Challenges in Couples and Couple Therapy Series

"Ouch! Where'd that come from?! The Borderline in Couples and Couple Therapy" addresses how the couple with a partner with borderline personality disorder challenges the therapeutic relationship in couple therapy as borderline issues and behaviors inevitably erupt simultaneously at home and in session. The therapist often considers working with the individual with borderline personality disorder among the most difficult clinical work to manage in therapy. The book explains how the couple can be the fundamental healing dynamic for the individual with borderline personality disorder. The couple therapist is guided through examination of the borderline character how to manage borderline reactivity targeted not only at the partner but also at the therapist. The therapist is prompted to attend to his or her feelings and instincts provoked by the individual- that is, counter-transference for assessment and direction for treatment. This includes borderline, partner, and therapist vulnerability desires to be "special." For the partner and the therapist, this leads to lack of preparation when naively traipsing among borderline traps hidden in the relationship, subsequent emotional, psychological, and relational injury- "Ouch!", and the shocked question of "Where'd that come from!?" The existential trinity of the individual with borderline personality disorder: betrayal, abandonment, and rejection (B-A-R) direct the partner and therapist response trinity: caring compliance, intimacy, and acceptance (C-I-A). Directions for combining confrontational and holding theories for therapy address borderline acting out, aggression, and abuse of the partner and the therapist. The individual's core paradigm that he or she cannot suffer emotional or attachment distress and survive is identified and subsequently, is challenged. Changing the borderline paradigm leads to clinical strategies for individual and relationship change. Practical applications including realistic quantitative change goals in five specific areas are explained for how they lead to qualitative change. Explanations and examples are presented about how incremental behavioral changes lead to greater intimacy and more fulfilling relationships. The book explains how the partner of the individual with borderline personality disorder is often targeted by the individual and in couple therapy to the detriment of growth and change. The therapist learns how to re-direct the partner from misguided attempts to meet needs and demands that perpetuate the individual's personal borderline-based mythology and dysfunctionality. Strategies are presented to empower and direct the therapist's stance and role to resist and challenge borderline demands, remove borderline entitlement to punish the therapist and the partner, while providing the deeper psychological support the individual craves. The therapist learns how to empower and direct the partner in a critical quasi-therapeutic role that provides boundaries, nurturing, and the reparative relationship necessary to support, heal, and guide the individual with borderline personality disorder.

“Conflict, Control, and Out of Control in Couples and Couple Therapy” addresses the continuum of assertion, aggression, and abuse between partners. The therapist is guided how to promote appropriate assertiveness and aggression while avoiding crossing the boundary of abuse. Conflict is intrinsic to most couples, but relative control vs. getting out of control varies greatly resulting in relationship health or dysfunction. The therapist is directed how to guide partners how to deal w/ anger and frustration- learning how to fight fairly and productively to prevent emotional abuse. The book discusses conceptual vs. practical distinctions between normal couple therapy and domestic violence therapy. Therapist boundaries and choices to engage or not in domestic violence therapy become functionally problematic when intimate partner violence is unanticipated but uncovered in sessions. The therapist will learn how to assess for, manage, and treat partners when emotional reactivity becomes emotional abuse- a focus of normal couple therapy; when verbal abuse predicts physical abuse; and when domestic violence is revealed. The book discusses attachment, bullying dynamics, cultural models, social information processing, verbal fluency, empathy, peer, cultural, and gender models, same sex relationships, disinhibition, stressors, dialogical processing, hypersensitivity and hypervigilance, and characterological issues including paranoid and antisocial personality disorder affecting partners' conflict, control, and out of control issues. The therapist will learn to shift couple therapy strategies and goals when noting distinctions between reactive aggression, abuse, and instrumental aggression more characteristic of sociopathic partners. Beyond fundamentally altering treatment to avoid perpetuating abuse, the therapist must identify counter-indications for conducting couple therapy.

"Scorpion in the Bed, The Narcissist in Couples and Couples Therapy" guides essential adjustments in therapy to deal w/ the narcissism of one partner in a couple. Otherwise effective couple therapy interventions fail if narcissism is missed, since narcissism affects all aspects of relationship functioning: intimacy, communication, reciprocality/mutuality, equity negotiation, boundaries, roles, & so forth. Intimacy & connection as expressed goals do not supersede the narcissist's compulsive needs for grandiosity, omnipotence, self-righteousness, & entitlement. Understanding narcissistic disruption & attacks- scorpion stings difficult to manage in individual therapy, direct dealing w/ couple therapy complexity including the partner who has endured narcissistic stings. Origins & characteristics of narcissistic personality disorder guide couple therapy similar to, but often highly distinctive from individual therapy. Beyond the therapist & narcissist dynamics, are 3 additional dynamics crucial to couple therapy: therapist & non-narcissistic partner, narcissist & non-narcissist partner, and therapist & couple. More passive or egalitarian therapies are shown to be counter-indicated because they often do not deal w/ grandiosity, self-righteousness, & resultant entitlement to strike out at others. Conceptual foundation & strategic approaches require the therapist to take a powerful, assertive, & authoritative role & stance to confront & successfully address individual narcissism & its effect in the couple. The therapist will learn interventions based on anxious partner scrutiny of the therapist to see if he or she will be similarly manipulated & abused. Therapist failure to successfully manage narcissistic assaults destroys the partner's hope for successful therapy & an improved relationship. The strong counter-transference of disliking the narcissist improves accurate assessment of narcissism & gives direction for effective treatment. The therapist must own & manage his or her need to be liked & respected, including any overt or latent personal narcissism. The therapist will learn how & why the narcissist instinctively & overtly attacks such issues in the therapist. A third-observer strategy to deal w/ narcissistic dismissal & omnipotence is presented for empowering both partner & therapist feedback. Without this key strategy, the therapist remains disempowered & dismissed by the narcissist to offer any interventions not to his or her liking. The therapist is directed to recognize that couple therapy may be the one & only opportunity to salvage the relationship. Despite recommendations to refer the narcissist to individual therapy to deal first w/ the personality disorder, the couple's viability may not tolerate any delay in treatment. Couple therapy is conceptualized as the best opportunity to force the individual teetering on the precipice of relationship dissolution to face his/her narcissism, including specifically his/her grandiosity. The book also describes the several types of & rationales for partners, specific personalities, & personality disorders who couple w/ narcissists. Included is a type of partner w/ non-pathological but defining family-of-origin experiences, who is also most likely to eventually transcend the partnership w/ a narcissist. The therapist is guided how to simultaneously manage these various partner styles along w/ the narcissistic personality for effective couple therapy. Couple therapy that includes a narcissistic partner is significantly more complex & difficult. The narcissism is not an extra or merely an important element in the couple, but fundamentally defines the couple, including how & why the partners coupled & remain coupled or not. Successful couple therapy that includes a narcissistic partner requires a conceptually sophisticated & skilled therapist wary of but able to deal w/ the scorpion's sting.

Individuals with dependent personality disorder or histrionic personality disorder create relationships that fundamentally challenge their partners, and when present in couple therapy, challenge the therapist. Despite enthusiastic participation in couple therapy, both dependent and histrionic behavior can seductively sabotage: one through deference and the other through flamboyance, an appropriate therapist-client relationship. These are parallel processes that create dysfunction in the couple, and waylays true intimacy and connection. The therapist will learn how to identify and manage both dependent and histrionic manipulations in therapy. While the dependent personality turns his or her partner into the sun, the moon, and the stars- the center of the relationship, the histrionic personality demands to be the sun, the moon, and the stars in every relationship. While a couple with a dependent partner and a couple with a histrionic couple may behaviorally appear and present in stark contrast to the therapist, conceptual similarities can empower treatment. Couple therapy must help partners of either personality who initially enjoyed the relationship create a new balance in the couple. The therapist is guided to incorporate conceptual understanding and compassion for the personality disordered individuals to challenge their fundamental survival mechanisms, which have become problematic. Origins of the disorders are examined to direct individual and couple therapy strategies. Of critical importance are the common emotional and psychological roots for both disorders despite their contrasting behavioral manifestations. Difficulties arising from the deep existential anxieties of the disorders both complicate and guide therapeutic intervention. The “good girl” and “bad girl” anxiety for female dependency is examined for how it elicits a “bad guy” role for the frustrated male partner. Passive aggressive strategies for the dependent individual are revealed. The therapist is directed to the deep fragile vulnerability of the histrionic that drives behavior. As a life strategy, it draws at least two types of partners into a skewed relationship. The reward or benefits for the “bland” partner or the obsessive controlling partner reveal their dysfunctional reciprocal dynamics with a histrionic partner. Gender and cultural influences are considered for diagnosis and treatment. Tendencies for dependent vs. narcissistic vs. histrionic characteristics caution diagnosis within groups: male and female, business and other mainstream situations, and heterosexual and homosexual communities. The therapist will learn about how male dependency otherwise not culturally supported may express in violent aggression. The book offers strategies for therapy for couples fundamentally shaped by these two personality disorders.

“Sorry is not Enough, Infidelity and Betrayal in Couples and Couple Therapy.” Despite social, cultural, and personal standards of monogamy, affairs remain prevalent in many committed couples. Possibly the most difficult challenge in couple therapy, infidelity in a committed couple can manifest in a variety of forms and for a variety of reasons that reflect the personality and issues of unfaithful partners. The therapist is guided in making accurate assessment of causes and types of affairs leading to therapeutic strategies. Reality that apology no matter how sincere is not enough for recovery lead to areas of clinical exploration. Gender and cultural standards and differences are differentiated as well as characterological issues including personality disorders in the assessment process. Authentic and inauthentic forgiveness in recovery, along with acceptance as an alternative approach/process are examined for reconciliation, as well as the roles of the unfaithful partner and the offended partner in creating the context of infidelity. Immediate considerations at the beginning of treatment including boundaries, decision-making, and discussing the impact of the affair lead to issues of intense scrutiny, transparency, flashbacks, trauma, and assessment of commitment along with etiological considerations such as attachment losses, social modeling, and family-of-origin dynamics that guide the therapist to identify the logic of infidelity and thus, the logic of recovery.

"Mine, Yours, and Ours, Addiction and Compulsivity in Couples and Couple Therapy" demonstrates how the therapist who tries to choose to not work with clients or couples with addiction and compulsivity issues cannot conduct therapy with integrity. As individuals, couples, and family enter therapy, so inevitably does addiction and compulsivity, whether substances or behaviors. The book demonstrates how addiction or compulsivity may be overtly presented, alluded to, or hidden initially in therapy. Arguments about who has what addiction: "mine" or "yours," can obscure addiction or compulsivity that is shared or is "ours." Assessment for addiction and compulsivity is critical in working with couples, since addictive or compulsive elements in a couple effectively sabotage much of the "logical" work of therapy (insight work, communications training, etc.). The therapist must address addiction or compulsivity (perhaps, "first") for other processes to move forward because relationship problems and substance abuse, behavioral compulsion, or addiction are intricately intertwined. The book shows how ambiguous or confusing individual or relationship behaviors become conceptually clear when addiction is uncovered. Problems about relationship, finances, children and family, and work presented in couple therapy often have the shadow of addiction and compulsivity. The therapist will also learn strategies and interventions to avoid therapy being stalemated by removing the necessity of the individual accepting being labeled an "addict." Co-addiction and the co-addict are examined in terms of mutual and reciprocal processes including attachment needs and family and cultural models in the system of the addictive couple. The therapist is guided to follow vague indications or probable concerns involving addiction and compulsivity, since just about anything can lead to self-medicating behaviors. The therapy can be diverted to premature and ineffective problem-solving rather than also addressing underlying causes for repeated choices and behaviors despite inevitable adverse consequences. The therapist is guided to address how a bad choice clearly identified and previously experienced has become an addictive behavior and/or a compelled choice... that is, a destructive compulsion. The role of the therapist is presented in psycho-education, as a witness, in prediction, and in relapse prevention in the process of therapy and change, along with a multi-layered intervention plan that incorporates inevitable relapse.

"I Don't... You Don't... It Don't Matter, Depression and Anxiety in Couples and Couple Therapy" Depression and anxiety are at the root of many relationship problems or are intricately and mutually related to several emotional, psychological, and intrapersonal or interpersonal dynamics. Feelings of not mattering combine with messages to the partner that he or she does not matter trigger. The therapist is shown how all therapy is essentially about depression and anxiety that almost inevitable comes up in intimate relationships or marriage. Resolution of needs to matter or not matter to each other determine whether relationship triggered depression and anxiety is transitory or becomes problematic and chronic. Ineffective and inefficient efforts to alter negative circumstances lead not just to depression, but also to anxiety that anticipates harm not just for an individual but for the couple. There are gender and cultural aspects to depression and anxiety that the therapist should incorporate into treatment. Identification of stressors- both proximal and distal and the individual and the couple's habitual responses lower or increase depression and anxiety. Therapy needs to address these issues along with underlying issues in the family-of-origin including attachment styles, communication patterns, and problem-solving models. The therapist is cautioned to avoid becoming infected with client depression and anxiety. Therapeutic frustration can lead to the therapist feeling his or her clinical actions: feedback, interpretations, caring, sensitivity, wisdom, interventions, and suggestions do not matter. Interrupting client-therapist depressed or anxious infection can be the key intervention to break negative partner mutuality..

"Off, Odd, Different... Special? Learning Disabilities, ADHD, Aspergers Syndrome, and Giftedness in Couples and Couple Therapy." When the therapist or a partner wonders if someone seems off, odd, different, or special, it is a clinical clue to the underlying issues causing dysfunction in the couple. Some individuals have demanded disproportionate time, attention, and energy from childhood and now as adults stress partners in the intimate relationship... and the therapist in session. Learning disabilities (LD), Attention Deficit Hyperactivity Disorder (ADHD), Aspergers Syndrome (AS), and giftedness not only affect academic and cognitive performance in childhood but can also negatively impact social/relational dynamics. Of concern for the therapist, the impact endures and continues for the individual in his or her adult intimate relationships. The therapist will be guided to the existential experience of gifted individuals and other challenged individuals as misfits. Giftedness or extremely proficient capacities must be examined for often unanticipated overwhelming emotional and psychological stress and confusion. The worlds of the LD, ADHD, AS, of gifted individual are examined for corruption of self-esteem and self-image problems starting in childhood and exacerbated by mature intimacy demands. The therapist will learn how to recognize when inaccurate interpretation of social cues harm relationship functionality. The therapist will learn how LD, ADHD, and AS are among thirteen reasons individuals miss social cues. Addressing ineffective reading of the non-verbal communication from a partner will improve receptive and expressive communication for both partners, but for the challenged individual in particular. Therapeutic strategies for dealing with the negative influences of LD, ADHD, AS, and giftedness for the individual direct couple therapy. The therapist will learn about common ineffective and problematic compensations used by challenged individuals, as well the principles for effective response. The therapist is guided to incorporate knowledge about such challenges into therapy to counter harmful impact on and thus, improving the couple's relationship.

The therapist must anticipate complications- anticipate uncovering a "can of worms," that confuse and overwhelm the partners and therapy. Issues arise or intrude that ignite intense emotional reactivity from beneath the psychic surface to make easy living difficult if not impossible. Often minor issues become major issues over time and/or with other contributing factors. The therapist is tasked to uncover how issues interact in complex, nuanced, and fluid ways to influence emotions, thinking, psychology, spirituality, and behavior. Therapy must adjust to discovering that the direction of lower emotional reactivity to reduce problematic behavior although appropriate is complex to activate. Therapy can direct clients how their emotional reactivity including as expressed in bipolar disorder, post-traumatic stress disorder, developmental trauma disorder, sexual trauma, self-medication, and personality disorders function as third partners in the couple that cause seemingly illogical behavioral changes. PTSD not just in warzones but also in family experiences, developmental trauma disorder, and the Predator-Prey-Witness triangle (aka Combat PTSD Trinity) are examined in particular for how they complicate later relationships. Gottman's Four Horsemen of the Apocalypse along with other theories of psychodynamic, attachment, family systems, and family-of-origin help direct important psychoeducation, therapy, and the partners' change. The therapist is guided how to anticipate and use inevitable therapeutic failures as well as issues of chronicity, grief, loss, and self-medication due to high emotional reactivity to hone and adjust the conceptualization, strategy, and direction of therapy.