, F. (1987). The tree of knowledge: The
biological roots of human understanding. Boston: New Science Library.
Ornstein, R. (1986). Multimind. Boston: Houghton Mifflin.
Ornstein, R. (1991). The evolution of consciousness. New York: Prentice
Hall.
Panksepp, J. (1982). Toward a general psychobiological theory of
emotions. The behavioral and brain sciences, 5, 407-468.
Panksepp, J. (1985). Mood changes. In P.J. Vinken, G.W. Bruyn, & H.L.
Klawans (Eds.), Handbook of clinical neurology (vol. 1, pp. 271-285).
Amsterdam: Elsevier.
Panksepp, J. (1986). The anatomy of emotions. In R. Plutchik & H.
Kellerman (Eds.), Emotion: Theory, research and experience. Vol. 3.
Biological foundations of emotion. New York: Academic Press.
Panksepp., J. (1989). The neurobiology of emotions: Of animal brains and
human feelings. In T. Manstead & H. Wagner (Eds.), Handbook of
anxiety: Vol. 3. The neurobiology of anxiety (pp. 3-58). Amsterdam:
Elsevier.
Panksepp, J. (1992a). A critical role for "affective
neuroscience" in resolving what is basic about basic emotions.
Psychological Review, 99, 554-560.
Panksepp, J. (1992b). Neurochemical control of moods and emotions. In M.
Lewis & J. Haviland (Eds.), Handbook of emotions. New York:
Guilford.
Rorty, R. (1991). Objectivity, relativism and truth. New York: Cambridge
University Press.
Safran, J., & Greenberg, L. (Eds.) (1991). Emotion, psychotherapy,
and change. New York: Guilford.
Schwartz, R. (1995). Internal family systems therapy. New York: Guilford
Press.
von Foerster, H. (1984). Observing systems. Seaside, CA: Intersystems
Publications.
Watzlawick, P., Weakland, J., & Fisch, R. (1974). Change: Principles
of problem formation and problem resolution. New York: W. W. Norton.
Endnotes
1Influenced by the postmodernist perspective, I believe we
can never know with certainty the best answers to questions such as,
"How do relationships work?" or "What makes people
healthy?" However, I do operate from the assumption that there are
real dynamics that influence, for example, how relationships work, and
that these dynamics exist independently of how we describe them
(Atkinson, 1992, 1993a; Atkinson & Heath, 1987, 1990b; Atkinson,
Heath and Chenail, 1991). It may help to think of these dynamics (and
other aspects of reality) as having broad and vaguely defined features
-- but they are not totally without features. Because they have some
features, we can generally agree that not just any description of them
will fit. But because the features are sufficiently vague and often
fluid, many descriptions may be plausible, and different descriptions
may be more accurate at different times. In my view, the postmodern
attack on certainty does not necessitate giving up on the idea that some
explanations and practices may really be better than others, nor does it
mean that we should stop trying to find better ways, or that we should
stop trying to persuade each other of the relative value of various
points of view. It just means that nobody can know for sure what the
best answer is, and everyone had better judge the evidence for
themselves.
2This is not always the case. Occasionally, I have
encountered a partner who seemingly has little ability to protect
him/herself emotionally. The principles and methods described in this
paper apply to such individuals as well, since (as will be discussed
later in this paper) therapy with those whose behavioral contributions
to the marital distress are embedded in self-protective states
ultimately focuses on work with underlying vulnerable states. Those who
enter therapy interacting with their partner with excessive
vulnerability are generally ready to work with vulnerable states sooner
than those whose interaction with their partner is embedded in
self-protective states.
3It is not the purpose of this therapy to eradicate
self-protective states. Often, the activation of a self-protective state
is necessary before a partner can assert him or herself in the
relationship, or refrain from allowing him or herself to be taken
advantage of. For example, a partner may not be able to say
"no," unless they are really angry, or unless they detach from
the other to a certain degree. Problems arise only when self-protective
states prevail beyond the point at which they are needed in order to
maintain boundaries with the other partner. As partners become more able
to decrease the intensity of painful feelings that often accompany
vulnerable emotional states, they are more able to use self-protective
states only as they are needed. In highly functioning partners, there is
a balance between self-protective and vulnerable states, and partners
are able to interact with each other while experiencing either state.
4The assumption behind this method of therapy is that a
certain feeling of vulnerability is normal and healthy in human
relationships, and that highly functioning partners are able to share
feelings of vulnerability with one another. However, it does not follow
that more vulnerability is always better in relationships. Unless each
partner is able to decrease the intensity of uncomfortable feelings that
often accompany their own vulnerable states, they will either
chronically activate intense, self-protective states, or they may
overwhelm their partner with their neediness, or both. This is one of
the reasons why I help partners work with their own vulnerable states in
the second phase of therapy before helping them sharing vulnerable
feelings with their partner in phase three.
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