Roadblocks in Therapy

Every skilled couples therapist needs to have some ideas about what to do when the treatment doesn’t seem to be working.  Fears of failure begin to creep into even the most experienced of us, so knowing how to identify the roadblocks in therapy can help us redirect the work and reduce feelings of responsibility for elements of treatment success that are beyond our control.

1. Diminishing desire and commitment — Three years ago in the third post on this blog, the issue of a couple’s level of desire to be together was presented as a factor in treatment safety.  If one or both partners have serious reservations about wanting to stay in the relationship, it will be quite difficult to get any traction in treatment.  However, the therapist should resist participating in any decisions about the relationship.  The therapist’s job is simply to guide both partners’ exploration of the full range of their feelings about staying or going.  Often ambivalence about the relationship, whether expressed by both partners or split out between them, is an important piece of a recycling drama containing significant unmetabolized feelings that can only be experienced through their ambivalence.  In the end, it is up to the couple to decide whether to continue their relationship.

2. Refusal to give up the victim role in the marriage — All couples therapists are familiar with the fact that most couples treatment starts with a recitation from both partners about how they have been victimized by the other.  Less frequently there is one identified victim and one perpetrator who have both “accepted” their roles in the marital dramas.  These roles have been nonconsciously adopted to access feelings from childhood, the time in our lives when we are all victims of circumstances.  Therapeutic work should help both partners voice their historical feelings enough that these roles are not needed in their relationship.  However, if one or both partners hold on to insisting that they carry no responsibility for the victim position, by refusing to experience and talk about their own feelings, therapy will be stymied.  At this point, the therapist is called upon to carefully, gently, but deeply explore why it is so necessary to one or both of the partners to cling to the victim role.  It should be stated here that any partner who is in true physical danger and does not find a way to exit the relationship is clinging to the victim role.

3. Therapist loses focus — An intimate partner who presents as being victimized is often demonstrating palpable hurt and helplessness, pulling from the therapist a compelling need to rescue.  However, any form of taking sides, pathologizing, or trying to get one partner to treat the other one better is a roadblock to Neurodynamic Couples Therapy.  If one or both of the partners begins to feel judged and corrected, the safety–and therefore continuity–of the treatment will be seriously compromised.

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