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.

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.”

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.

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.

Some forms of couple therapy have emphasized the importance of helping couples differentiate–helping them see each other as two separate individuals, instead of succumbing to a type of “twinning” where only alikeness is tolerated.  There are certainly benefits to helping couples resist the draw to substitute being alike for being close.  However, ignoring the nonconscious “sameness” of intimate partners is also missing an opportunity to make use of the right-brain natural attraction of similars in service of healing.

I recently came across an article titled, "Reframing Clinician Distress: Moral Injury Not Burnout." Moral injury is a concept that refers to the psychological, social, and spiritual impact of challenging events on individuals who uphold strong values, such as providing quality care for patients, especially in high-pressure situations where they may have to compromise these values. Common symptoms of moral injury include feelings of guilt, shame, anger, and contempt towards a system that may prevent individuals from delivering proper care.

The concept of moral injury sheds light on many of the difficulties we currently face in our profession. As clinical social workers, an understanding of moral injury can help us to identify the root cause of our distress and burnout within a flawed system, rather than attributing it solely to individual shortcomings. This perspective allows us to recognize and address larger systemic issues at play. By acknowledging our role within the system, we can work towards implementing meaningful changes.

Whether we work in private practice, academia, or healthcare settings, it is important for all of us to understand the factors that contribute to moral injury and how the existing system perpetuates it. This understanding can guide us in advocating for systemic improvements that promote well-being for both clinicians and the individuals they serve.

Many types of mental health treatment include some form of exploring feelings.  In Neurodynamic Couples Therapy, exploring feelings is the pathway to metabolizing and integrating them into a cohesive sense of self and relationships and creating a bond of empathy and understanding between partners.

The term “woke” means to be aware. It is the opposite of slumber and suggests a person is consciously aware of their role, its influence on others, and the associated societal climate. It is an act of submission which recognizes the importance of the patient’s agency.  The term “woke” was first introduced in the 1940’s to emphasize the importance of being aware of social injustices (Ng, 2021). At the height of the racial tensions within the last ten years, the term was used in a pejorative nature to undermine another person’s stance on issues that he or she identified as worthy cause(s) to elevate. To be deliberate in addressing systemic issues that impact the underrepresented members of our communities as well as granting them the authority to narrate their stories clinicians must practice “staying woke.” Wokeness suggests an active pursuit of knowledge and consciousness. Wokeness is a deliberate practice of taking action to better inform a clinician’s practice. It requires introspective engagement, minimizing judgment to promote social change.

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.

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.

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.

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.