At the end of the previous post, I described couples therapists with these words: “We are the guardians of safety within the therapeutic system…. We hold the healing frame….” This blog has addressed the issue of therapeutic safety numerous times, but we cannot be reminded too often to take another look at safety.
A few years ago, I nearly left clinical social work. I was working with individuals who use drugs, navigating systems that felt impossible to change. Every overdose loss felt personal. Every barrier, from insurance coverage to stigma, felt insurmountable. I was emotionally and physically exhausted. Then I discovered harm reduction, not just as a concept, but as a paradigm that reconnected me to the values that first brought me to this field.
In the previous post, we looked at the patterns of couples’ interactions that we most commonly see when the partners are in conflict. Now we turn to how we address their patterns therapeutically.
As a clinical social worker and supervisor in a hospital setting, I once assumed that professional advancement naturally reduced the need for oversight. After years of providing clinical care, coordinating interdisciplinary responses, and supervising social workers who support wounded, ill, and injured service members, I believed that experience would protect me from professional blind spots. That belief was quietly challenged through my pursuit of board certification in Clinical Social Work.
Burnout among clinical social workers has become a pressing issue, particularly in today's landscape marked by unprecedented challenges and increasing demand for mental health services. Defined by emotional exhaustion, depersonalization, and reduced feelings of personal accomplishment, burnout not only impacts clinicians’ well-being but significantly affects their ability to deliver effective care. However, integrating self-compassion into everyday practice presents a promising pathway toward sustaining resilience and maintaining professional fulfillment.
Anyone who has done couple therapy is familiar with the patterns of behavior that partners demonstrate with each other from the moment we meet them. Some of these patterns can be pleasurable and functional, but those are not the ones that lead couples to seek treatment. We identify them as patterns because they are repeated with amazing similarity across conflict content. They contain the painful material that has brought the couple to treatment, as both partners compulsively and consistently perform the complementary roles that are necessary to maintain the patterns. Neurodynamic Couples Therapy names these patterns recycling dramas.
What is it that creates human psychological growth and development? To borrow from Winnicott, it takes “good enough” relationships, the type that all therapists strive to have with their clients. Children must feel sufficiently mentally and physically safe in the relationships with their caretakers for their brains to proceed with a natural flow towards useful growth and development. In a sufficiently safe environment, they are allowed to explore that which naturally interests and excites them. Their good enough caretakers know, accept and enjoy the persons they are becoming. Limitations on their behavior are in service of gently enforcing safety, rather than shaming with judgments. Acceptance and understanding from caretakers naturally lead to the development of an authentic and productive self.
Most of us who become psychotherapists want to help people feel better, so we are primed to want to fix their problems as quickly as possible. It is reasonable that couples come to us wanting to feel better as quickly as possible. Most of them want to keep their relationships, although they are often afraid that this might not be possible. They are looking to us for hope, and they want us to stop the painful patterns that they have been repeating with each other. They are at the end of their own attempts and those of their friends and family to change the way they have been relating to each other, and they are trusting that our expertise will make things better.
February is Heart Health Month and cardiovascular conditions continue to be the leading cause of mortality in the U.S. Over 2,500 deaths occur daily from total cardiovascular disease. According to the American Heart Association (2025), cardiovascular disease encompasses several conditions including coronary artery disease and hypertension. The rates of disease and death are higher among women. Risk factors comprising high cholesterol, smoking behaviors and overweight increase the chance of a person developing cardiovascular disease (CVD). While clinical care and medication therapies remain a crucial part of treatment, the interprofessional team including clinical social workers, can support whole heart care. The American Heart Association’s Life Essential 8 measure is holistic in that it incorporates diet, physical activity, avoiding nicotine exposure, sleep health, a healthy BMI, lipid control, blood glucose control and blood pressure management. A Whole Heart approach can advance a healthy lifestyle through interdisciplinary services such as nutrition counseling, health coaching and mindfulness-based therapies. Mindfulness-Based Stress Reduction (MBSR) was studied in a group of women veterans at risk for cardiovascular disease. A cohort of 164 women with CVD risk participated in an 8 week MBSR group (Saban et al., 2022). At follow-up they reported less perceived stress, less loneliness and reduced symptoms of PTSD compared to women who completed the standard 8 week health promotion group. Their psychological well-being improved overall. Similarly, Mindfulness-Based Cognitive Therapy (MBCT) was studied in a group of women who experienced a heart attack. The group therapy was conducted through a teleconference modality as part of their recovery, with the aims of stress reduction. At 6 month follow-up, women from the MBCT group reported greater reduction in stress compared to a control group that received heart health disease information (Spruill et al., 2025). These outcomes underscore the benefits of a Whole Person approach that can leverage the skills of clinical social workers on an interprofessional team.
In the late 1980’s, a film entitled Look Who’s Talking came out in which Bruce Willis gave voice to the inner thoughts and feelings of an infant. I will never forget one scene in that movie, because of its eloquent demonstration of a piece of human development. The baby’s mother is leaning over his crib, with the camera shot of her being from the baby’s perspective. He has been crying, and the mother responds with, “Ooh; it looks like you’re hungry.” The voice of the baby responds, “Whoa! How did she know?!”
A few years ago, the University of Denver administration conducted interviews with corporate CEO’s and upper level management within the government to determine what their students should be learning in order to be attractive in the current job market. The consistent answers were the ability to work in teams and good EQ. Interesting that the art of accompanying is valued in many settings!
The theoretical foundations, structure and techniques of Neurodynamic Couples Therapy provide built-in motivators that enhance a couple’s desire to stay in treatment. Those primary motivators are hope, respect and mutual understanding.
It has been said almost too many times that treating couples is very hard work. But, so what. Most couple therapists aren’t afraid of hard work. What they don’t like is working too hard and feeling like they are getting nowhere. It is very difficult to stay motivated that way.
Throughout my career, I have been drawn to opportunities that blend leadership with service. As a Public Health Service Officer and Licensed Clinical Social Worker, my commitment has always been to serve where the need is greatest. Whether during deployments addressing humanitarian crises or through research focused on homeless veterans, I’ve seen firsthand the difference compassionate leadership makes.
Fleeing treatment is an understandable wish. Effective Neurodynamic Couples Therapy is often frightening and painful–sometimes horribly painful. Metabolizing historical feelings requires that they be relived precisely as intensely as they were originally experienced when first stored, along with the perceived sense of danger that was present in the original experience. It makes sense to be scared of this process, so addressing the wish to flee should be seen as a normal part of the treatment.
There is no doubt that treating couples is often quite difficult. This is a primary reason that many therapists decide to not treat couples at all. In fact, statistics say that the rate of failure for couple therapy is higher than for individual therapy.
Most of the time most of us therapists work as hard as we can to keep a treatment going, knowing that attempts to derail therapy have many meanings that can be explored and understood. I know that I have always been extremely reluctant to “give up.”
What do prospective clients look for when seeking a new therapist? Credentials, education level, years of experience, and specialization are all important. But what about languages spoken, ethnicity, gender, clinician’s age, or their preferred pronouns?
Frequently in my consultation groups, I hear from therapists, “They just aren’t getting it.” They are referring to the couples they are treating who feel particularly frustrating to the therapist. “We’ve talked about the same things over and over again, and nothing is changing,” exclaims the exasperated therapist.
Men's health month is recognized in June of each year. This health awareness observance brings attention to a range of well-being concerns affecting men and encourages self-care along with preventive health visits. Well-being is an experience of health, happiness and prosperity. It is holistic and consists of many domains including physical, mental, spiritual, and social. These can impact the total health of men and illnesses unique to them such as prostate cancer.
