Couples have a nonconscious, intersubjective system between the two partners that has been existent and developing in complexity since they first met each other. It has been well-established in recent years that this type of system gestates during childhood and becomes the template that dictates who we will be attracted to and commit to as a life partner.
I have written many times about the radical intersubjective stance that Neurodynamic Couples Therapy takes regarding the treatment of couple relationships. In essence, we are treating what happens between the partners–not individual psychologies. The theory holds that it takes two brains in each other’s presence to access the affective material that has been generating the couple’s conflicts in order to heal historical wounds. The individual psychologies heal and change through the couple work.
“You can’t go back and change the beginning, but you can start where you are and change the ending.”
It is said to be ‘the most wonderful time of the year,’ however, we must recognize that the winter holiday season is not a season of festivities and joy for everyone, especially those grappling to live with the loss of a loved one. As social workers, this truth offers us opportunities to reflect on the pain, loneliness and sorrow some may feel and offer to hold space for those in need of hope and comfort in knowing that they are not alone. Pausing and remembering the past weeks, months, and for some years of difficult times, we can remember the poignancy of memories, the grief, the sadness, the hurts, the pain of reflecting on our own mortality.
One of my patients recently informed me that November is the National Month of Gratitude. This makes sense given the date of our Thanksgiving Holiday. It reminded me of some basic mannerisms and courtesies associated with general civility but also within the context of professional social work. Patients often express gratitude for the care they receive at my clinic. Their topics of discussion are typically too delicate to share with family and friends. Many feel socially isolated or disenfranchised to openly discuss such sensitive and personal matters. Similarly, I try to remain grateful to my patients for inviting me to discuss their private thoughts and feelings.
I have been thinking a lot about self-care in my work with patients experiencing high-stress circumstances. In my practice, with peers and patients, I tend to ask, “what are you doing to take better care of yourself?” The frequent response is so common it could be considered universal …blank stare, awkward silence, and a sheepish, “I don’t know,” usually accompanied with a shrug.
Most therapists have had the experience of feeling that a treatment is being derailed and perhaps headed for failure. Even when we are able to see it coming and try to redirect the treatment, it can be like attempting to turn a battleship around (as the saying goes).
September is Suicide Prevention month. Suicide continues to be among the leading causes of death in the U.S. This public health challenge affects various population groups ranging from youth to White men and Native Americans to Veterans. According to the American Foundation for Suicide Prevention, 94% of adults believe that suicide can be prevented. When considering this and protective factors such as social support, relationships are an area to further explore. A question is “how can we be more intentional to support meaningful social connectedness?” Social connectedness is recognized among the pillars of lifestyle health. Being connected well has been researched through the quality of interactions, belonginess and longevity. Social connection was recently discussed in relation to near-term suicidal ideation (Ammerman & Jacobucci, 2023). Preliminary evidence suggested the need to assess for current social contact in conjunction with the risk for suicidal ideations. This could facilitate timely interventions.
In previous blog posts, I have written about the importance of understanding a couple’s persistence in seeing one partner as the identified patient. Quite often, couples will enter treatment with both partners having decided that there is something wrong with the other, and that they themselves are in fact “normal” or “innocent.”
A major goal of Neurodynamic Couples Therapy is to help partners complete the metabolizing of troublesome emotions, which they have already been nonconsciously attempting to accomplish through their conflicts. Some forms of therapy purport that this metabolizing can be done nonverbally, but we believe that it takes the translation of right-brain experiences into words in order to adequately and fully create the understanding of self and the other that is necessary for genuine empathy.
John Donne penned the often-quoted line “No man is an island entire of itself”. Similarly, most of us are familiar with the African proverb “it takes a village”. One of my personal favorites is a quote from Aristotle “nature abhors a vacuum”. As clinical social workers we come alongside individuals, couples, and families at some of their most challenging times; but we don’t do the work alone. We collaborate with our clients, their families, support systems, community resources, other providers and the list goes on. We recognize that healing happens best when we engage our clients within a larger restorative community.
The Corona Virus Pandemic taught us numerous life-long learning experiences.
Three years later, we continue transitioning.
Mandatory masking was finally lifted a few months a- go.
Some of us working remotely returned to the office for increased socialization.
Others found remote work was perfect and won’t look back.
Virtual modality of conducting business is a new norm.
As things return to their new “normal”, a greater emphasis is now placed on not solely existing.
But Living and finding a good work and life-balance.
Compressed schedules have gained popularity.
Work meetings are integrating a few minutes for meditation and social interaction.
Self-care and being happy are now cultivated and encouraged.
Finding joy in life again is a new must.
So I’m working on re-shifting my life-long process of self-sacrifice for the cause of serving others..
To focus on helping myself.
And find joy again.
Have you found yours?
As I was growing up, I remember one of the mantras that I heard from some of the adults in my world. They would say one of the best approaches to difficult situations is encapsulated in the acronym KISS–Keep It Simple, (warning! pejorative word coming up) Stupid. I found this to be quite helpful as I grew and developed.
Juneteenth became a National Holiday in June 2021. For years, this observance also known as Freedom Day was celebrated across African American communities and into others. Juneteenth is widely becoming an American observance and provides an opportunity to learn the full narrative. Enslaved people in Galveston Bay, Texas were informed of their freedom on June 19, 1865, however, enslavement continued in some U.S. border states. At the end of the year, the 13th Amendment abolished slavery in America. As we reflect on the past and embrace how far society has come, optimism and open perspective can guide mindsets. Social well-being and health equity are central to ongoing progress. The underserved and under resourced people are part of a humanity, deserving of social parity and access to care. The disparate conditions affecting them can be seen as remnants of practices such as redlining. Similarly, maternal health disparities largely impacting Black women have some origins in implicit bias. As clinical social workers and human service professionals, what is your call today for the cause and how can you activate it? Does the practice setting provide space for advocating, mediating, or bridging the gap as a trusted professional?
The New Oxford American Dictionary defines resistance as “the refusal to accept or comply with something”; and “the ability not to be affected by something, especially adversely.” Our training histories as therapists have unfortunately tended to focus more on the first definition. I would like to challenge us to think more about the second one.
Brenda was a beautiful woman with long black hair who came for therapy and recounted her story: “Two months ago I had a double mastectomy. At that time, my husband left me for another woman. My daughter, who saw me through all this, is leaving next month for school in California. Now I have no one. Both my parents died in a car crash when I was 12. I went to live with my grandmother who died when I was 17. That’s when I got married. And now I have no one.” She stared straight ahead, lost in reverie. The image of her parents’ violent death, her mastectomies, and all her other losses were overwhelming.
As a private clinician, and Manager of the Social Work Department at the Valley Hospital, collectively we view our purpose as making a difference, making connections, making meaning and making a life- all of which entails breaking barriers on a daily basis. As social Workers, we are trained to help people address personal and systemic barriers to optimal living. Social workers are tasked uniquely to assist patients in the most difficult psycho-social circumstances and guide patients families and medical providers with navigating medical care coordination and social service challenges in the midst of an unprecedented pandemic. We must adapt to change manage stress and innovate. We are employed to effect positive change with individuals, families, groups and entire communities. Social workers use their collective skills to establish policies that give more people to access community services.
In the previous blog post, I addressed the importance of using the present-day conflicts that couples bring to therapy to access historical wounds, traumas and losses. But often couples don’t want to talk about their pasts. They have usually come to deal with current conflicts–not their family histories.
Intersectionality refers to the interconnectedness of social categories such as race, gender and socioeconomic status. It can enhance understanding an individual and the interplay among their identities. For example, a person may identify as non-binary and self-report in an ethnic minority category. In addition to these primary identities, there could be less salient ones such as religious or spiritual preferences and generational group. Intersectionality was first coined in 1989 by Kimberlé Crenshaw, Columbia University law professor, to describe factors contributing to the social being of African American women. In particular, the intersection of their race and gender was purported as a significant factor. Intersectionality became widely applied over the years and has relevance when understanding systems and structures that impact vulnerable populations such as children and persons who are wrongfully criminalized. Consider a child who experienced adverse events such as family violence and is also subjected to impoverished conditions. Knowing them from these circumstances will offer insights for clearer visibility.
Couples come to see us to help them resolve their conflicts — not to create growth. But if we stop at attempting to help them resolve their present-day conflicts without moving on to creating growth, we have cheated our clients out of at least half of the potential of couple treatment.
