The Evolution of Modern Sex Therapy

by Katy Butler

Twenty years after the sexual revolution, in the most sexually explicit culture in the world, a surprisingly large number of people continue to have difficulties with the sexual basics. The Social Organization of Sexuality, a statistically balanced 1994 survey of the sexual habits of 3,432 Americans, found that 24 percent of the women questioned had been unable to have an orgasm for at least several months of the previous year. Another 18.8 percent of the women (24 percent of those over 55) reported trouble lubricating; 14 percent had had physical pain during intercourse; and 11 percent were anxious about their sexual performance. Equally high proportions of men reported interlocking difficulties: 28 percent said they climaxed too quickly, 17 percent had performance anxiety and 10.4 percent (20 percent of those over 50) said they'd had trouble maintaining an erection.

Before the 1950s, people with these sorts of problems were given pejorative labels like "impotent" and "frigid." Psychoanalytic therapy had little to offer them beyond symbolic explorations of their upbringings and "Oedipal" conflicts. Things got slightly better in the 1950s, when Joseph Wolpe and other behaviorists taught people to reduce their fear by breathing deeply and relaxing while imagining sexual situations that had made them tense. This was of some help, but things only really changed in the 1970s, after gynecologist William Masters and his research associate Virginia Johnson began studying the physiology of human sexual response in the laboratory.

Modern sex therapy--a repertoire of precise physical techniques that teach the body new responses and habits, lower anxiety and increase focus on the here-and-now--builds on Masters and Johnson's work. Therapy consists mainly of counseling and "homework" in which new experiences are tried and new skills practiced. If clients are too tense or reluctant to try something new, systems approaches, couples therapy, drugs and psychodynamic therapy may be tried as well.

Modern sex therapy often begins with instruction in "sensate focus." The pressure to have an orgasm, keep a firm erection or prolong intercourse is taken away. Instead, individuals or partners are told to set aside time to caress themselves or each other in a relaxed environment, without trying to achieve any sexual goal. Once anxiety is lowered, sex therapy often proceeds successfully, especially in treating the following common problems:

Vaginismus. Vaginismus is the spastic tightening of the vaginal muscles and can make intercourse impossibly painful. It can be so severe that not even a Q-tip can be inserted in the vagina, and some women with vaginismus have never, or rarely, completed sexual intercourse in the course of years of marriage. Often the result of physically painful experiences like childbirth, painful intercourse, rape or molestation, it is a learned fear response. Therapy involves teaching the woman to relax and breathe while gently inserting the first of a graduated series of lubricated rods, starting with one as small as is necessary for comfort. In ensuing weeks, the woman uses incrementally thicker rods and then inserts her partner's finger and finally his penis into her vagina. Nothing is forced, and insertion is always under the control of the woman.

Premature ejaculation in men. Treatment involves lowering anxiety and teaching the man to become aware of his arousal during lovemaking, until he recognizes the sensations that precede his "point of no return." Then he practices what sex therapist Barbara Keesling, author of Sexual Healing, calls "peaking"--pausing before the point of no return and relaxing, breathing and stopping movement until his arousal subsides. After a few minutes' rest, the man returns to movement, stimulation and arousal. The "peak and pause" routine is repeated five or six times per homework session. The exercise can be done by a man masturbating alone, while his partner is giving him oral sex or during intercourse. Men can squeeze their pubococcygeal or PC muscles during the pause to dampen arousal, or the man's partner can squeeze on the coronal ridge just below the head of the penis.

Erectile difficulties in men. A common problem among older men, erectile failure is often caused by an interaction of physical and psychological factors. Smoking, diabetes, blood pressure drugs, alcoholism, neurological injury and normal aging can all worsen erectile problems. Treatment has been revolutionized since the introduction of Viagra, which not only helps men with primarily physical problems, but can also jump-start those suffering primarily from anxiety.

Men who awaken with erections or have them while masturbating can probably blame anxiety if they have trouble during intercourse: muscular tightness and breath-holding can send blood out of the penis, causing it to wilt. Sex therapy requires slowly disarming anxiety and performance pressure, and learning to enjoy sex with and without an erection. Therapy often begins with declaring intercourse off-limits and encouraging the couple to enjoy each other orally and manually, without demanding that the penis perform.

In the next "stop-start" phase, the man's partner stimulates him to the point of erection, stops until his penis becomes totally soft and then stimulates him again, repeating the process up to three times if the erection returns. Other exercises include "stuffing," which allows the man to become familiar with the sensation of being in the vagina without having to perform sexually. The female partner gently folds his flaccid penis into her vagina, using her fingers as a splint while lying in a scissors position, at right angles to the man, with one of his thighs between her legs. The couple then lies together for 15 to 30 minutes without moving. In subsequent sessions, as anxiety lessens, the man practices moving slowly while breathing evenly and staying relaxed.

Orgasmic difficulties in women. Therapy with "pre-orgasmic" women was pioneered by psychologists Lonnie Barbach of San Francisco, author of For Yourself: The Fulfillment of Female Sexuality, and Joseph LoPiccolo, a coauthor, with Julia Heiman, of Becoming Orgasmic. It has extraordinarily high success rates with women once written off as frigid. In group and individual programs lasting 6 to 10 weeks, women are given basic information about female sexual response and are encouraged to spend one hour a day on self-pleasure "homework," familiarizing themselves with their own anatomies and sexual responses, examining their vulvas with a mirror and speculum, massaging themselves, perhaps reading Nancy Friday's collections of sexual fantasies and masturbating. Most of the women soon learn to give themselves orgasms, and then gradually transfer their new skills to lovemaking. First they masturbate to orgasm in front of their partners, then learn to come while touching themselves during intercourse, and then teach their partners to pleasure them to orgasm using their fingers or penis.

Most women successfully transfer their new responsiveness to partnered sex. The exceptions tend to be women who have learned to reach orgasm by squeezing their thighs tightly together--a position that makes it virtually impossible for them to have an orgasm with a penis inside them. In LoPiccolo's clinic at the University of Missouri in Columbia, such women relearn a more fluid orgasmic response by deconstructing their masturbation rituals step-by-step and gradually learning to have orgasms without clenching their thighs. They may begin by simply uncrossing their ankles while masturbating and then slowly change their patterns until they can have orgasms with their legs apart.

If a woman can reach orgasm with digital stimulation from her partner, LoPiccolo considers that therapeutic goals have been met. Women respond orgasmically to a wide variety of stimuli--some to dreams and fantasies; others to the rubbing of an earlobe or breast; others to digital caressing of the clitoris or G-spot; and still others to intercourse. All are considered normal human variations. At an American Association of Marriage and Family Therapy conference last year, LoPiccolo said that when couples come to him saying they'd like the woman to have an orgasm during intercourse, he doesn't consider this a therapy goal so much as a growth goal, like learning to dance. "If you want to learn the tango," he said by way of analogy, "You get tango lessons, not therapy."
Tantra at Home

Modern Tantric techniques to improve anyone's sex life:

Heighten Awareness of All the Senses William Masters and Virginia Johnson introduced to the West a technique called "sensate focus," in which the receiving partner focused on his or her own sensations while being slowly and nonsexually caressed.

Tantric versions are more playful and aesthetic: Tantric teacher Margo Anand of Mill Valley, California, for instance, recommends that the receiving partner sit blindfolded on the bed, while the nurturing partner wafts a variety of smells, such as peppermint, licorice, gardenia, or even Chanel No. 5, under his nose. Next he is treated to sounds--bells, gongs, even crackling paper. Then he is fed distinctive-tasting foods--almonds, grapes dipped in liqueur, whipped cream, fruit or bittersweet chocolate. Finally, the nurturing partner strokes the receiving partner's body with pleasant textures--silk scarves, fur mittens or feathers. The ritual closes gently and formally. "With utmost gentleness, as if you had never touched him before, let your hand rest on his heart," writes Anand. "Allow your hands to radiate warmth, tenderness, and love."

Create Intimacy Through Gentle Contact: Modern Tantrism focuses strongly on the subtle physical harmony between partners. In Tantra: the Art of Conscious Loving, yoga teachers Charles and Caroline Muir of the Source School of Tantra in Maui, Hawaii, recommend spoon meditation:

Lovers lie together spoon-fashion on their left sides and gently synchronize their breathing. The outer person, the nurturer, rests his right hand on the heart of his partner. Placing his left hand on her forehead, he visualizes sending love and energy from his heart down his arm and into her heart on his out-breath. On the in-breath, he draws energy back from her forehead and into his body in an endless circle.

The Muirs also recommend that partners do yogic breathing in unison: inhaling, holding the breath for a few seconds, exhaling and holding the breath out for a few more seconds. While breathing out, one partner visualizes accepting energy while the other visualizes projecting it. Couples can also inhale and exhale in counterpoint, visualizing "shooting out" energy on the out-breath through heart, head or groin and receiving it on the in-breath.

Focus on Connection Rather Than Orgasm: Much of conventional sex therapy has focused on orgasm. Many previously unsatisfied women were liberated in the process, but it also turned intercourse into a big project, made orgasm the be-all and end-all of being together sexually, and defined any other sexual interaction as "the failure to achieve orgasm." Tantrism extols the joys of brief sexual connections without orgasm. In The Tao of Sexology, for example, Taoist teacher Stephen Chang recommends that couples practice the "Morning and Evening Prayer" for at least 2 to 10 minutes, twice a day. Every morning and evening, partners are to lie together in the missionary position, lips touching, with arms and legs wrapped around each others' bodies and the man inside the woman. The couple breathes together in a peaceful, relaxed state, with the man moving only enough to maintain his erection. "The couple enjoys and shares the feelings derived from such closeness or stillness for as long as they desire," writes Chang, who notes that orgasm sometimes follows without any movement. "Man and woman melt together, laying aside their egos to exchange energies to heal each other."

Enhance Sexual Pleasure: Ancient and modern Tantric and Taoist sex manuals are full of sophisticated physical techniques designed to enhance the pleasure of both partners, stimulate orgasm in the woman and delay orgasm in the man. Chang, for example, recommends a Taoist practice called "Sets of Nine." The man slowly penetrates the first inch or so of his lover's vagina with the head of his penis only. He repeats this shallow stroke slowly nine times, followed by one slow stroke deep into the vagina. The next "set" consists of eight shallow strokes and two deep strokes, followed by seven shallow strokes and three deep strokes and so on until a final set of one shallow stroke and nine deep strokes. The "sets" help men prolong intercourse by balancing intense and less intense forms of stimulation and arouse women by stimulating the G-spot and numerous nerve endings in the neck of the vagina.

Separate Orgasm From Ejaculation: In its most signal departure from Western sex therapy, modern and ancient Tantrism recommend that men, especially older men, frequently enjoy what it calls a "valley orgasm"--orgasm without ejaculation. Chang recommends that as the man senses himself approaching the "point of no return," both partners stop all movement while the man clenches his pubococcygeal or PC muscle (the urination-stopping muscle known to many women from the Kegel exercises they were taught to strengthen uterine and bladder muscles after giving birth). The man also slows and deepens his breathing, looks into his partner's eyes, connects with her heart and channels energy upward from his groin toward his heart and the crown of the head. Orgasm without ejaculation often follows. Ejaculation can also be reserved, without stopping the experience of orgasm, by pressing on what Chang calls "The Million Dollar Point," in a small hollow between anus and scrotum.

Honor Sex, But Keep It in Perspective: "When sex is good," Charles Muir said at a recent workshop, "It's 10 percent of the relationship. When it's bad, it's 90 percent."


Networker associate editor Katy Butler, a former reporter for The San Francisco Chronicle, has contributed to The Los Angeles Times, The New Yorker, The New York Times Book Review and The Washington Post. For more information on Charles Muir, write to P.O. Box 69, Paia, HI 96779. Correspondence to Katy Butler may be sent to the Networker .

 

Pathways to Sexual Intimacy

Revealing Our Many Selves in the Bedroom

by Richard Schwartz

Mark and Stacey, an attractive couple in their early thirties, have only been married two years and they're already knotted in conflict. In our first session, Mark, an intense, athletically built man, gets to the point, "I hate it that we're such a stereotype, but it's the typical scenario of me wanting more sex than she does. We're down to once every two weeks--if I'm lucky--and it's driving me crazy. I have a strong sex drive, so if it were up to me, we'd do it every day, the way we used to when we were dating. Now, not only do I not get my sexual needs met, but I feel rejected because most of the time I get shot down when I initiate."

Stacey, slim, darkhaired, sits rigidly in her chair. "I know we don't have sex as much as Mark likes," she says, with an edge in her voice, "but for me to want to make love, I have to feel emotionally connected to him and, to be honest, most of the time, I just don't. He seems so obsessed about this issue. I constantly feel pressure to satisfy him. It's like raw sex is the only thing he wants from me. It's gotten to the point where any time he touches me I freeze up--I'm afraid to respond even affectionately because if I do, he thinks it's an invitation to sex."

"Yeah, in some ways that's the hardest part of it for me," Mark interrupts, "the way she sees me now. She looks at me like I'm one of those guys on The Sopranos. I like sex, but I'm no drooling animal. I can be romantic and I do try to help her feel close, but whatever I do does no good," he says despondently. "No matter how sensitive I try to be, it's like she has this view of me as a sex-crazed gorilla."

I ask each of them to describe what typically happens when they do have sex. Stacey says, "After some time goes by when we haven't had sex, Mark gets more and more sulky, and I begin to feel I'm like a bad, unloving wife. So I hug him or pat his shoulder or maybe just smile at him or something and, oh boy! That's all it takes--he's off to the races. I feel I can't say no again, and so we'll get in bed and start kissing. I try to be as warm as I can get myself to be; I don't want to just lie there like a dead fish. And, usually, at a certain point, I can work myself up so that I'm into it, sort of. Afterwards, I feel relieved because I know he feels happier and not so angry at me and, also, he'll back off and I won't have to do it for a while."

Mark seems not to have heard the many negative qualifiers in Stacey's description of their sex life. "That's what I don't get," he exclaims with exasperation. "In the middle of it, she comes alive and seems to like what I'm doing, but the next day she's uninterested again. If you like it, why not want more? Also, I don't enjoy the beginnings that much because I want to feel wanted by her, not like I have to kick start her engine every time. I'm not one of these guys who just wants to satisfy himself. I'm good at foreplay and I've learned what she likes."

Mark and Stacey are caught in a classic struggle, and most couples therapists have responded with a now-classic technique: get him to back off by issuing a moratorium on sex and assigning exercises that allow them to show affection to each other without any sexual expectation. Trained as a problem-solving, strategic therapist, I used to give that directive to couples and often found that it had the desired effect. It probably would've worked with Mark and Stacey, too. As he contained himself so she felt less under seige and more cared for, eventually they could've found a frequency that felt okay to each, checked off this particular glitch on their list of relationship issues, and left therapy reasonably satisfied.

I once felt an outcome like that meant I'd done my job. Not anymore. Through the years, I've come to see that this kind of technical fix, however immediately useful, is unequal to the inner complexity of people and their potential to know each other intimately.

Know Your Selves

No other area of a couple's life holds as much promise for achieving intimacy as sex. Indeed, the promise of intimacy may be as important as lust for drawing human beings toward sex in the first place. My goal now is to help partners reach the kind of soul-deep connectedness in their sexual encounters that can transform their lives and their relationship with each other.

The Latin adjective intimus means "inmost, deepest." So real intimacy means, first of all, that both partners listen deep inside--i.e., get to know their inner worlds of emotion, desire, and vulnerability--and then reveal what they've learned to each other in an atmosphere of loving acceptance. The couples I've helped reach that level of resonance report tremendous rewards for themselves and their relationships. However, as rewarding as that state is, it's also quite rare--both because of the risks involved in being that vulnerable and because knowing yourself isn't a simple task.

When people listen deeply inside, they encounter a host of feelings, fantasies, thoughts, impulses, and sensations that comprise that background noise of our everyday experience of being in the world. When they remain focused on and ask questions of one of those inner experiences, they find that it's more than merely a transient thought or emotion. Within each of us is a complex family of subpersonalities, which is why we can have so many contradictory and confusing needs simultaneously, especially around sex. American poet Walt Whitman got it right in "Song of Myself": "Do I contradict myself? Very well then I contradict myself, (I am large, I contain multitudes.)" So do we all contain multitudes.

Thus, the Oracle of Delphi's admonition to "know thyself" should really have been to "know your selves." I call these subpersonalities "parts" because, when I first started doing this kind of work, that's how my clients referred to them. "Part of me wants to stay married and faithful, but another part wants to be free to get laid every night of the week with a different woman," a client might say. "I know I'm successful at my job, but there's a part of me that says it's only a matter of time until everybody else finds out how stupid and incompetent I really am," another would report. While people like parts of themselves that make them feel powerful, competent, and in control, they tend to dislike and even despise what they feel are their less attractive, more troublesome, parts. In one session, Stacey said spontaneously "I hate the part of me that's so scared to have sex with Mark." But hating and trying to get rid of parts that we don't like doesn't work. We only feel more polarized inside, and the despised part gets stronger.

Getting to know ourselves in all our multiplicity isn't an easy stroll through a familiar neighborhood. When our inner parts meet our partner's parts, the complexity is compounded, which is why couples therapy can be so difficult. Despite the fact that, like Mark and Stacey, most partners want me to get the other to change, I try to help each listen inside to discover why they respond to their mates in such extreme, and often damaging, ways.

I've found that, if I establish a safe, accepting atmosphere in our sessions, clients can have inner discussions with their parts. In a trancelike state of internal focus, they can dialogue with their parts about what motivates them to react in irrational or self-defeating ways. In listening to their parts' stories, their behaviors or beliefs become comprehensible.

As clients learn to separate from their extreme emotions and thoughts (their parts) in this way, I find that they spontaneously tap into a calm, centered state that I call their Self. When this happens in a session, it feels as if the very molecules in the atmosphere have radically shifted. My clients' faces and voices grow softer and more tranquil; they become more open and tender, able to explore their parts without anger, defensiveness, or dislike. When accessing this state of Self, clients are tapping into something deeper than all these conflicting inner warriors, something that spiritual traditions call "soul."

Now imagine what it can mean for a relationship when each partner connects to such a Self. If intimacy means being able to truly know and reveal all our parts to a beloved other, then the presence of Self makes doing so possible. When they make a Self-to-Self connection, people sense at a very deep level that they aren't alone and that even their most shameful facets are loved. When, during sex, each partner can dive beneath the surface where their contending parts are creating stormy waves and into the calm depths of Self-to-Self connectedness, their bodies and souls meet and sense a oneness that's delicious and profoundly satisfying. For me, then, intimacy has two components: the knowing and revealing of one's secret parts and also the sense of awe and belonging that comes with Self-to-Self connectedness.

Managers

The first step toward that kind of intimacy involves helping each partner get to know the parts that are triggered by their problems. Because Mark and Stacey were polarized around their sexual relationship, I thought they'd feel safer doing this exploration in private. I suggested that I meet with each of them separately for a session or two. To help people find their parts, I usually begin by asking them what they think or feel about the problem they bring me. When I saw Stacey individually, for example, I asked her what she said to herself when Mark approached her for sex. "Oh no, here we go again!" she replied contemptuously. "I feel angry and helpless and just yuck! But then, I tell myself, 'God, I suppose I've got to do it or he'll make me pay.'"

I then asked her to focus on the disdainful voice. She said she sensed it in the back of her head. As she focused there, I suggested she ask it why it felt such revulsion for Mark and for sex? Putting her hands up as if to push the entire subject away, she said the voice was really disgusted by the whole thing--sweaty, naked bodies, ugly, hairy genitals, revolting fluids, and ridiculous animal noises. Stacey's face was scrunched up in a look of loathing as she spoke, when suddenly she stopped cold and put her hands over her eyes."Oh my God, it's my mother!" she cried out. "It's my mother's voice in me!"

As we explored this revelation, Stacey recalled that her mother had conveyed her own deep revulsion with all things having to do with the body and sexuality. Some schools of therapy consider a voice like that a "parental introject" or a "schema" of learned cognitions (i.e., the internalized attitudes of Stacey's mother), and would encourage Stacey to ignore or argue with it. While there's no doubt that this part absorbed aspects of Stacey's mother, I find that such parts intend to protect rather than torment. These aversive, controlling voices belong to a category of parts I call the Managers, which act to protect people from hurt and trauma suffered in the past--usually when they were very young and unable to defend themselves emotionally or even physically. There are all kinds of Managers. Some are inner critics who drive people to perform perfectly so they'll never reexperience old feelings of failure and inadequacy. Other managers, like Stacey's, are early-warning systems that operate to prevent the person from even getting near an experience that might cause harm. Sex is perhaps the area of life most prone to the meddling of overzealous managers.

Managers like Stacey's bring new meaning to the phrase "safe sex." They have to be in control of the action. They see spontaneous expression as dangerous. They don't want anyone to know about, much less witness, certain parts of you. They also don't want you to be rejected or exploited, so they keep your heart closed to others. Managers monitor the passion, affection, play, and spontaneity you express in sex. If you begin to get carried away, they might interrupt the action with distracting thoughts, suddenly erase sensation or inject pain, or make you tense and uncooperative. Managers are the ultimate control freaks.

The Return of the Exiles

If you think of Stacey's voice as an introject or a cluster of thoughts, it makes sense to try to get her to challenge or eliminate it. If, in contrast, you view it as an inner personality, you get curious about why it's in the role of puritanical mother. Rather than try to shut down this "manager-mother," I wanted to know why she had this role in Stacey's inner drama. I've found that when we approach our Managers with respect, instead of resentment and dislike, they often have good reasons for what they do. I asked Stacey to sit quietly, breathe evenly, and go inside. "Ask the mother part what it's afraid will happen if it doesn't keep you so repulsed by sex," I said.

After a moment, Stacey had a vivid image of herself as a 6-year-old girl in the bathroom. Her father was helping her undress to take a bath, and as she watched the scene play out, she could see something wrong about it. Her father was looking at her in a funny way, once she was naked, his voice sounded different, and he trembled slightly. She sensed again the fear and confusion she'd felt then--the feeling that something bad was happening, and that it had something to do with her being naked.

The 6-year-old was one of Stacey's Exiles. Exiles are often childlike parts of ourselves that carry the memories and sensations from times when we were hurt, terrified, abandoned, or shamed. Because we want to forget those experiences, we exile these parts, and our Managers do their best to keep them from ever being triggered. Whenever Mark became amorous, it began to scare Stacey's little girl, so her manager-mother went into action, damping down any sexual feelings. Unfortunately, by keeping the Exile deep underground, Stacey not only missed unpleasant memories and sensations, she also missed the most sensitive, innocent, and open aspects of herself. If Exiles carry our most rending pain, they also can give us our capacity for joy, love, passion, creativity, imagination, playfulness, and sheer zest for life. If we shut away the Exiles, we also shut away much of what gives sex, and life in general, pleasure and adventure and meaning.

Mark, too, had parts that influenced the patterns between him and Stacey. When I saw him alone, I asked him to relax and focus on the feeling of frustration he felt whenever Stacey "shot him down." He closed his eyes and said he noticed a voice saying that he needed and deserved lots of sex. I told him to ask the voice about itself. Mark smiled and said that that voice called itself "The Stud," and it looked like a very buff, very macho, very tan version of himself. Mark said The Stud bombarded him with images of himself having sex in numerous hot and ingenious ways with his wife and other women, who panted and moaned in lusty abandon. Mark said he liked The Stud and that it had a powerful influence on him. He basically agreed with The Stud that his life should be more like those images. Many men have parts like Mark's stud, but not many are so open about it so early in therapy.

"Ask The Stud," I said, "what it's afraid would happen if you don't get to have sex all the time." He soon became quiet. After a long silence during which his face betrayed intense emotion, Mark said he'd felt waves of shame as he watched an image of himself as a 13-year-old in the boys' locker room. Talking in a bare whisper, he said that, at that age, he'd had small protuberances at his nipples. The other boys had ridiculed him mercilessly, calling him "Tits," asking him when he was going to buy a bra, and telling him he was really a girl. At such a vulnerable age, this kind of abuse was deeply traumatic to a young boy's developing sense of his own manhood. It was then that The Stud stepped into its role and the devastated 13-year-old was exiled. Never again, vowed The Stud, would he let anybody doubt Mark's masculinity, and it pushed him to seduce as many girls as he could.

Since he'd married Stacey, The Stud constantly pressured him to have affairs, especially after Stacey started rejecting him. So far, he'd resisted--he loved Stacey and wanted their marriage to succeed--but he was afraid that, if their sex life didn't improve, he'd succumb.

Firefighters to the Rescue

Mark's stud is characteristic of a third category of parts that I call the firefighters.

Like the Managers, the Firefighters want to protect the Exiles, but where Managers are cautious and often very rational in their attempts to protect Exiles, Firefighters leap into action after the Exile's feelings have been triggered. Firefighters are emergency responders who come out, hoses on full blast, when we feel so bad we have to drown the flames of emotion before they destroy us. These Firefighter parts manifest as urges to binge on food, alcohol, drugs, sex, work, or anything else that offers quick relief from pain.

Firefighter sex is one way to stave off intolerable feelings. Only while having or fantasizing about sex can people like Mark feel they have value, strength, or personal agency. Furthermore, a sexual Firefighter's obsession with power, dominance, and high-voltage sensation, can make us oblivious to the human being we're having sex with. Indeed, Stacey complained that she felt that Mark wasn't really there with her during sex; he didn't seem to care who was there, as long as a compliant body shared his bed. As is true for most Firefighter activity, the irony is that this part's efforts to help the exiled 13-year-old didn't work: ultimately they backfired. Stacey repeatedly rejected Mark for his sexual boorishness, only making Mark's exiled teen more ashamed and his stud more desperate.

When we uncover the dance of parts within and between members of a couple, we see many vicious cycles. The aggressiveness of Mark's stud triggered Stacey's Manager, which further triggered his stud, and so on, with disastrous results for their sex life. An Indian proverb says when the water buffalo battle in the marsh, it's the frogs who suffer. As Mark and Stacey's protective parts became increasingly extreme, the Exiles in each of them were increasingly wounded. My experience is that until each partner can care for and heal their own Exiles, these battles will continue. So I asked Mark how he felt about his young teen, and Stacey about her 6-year-old girl. Predictably, Mark was ashamed of the boy and didn't want to remember what he'd felt like. "That was all a long time ago," he said with a dismissive wave of his hand, "and I can't see any point in talking about that now." Similarly, Stacey was irrationally critical of the little girl. "She must've done something to make my father change like that," she said stubbornly.

It's very common for people to fear or dislike their Exiles initially. So I ask a client to find the rejecting or fearful voice that dislikes the Exile and politely ask it to just step back or relax for a bit. Sometimes it takes several requests for it to step back, but when it happens, the client's feelings toward the Exiles change dramatically from disdain and anger to curiosity or compassion, from fear to a sense of peace and confidence. When I ask clients what this calm, compassionate part is, they often reply with  something like, "This isn't a part like those other voices. This feels more like who I really am, like my real self." It seems that as people separate from their parts, their Self spontaneously emerges.

Once a client shows more qualities of Self, I ask him or her to enter the scene that an Exile is stuck in. "Can you go into that locker room and be there in the way that boy needed someone to be there at the time?" I asked Mark. Even after 20 years of doing this kind of work, I'm still awed by the way people unerringly know just what to do to heal these wounded inner parts. Mark said that as he approached the 13-year-old, the boy looked up with fear and embarrassment, thinking that this strong, athletic man would also make fun of him. Instead, as Mark played the scene, he sat down on the bench a few feet from the boy. He gently told the boy that there was nothing wrong with him or his body, that the appearance of his breasts was due to hormonal changes and they'd soon look perfectly normal. Other boys were also insecure about their bodies, Mark pointed out. "And anyway, I love you," he said to the boy. At this, the boy dropped his guard and burst into tears. Mark put his arm around the boy and took him out of the locker room, to a safe and pleasant place in the present--Mark visualized taking the boy canoeing on a nearby lake that he and Stacey often visited.

Meanwhile, Stacey went through a similar process. She helped the little girl out of the tub, carefully folded her in a fluffy, warm towel, and, embracing the girl, told her that she'd done nothing wrong. Whatever happened was her father's problem, not hers. Stacey, too, brought the girl into a safe and comfortable setting--to the living room couch--where she folded her arms around the little girl as she read her a story, while the sun streamed through the window.

After people compassionately witness their past in this way and retrieve the Exiles that are frozen there, they feel far less vulnerable. Consequently, the parts that guarded those Exiles are freed from their protective roles. The inner, reactive voices--explosive anger, self-hatred, anxious vigilance, compulsive behavior--transform into valuable helpers. A chronically suspicious, distrustful inner voice, for example, becomes an accurate intuition, helping the person sense who's safe to open up to, but no longer automatically closing off to everyone or keeping him in a fog of paranoia. A carping inner critic becomes a supportive voice urging the person to keep trying rather than constantly beating her down. After rescuing his 13-year-old, Mark focused back on The Stud, who was relaxed and smaller, less musclebound. Similarly, when Stacey returned to her manager-mother, the part was willing to reconsider the beliefs it had taken on from her mother, now that it didn't need to keep the little girl safe. These are the beginning steps in the process of transforming inner parts.

The Exiles of both Stacey and Mark carried feelings of worthlessness and self-loathing, and believed that they were fundamentally flawed and unlovable. Stacey's little girl craved the tender affection and protection that a father is supposed to provide--and, in fact, that's what she wanted from sex with Mark. She was drawn to him in the first place because of his strength, competence, and apparent self-confidence--his take-charge personality seemed to promise perpetual safety. Stacey's Exiles would only let her enjoy sex that was cozy, warm, adoring, and not terribly erotic; they were frightened by insensitivity, crudeness, or, often, even unashamed lust.

Mark's Exiles, meanwhile, couldn't at first believe that a woman as pretty and vivacious as Stacey would find him--a weak, "effeminate," 13-year-old--attractive. Because of the Exiles' own fears and anxieties about his manhood, he only let another person have access to him through sex--but sex was also the way he reassured himself that he was really a man. As a result, men like Mark become highly attached to and possessive of their current lover while constantly looking around for another. Since Mark and Stacey had Exiles that were extremely needy and full of impossible expectations of the other, and Managers and Firefighters that strongly provoked the other's protectors, their sex life was doomed from the start.

Healing Together

After Mark and Stacey made peace with their inner exiles in private sessions and, consequently, were each less vulnerable and reactive to the other, I brought them together for a joint session. I told Mark and Stacey, "No wonder you feel so hopeless. You never had a chance for real intimacy. As you heal these parts we've found, you'll finally have a chance."

In the joint session, my role is to help them remain Self-led as they speak to each other. When I notice that either of them has been hijacked by a part, I encourage them to focus inside briefly and then come back and speak for their parts rather than from them. When a partner speaks from the Self about its parts, the other partner is less likely to be triggered and more likely to hear the message.

Mark and Stacey nervously shared with each other what they'd learned in individual sessions. It was extraordinarily touching--as it often is when embattled couples begin to thaw out--to see Stacey tell Mark with unfeigned emotion how sad she felt for that young boy who had been so cruelly humiliated. "I can understand now why you feel so driven, and why my rejection hurts you so much," she said, looking him deeply in the eyes. Mark said he'd never known about the old incident with her father, and now it made complete sense that she'd cringe when he pursued her. He knew what it felt like to be hounded. The quality of the conversation between the two of them was soft and hesitant, but direct.

Stacey asked Mark if he was willing to be patient around sex while she continued to work with her own inner parts--several other Managers had surfaced in therapy. Mark said that he'd really try to let her be in control of that arena, which would be easier now that he knew himself and his stud better. Both sighed as they began to understand that this was only the beginning of a long process. This was different from any conversation they'd ever had. They'd felt closer and more real to each other than any other time during their marriage.

Self-To-Self Connection

Once couples get a taste of what real Self-to-Self connection feels like, they're eager to keep going, particularly when they see the barriers to their own freedom fall away. Over the course of a year, working with their parts, sometimes individually, more often in front of each other, Mark and Stacey reported continuing changes in their sexual and nonsexual lives together. Each was becoming a different person with the other; in fact, they were becoming a lot of different people with each other in ways that increasingly energized, touched, and delighted them both.

As the polarization between parts diminishes within a person, so it diminishes between partners. Stacey was no longer afraid of Mark's stud. In fact, she was surprised to discover a formerly hidden "hot babe" part of herself that could sometimes meet or even exceed the energy of Mark's stud. Mark said that whereas all his previous sexual experience had been dominated by his stud's frenzied aggressiveness, now he'd come to also enjoy the softer, slower kind of sex that Stacey preferred. His stud was less agitated and more sensual. It no longer hijacked him and took him away into fantasy worlds, so he was more responsive to Stacey's moods.

What most surprised this couple was discovering how moving and powerful sex was when they allowed their more vulnerable parts to be present--those parts that they'd previously barricaded behind various protectors. No longer terrified, wounded victims, the Exiles began to exhibit their capacity for openness, innocence, sensitivity, and childlike pleasure. "You know," Mark said, "sometimes when Stacey and I are together, I feel like that embarrassed 13-year-old kid I used to be. I even let myself act as if I'm more like I'm 8 or 10, or even younger--all bouncy and eager the way I was then." To his wonder, when he let himself feel young, vulnerable, and a little awkward, rather than cleaving to the old image of a technically perfect sexual operator--Stacey responded with loving warmth and laughter, kissing and stroking him as if he were her beloved child. While feeling highly charged sexually, he also felt, for the first time in his life, utterly cherished and nurtured.

It took longer for Stacey to let herself feel that vulnerable--her distrust was very intense. Eventually, however, she could let the little girl out in a nonsexual context during sessions, becoming playful in a funny, slightly silly, way. Later, the little girl began to spontaneously show up in their bed. As the little girl took part in sex, Stacey said she felt the same kind of total love and acceptance from Mark that he'd reported from her when his boy was present. They both found humor and playfulness moving seamlessly from their nonsexual to sexual lives and back again. They teased each other during the day, which often became a prelude to sex.

One of the enormous advantages of this kind of free-flowing give-and-take of parts between a couple is the variety and richness it brings to their lives. Stacey remarked one day toward the end of therapy that what she loved most about their new sexuality was the unpredictability of it. For the first time in her life, she was no longer trying to control every aspect of their sexual encounters and, instead, could let any part of herself spontaneously emerge in her body during their lovemaking. The appearance of a part in her often elicited a new part in Mark, so sex, which had been a predictable deployment of stereotyped parts, became an improvised and often astonishing dance in which neither one knew in advance who would show up. This meant for Stacey that she'd suddenly find herself moving in ways she'd never moved before and saying words she'd never said, and all the different parts seemed to find great joy in finally expressing themselves as openly and physically as they wanted. She constantly expected to berate herself for acting so brazenly, but the torrent of criticism from her Managers seemed to have dried up. She still occasionally felt embarrassed the morning after, but that didn't last long, since Mark seemed so happy about it all.

Mark and Stacey were also experiencing more and more Self-to-Self intimacy, although they'd have been puzzled by what I meant, if I'd told them this. I don't talk very much about the Self with clients; before they've done much work with their parts, it might sound incomprehensible to them. Afterward, they know and experience Self-to-Self connection without having to name it. Clients still in thrall to their parts, manifesting in extreme and polarized form, or couples who mostly see only angry, resentful, dependent, jealous, self-pitying parts in each other, may not know there's anything like a Self within them. But the simple process of learning to help a part "step back" before they talk to each other allows the couple to experience a few minutes of agenda-free, open-hearted curiosity about the other. Fleeting as they are, such moments inevitably create an almost palpable sense of connection that wasn't there before and can carry them through ensuing "parts wars."

Enough of these moments and a couple begins to know that, whatever stormy melodrama roils the waters of their relationship, it cannot interrupt a deeper, more enduring current flowing between them. When your partners hold Self-to-Self connection, parts can come and go spontaneously within both, without eliciting the old fears, angers and misunderstandings, because each of them senses the calm, abiding presence of an essential "I" in the storm. That connection forms a loving backdrop to a couple's sexual experience that makes it safe and wonderful for any part to come out. It's the safety of the Self-to-Self connection that allows the delicious surrender to the sexual process.

Once a couple has tasted Self-to-Self intimacy, they know that whatever tempests they find themselves in aren't the essential reality of their connection. No matter what the parts are saying during these inevitably rough times, the couple knows that sooner or later they'll again speak to each other in their true voices. And when that happens, each loses a sense of lonely separateness, and, at some level, experiences a state of union and oneness. They sense that both of them are part of the deep ocean, not the isolated waves. Both are home.

 

Richard Schwartz, Ph.D., is the director of the Center for Self Leadership (website: selfleadership.org). He is the originator of the Internal Family Systems Model and author or coauthor of five books, including Internal Family Systems Therapy . Address: 217 North Lombard Street, Oak Park, IL 60302; e-mail address: r-schwartz1@nwu.edu. Letters to the Editor about this article may be sent to Letters@psychnetworker.org.

 

Satori in the Bedroom

Tantra and the Dilemma of Western Sexuality

by Katy Butler

Freud once said that four people--two mothers, two fathers--lie in bed with every couple making love. If only that were all. Hugh Hefner is under the covers with us, and Carl Djerassi, who invented the birth control pill, and Alex Comfort, who wrote The Joy of Sex. Shere Hite is there taking notes, and a doctor from the Centers for Disease Control, and Pope John Paul II and Kenneth Starr. Cindy Crawford's perfect body may float in space above us, or Long Dong Silver's, daring us to turn on the light and look at how we don't measure up.

When a man sleeps with a woman, he sleeps with her past as well, including her memories of pregnancy, date rape, abandonment or shame. When a woman sleeps with a man, she sleeps with the young boy caught reading his father's Playboy magazines and the teenager in the back seat, expected to know everything without being shown. Each of us in the industrialized West carries into the bedroom not only personal memories, but collective ones: we are layered with exhortations, like sedimentary rock. Sex, the Victorians told our great-grandmothers, is dirty: Save it for the one you love. The mature female orgasm, said Freud, is the vaginal orgasm: That comes only to women who resolve their penis envy. Women's sexuality, said the marriage manuals of the 1950s, is problematic, like the delicate wiring of an old MG: Husbands must be master mechanics. Vaginal orgasm is a myth, said the feminist theorists of the 1980s. Find the clitoris. Now.

Sleeping around will ruin your reputation, we were told in the fifties: Why buy the cow when you can get the milk through the fence? Sleeping around will free you, we were told in the sixties: Smash monogamy. Men and women are pretty much alike, we were told in the seventies. Men are from Mars, women are from Venus, we are told today.

Many of us enter the bedroom now as if we have been told we are about to play a high-stakes game. There is no rule book, or else it's been hidden. Everyone else, we think, knows how to play. We charge down the field. We pass the ball. A whistle blows. The rules have changed. The teams are being shuffled. We'll be playing with a shuttlecock now instead of a ball, and the goalposts have been moved to the other end of the field. We start running and the crowd roars, but we're not sure what we did right. Now we are on the bottom of a pile of bodies. We are given five different rule books and told to choose one that suits us. (We have no idea what book the other team is playing from.) Bleeding from the shin, we strap on our battered equipment again and once more run down the field.

We lie down with all of this, and more, when we lie down in bed with each other. We sleep with the war between men and women fueled by patriarchy and differences in physiology, and with the uneasy cease-fire in the erogenous zone that followed the feminist and sexual revolutions. We sleep with the legacy of the 1970s, when you could find, on many a middle-class nightstand, the dry, clinical bestsellers of William Masters and Virginia Johnson, the pioneers of behavioral sex therapy. The bright lights of their science were supposed to banish our fears and superstitions, like crucifixes held before a vampire. Yet the fear of pleasure, and of being discovered having pleasure, still runs beneath our bedroom floors like an underground river.

For most of us, our first sexual act was also an act of secret rebellion against our parents. The memory of this defiant split lives on in our cells in the disembodied, suppressed yet obsessed way our culture approaches sex today. Few of our fathers talked to their sons about how to enhance a woman's pleasure or prolong their own; few of our mothers ever told their daughters about the delights or even the location of the clitoris. We found out anyway, and paid the price.

In the dark recesses of our mental closets lies a negative cultural dowry--the muumuus that missionaries gave the naked Polynesians; the penitentes' cat-o'-nine-tails; the chastity belt; and the confessional--all the trappings of the Augustinian Catholic tradition that declared sex a dirty distraction on the path to God and the source of original sin. ("As the caterpiller chooses the fairest leaves to lay her eggs on," wrote the poet William Blake two centuries ago, "so the priest lays his curse on the fairest joys.") All of this we bring into the bedroom.

When we sleep with each other, we sleep with images we've absorbed and, without knowing it, those our lovers have absorbed as well. Like fast food, images of other people's orgasms, stripped of context and connection, are now available 24 hours a day and consumed alone and on the cheap. They demand of us a bravado we rarely feel. They lurk eternally on the Internet and in the phone-sex banks, at the corner video store and in the Congressional Record . Our bedrooms are colonized by them. When a woman lies down in bed with a man, a light show of images plays over her body without her knowing it: red-satin garter belts, perhaps, or beaver shots or Marilyn Chambers or Monica Lewinsky or the Penthouse Pet of the Month. When a man lies down with a woman, images of imaginary men play over his face without his knowing it--the hero of Tristan and Iseult, perhaps, or a Tammy Wynette song or a romance novel. No wonder we feel split within ourselves and from each other. We expect sexualized romantic love to carry a greater psychological burden than does any other culture on earth while we simultaneously denigrate the sexual. And so we reverberate between sexual obsession and sexual shame.

Last September, we found on our doorsteps newspapers full of the details of the president's intimacies with Monica Lewinsky--the thong underwear, the cigar, the joke sunglasses, the rejected girl crying in the rain. It didn't matter what the details were or the context in which they occurred. All that mattered was the telling of them. Opening the paper, some of us imagined how our own intimacies would read some morning, printed in black and white and dumped on our neighbors' doorsteps.

What we read in the papers that day reflected the impoverished language we bring to sex. In 1931, the English novelist Virginia Woolf wrote in The Waves, "I need a little language such as lovers speak, words of one syllable." But we can speak of lovemaking everywhere except the bedroom. For the delicate skin that touches our lover's most tender places, we have no words except the pornographic, the childlike and the scientific. We speak of vaginas, labiae, clitorises, cunts, hair pies and "down there." We call it a prick, a dick, a sledgehammer, a penis, a pee pee or Mr. Happy. Our worst insults are sexual: cunt, slut, whore, dickhead, pussy-whipped, cocksucker.

And so we lie in bed with each other, reaching for pleasure, tenderness and connection, with both too much and too little to guide us: Hustler on the newsstand, Dr. Ruth or Dr. Laura on the radio and Debbie Does Dallas on the VCR. "You do not have to be good," wrote the poet Mary Oliver. "You do not have to walk on your knees for a hundred miles through the desert, repenting. You only have to let the soft animal of your body love what it loves." But that's a big only. No wonder we are sure that someone, somewhere, is having better sex than we are. No wonder someone, somewhere is pretending to have better sex than we are. No wonder we fear we will never get it right.

Yet sometimes we do get it right--or it gets us right. Many of us have experienced something in bed that the languages of pornography, sex therapy, feminism and the double standard could not contain. It might have been the afternoon we washed our partner from head to toe in the shower, kneeling under the spray to scrub even the soles of her feet, until washing became a ritual of tenderness and awareness. It might have been a dawn when we woke from a dream experiencing what the radical psychoanalyst Wilhelm Reich called a "full-body orgasm," in which we were the wave and also a body drifting at the water's edge, pulsating to our fingertips as the wave broke on the shore. It might have been a night a man looked into our eyes and stroked our nipples for hours until we gave in to our own responses rather than following what we imagined to be his timetable. Or a night a woman looked into our eyes while we were coming and we felt safe, seen and known.

In these moments, lovemaking is sensed as healing, wholesome and holy. Our focus broadens out beyond orgasm. Our small selves are no longer in command, and we give ourselves over, little boats on a deep river. The fear of not performing well disappears, the ghosts are banished from the bedroom and the present moment absorbs us. The West's self-created divisions--between sacred and profane, heart and pelvis, male and female, victim and predator, body and soul--are temporarily healed. We understand what Walt Whitman meant when he wrote, "If anything is sacred, the human body is sacred," and what the 16th-century Anglican marriage ceremony meant when it included among its vows, "With my body, I thee worship." Our bedroom is no longer hostage to the porn palace, the sex lab or the unfinished war between men and women. For a moment, the bedroom becomes a ritual space where we enter trance and forget time.

For most of us, such moments are rare and random, despite the mixed sexual blessings of the past three decades. The sexual revolution rightly told us that sex could be a domain of pleasure and self-expression. But its prescription--quantity over quality--did not free us. The feminist revolution challenged the practice of sex as a ritual of loving female submission and encouraged women to speak of their sexual desires and sexual violations. It lit up ancient chasms between the genders, but did not bridge them.

Modern sex therapy helped thousands with simple, effective behavioral techniques, usually focused narrowly on achieving erection, intercourse or orgasm. Yet few of us have much of a clue about continuing to create the more profound joys of sexuality--especially after the first six months to two years of a relationship, when hormones subside and desire fades. We may move from arousal to contentment or indifference or contempt. We may not know how to contend with softer, slower erections and other changes related to aging. A surprising number of stable couples stop making love much, or altogether. The ghosts return to the bedroom. We may lie down in resignation in the bed we've made together, or walk once more out the door.

Or not. Some of us will embark instead on a quest for a fuller experience of intimate sexuality. We will use whatever tools we can, depending on who we are and the decade in which we set out. We may enter Reichian therapy, wrap ourselves in Saran wrap, read Nancy Friday, follow The Rules, or repeat phrases from Men Are From Mars, Women Are From Venus, but we will not give up. We want to banish the bedroom's ghosts or at least replace them with more benign presences. Risking the humiliation our culture visits on those who speak of their own sex lives rather than other people's, we will try to decolonize the bedroom. We sense that this quest requires not "more of the same"--not more sexual perfectionism or ever-more-exotic partners or positions--but a broader context, a change at the metalevel. If we embark on this quest today, we may buy a book, watch a video or go to a weekend workshop on Tantrism, which is now the West's most popular form of adult sex education.

Presaged by the popularity in the 1960s of the Kama Sutra of Vatsyayana, a 3rd-century Indian sex manual, Tantra has become a postmodern hybrid. On the most prosaic level, it is nothing more than a pastiche of positive sexual attitudes and techniques drawn from Western humanistic psychology, Chinese Taoist sexology and classical Indian Tantrism--a wild sexual and religious tradition that influenced both Buddhism and Hinduism and flourished in India about 500 A.D.

This esoteric system used breath, visualization and other yogas to arouse, channel and transform energy throughout the body. Its meditations often took the form of visualizing gods and goddesses in sexual union. In India, adherents of the tiny sect of "left-handed" Tantra took things a step further: in secret rituals, they broke all the rules of their caste-bound society, consuming taboo foods, such as alcohol and meat, sounding yogic bijas or sacred syllables and coupling with one partner after another. In contrast to monastic traditions that suppressed sexuality and avoided women, Tantrikas welcomed the energies of aggression and sexuality and transformed them. Men did not ejaculate, and the goal was to move arousal up the spine to the brain in an explosion of enlightenment and bliss. Sex was not a dirty detour from the path to God, it was the path

Today, Tantra's esoteric practices are being pressed into the service of goals that are tamer, more domestic and less religious: uniting sexuality and intimacy, and enhancing sexual pleasure for long-term couples. It's not the techniques that count so much as Tantra's enlargement of the context in which sex is held--as pleasurable, inclusive, healing, and holy. This widening of the lens was apparent as soon as modern Tantrism first registered on the American cultural radar in 1989, when a 450-page book called The Art of Sexual Ecstasy: The Path of Sacred Sexuality for Western Lovers tried to sweep the clutter of negative sexual images out of the Western bedroom. Written by Margo Anand, a writer and sex workshop leader who had studied psychology at the Sorbonne and meditation in India, it was like no sex manual the West had ever seen. She spent eight pages alone describing how to prepare a bedroom for lovemaking. Think of the bedroom as a "sacred space," Anand wrote. Vacuum the bedroom and take out the newspapers and coffee cups. Bring in plants, flowers and candles. Drape a scarf over the bedside lamp to create soft lighting. Walk three times around the room with your partner, misting the air with a plant sprayer of scented water while saying "As I purify this space, I purify my heart." This, Anand implied, was as much a part of sex as kissing.

The suggestions might seem impossibly precious. But ceremonially cleaning the bedroom and bringing in flowers and soft lights contained a metamessage: You do not have to go somewhere else or become a sliver of yourself to have sex. You don't have to "do the nasty" while hiding in the dark from your disapproving parents. When you bring flowers into the bedroom, you bring in more of yourself as well, and that can make you realize how much you had previously left outside the bedroom door. And if the bedroom is already inhabited by ghosts, why not bring in flowers as well?

In the place of pornographic slang and Latin words, Anand suggested Taoist phrases that were free of negative Western sexual connotations. Try saying "jade stalk"or "wand of light" for penis, she suggested; for vagina, substitute "cinnabar cave" or "valley of bliss." Or call them "yonis" and "lingams," after the Sanskrit words used to describe the stone sculptures of sexual organs that are still bedecked with flowers and worshiped in rural temples in India. "Behold the Shiva Lingam, beautiful as molten gold, firm as the Himalaya Mountain," she quoted the "Linga Purana," a Hindu ode to the penis of the god Shiva, Lord of the Dance. "Tender as a folded leaf, life-giving like the solar orb; behold the charm of his sparkling jewels!" It was heady stuff for a culture where "testosterone poisoning" is a running joke and the only goddess worshiped is a virgin mother. And it cleared the decks for something new.

Anand and other teachers of modern Tantra suggested that sex could involve all of us, including the warring inner parts we think we've transcended but have merely avoided: the lustful and soulful; the wounded and voracious; the slutpuppy in her Victoria's Secret lingerie and the good girl in her flannel nightie; the sensitive postfeminist man and the crude teenage boy.

Last October, at a five-day, $795-a-person workshop for couples at the Esalen Institute, yoga and Tantra teacher Charles Muir wove these warring inner and outer sexual worlds together. On the first night, he spoke about his own sexual upbringing to 23 couples sitting before him in a circle. His listeners ranged in age from 22 to 73. Among them were two Latin American academics, four lawyers, a black woman doctor, two construction managers, two women who worked in television, several massage therapists from the Esalen staff and an Irish farmer. Some sat as entwined with their partners as trailing vines, while others betrayed, in their gestures and body language, uneasiness with each other and an inequality of love or desire.

Muir, who is now separated from his wife and coteacher, Caroline (she wanted sexual fidelity; he didn't), runs the Source School of Tantra in Maui, Hawaii, and leads frequent workshops around the country. He was wearing a silk shirt and an amethyst pendant. He was slim, in his early fifties, with brown hair, protuberant eyes and spatulate fingers that gave him the look of an elongated frog. His language was closer to New York street than Hindu temple.

He had come of age in the Bronx, he said, during "The Great Fuck Drought of the Fifties." Everything he knew about sex, he said, he had learned from Johnny Patanella, the leader of his childhood street gang: Get it up, get it in, and get it off. Fuck 'em hard and fuck 'em deep. Muir said that before he discovered Tantra, he was a yogi on the mat and a "sleazebucket" in bed. He said that men give nicknames to their penises because they want to be on a first-name basis with the one who makes all their important decisions.

There were shocked laughs, a snigger. The men thought they were long past this. The women didn't want to think their men had ever thought this way.

But there was a method to his crudeness. Once Muir bonded with the part of the men that had eternally remained the teenage boy, he gently, without emasculating them, brought them into the sexual realm of context, emotion, feeling and intimacy traditionally defined as female. "In lovemaking, women lead with their hearts," he went on more softly. "Men lead with their second chakra [their groins]. We hurt each other."

Tantra, Muir said, could help them make love stay. "The average couple makes love 2.3 times a week for the first two years," he said. "After two years, the average couple makes love once a week--and making love can be a well of energy and healing.

"Chemistry is temporary. You're going to learn to base love not on chemistry--which lasts six months or two years, if you're lucky--but on alchemy. When the chemistry is no longer there, alchemy says you take what is there and you change it. Become a master alchemist."

Easier said than done, given some of the histories that the couples revealed in private conversations. One couple came to Esalen to put the "pizzazz" back in their marriage; later they acknowledged they'd hardly made love in the nine years since the birth of their son.

Paula, a Mexican American academic in her fifties who was there with Carlos, the professor with whom she lived, had not had an orgasm in the year since her hysterectomy. She had been raised a Catholic and was date raped in college. She still couldn't shake off a notion her mother had given her--that only bad girls are good at giving men sexual pleasure; at night, she still put on her pajamas behind the bathroom door. Carlos was in his forties; he had been divorced twice and had been raped and tortured a decade earlier in a South American prison.

Russ Solomon, a retired San Diego real estate developer, had raised four children with his wife, Liz, during 40 years of marriage. They looked as comfortable together as old shoes and clearly liked and respected each other. But sex, they said, had been disappointing on their wedding night when they'd both been virgins and disappointing ever since. "All I knew," Russ told me one day, "was that I was to get my penis in her vagina, and that was it." He had lain back, expecting Liz to arouse and satisfy him.

She said nothing that night, and nothing for many nights to come. She had no language then, no woman had language then for what she felt or wanted. "When you were born in 1937," she says, "it wasn't your place to show him."

Since then, they had rarely taken more than 15 minutes to make love. She spoke frequently, in front of Russ, of "40 years of shit and disappointment in the bedroom." Russ didn't treat her like a woman, didn't measure up. "I would love a flower on the pillow or a note," she said one day. "But Russ cuts articles out of the newspaper that he thinks I would be interested in. And I am. But it's not the intimacy I long for."

Couples like these could have taken their "sexual dysfunctions" and marital issues into the private confines of a sex therapist's office. But they were seeking something that Western sex therapy, for all its strengths, does not provide. Sex therapy's pioneers, Masters and Johnson, had brought thermometers, charts and transparent vaginal probes mounted with tiny video cameras to the study of sex. Sexual problems, they argued, weren't usually rooted in intractable intrapsychic or interpersonal conflict; they could often be solved by learning new behaviors. They, and those who followed them, taught women to masturbate to orgasm and men to squeeze their penises just below the coronal ridge, before they reached the "point of no return," to resolve premature ejaculation. Their techniques often worked with amazing ease, and they drained sex of some of its shaming power by making things seem as brisk, practical and scientific as a good recipe for apple pie.

But they also drained sex of magic. If their governing metaphor was the bedroom-as-medical-lab and sexual practice as an antiseptic medical-behavioral prescription, Muir's guiding metaphor at Esalen was the bedroom as temple and sexual practice as worship. And if sex therapy was predicated on healing people so that they could have sex with each other, Muir suggested that sexual pleasure itself could be healing.

In the course of the week, Muir gasped, held his breath, bugged out his eyes to demonstrate how men could use yogic breathing, pauses in lovemaking and finger pressure on their perineums to delay or forgo ejaculation. He and his coteacher, yoga practitioner Diane Greenberg, showed women how to take a man's "soft-on" and "use it like a paintbrush" to stimulate their clitorises and outer lips, or stuff it softly into the vagina. And he extolled the sensual pleasures of the half-erect penis. Referring to the Kama Sutra , he talked of varying strokes, pressure and speed. "If we go straight down the fairway--deep deep deep--we'll only be stimulating one area, guys," he said one afternoon, stroking a Plexiglas wand inside an anatomically correct, purple-velvet and pink-silk "yoni puppet" from San Francisco's House of Chicks. "Try shallow, shallow, shallow, deep! The more variety, the more information floods the brain, and the more you wake up."

A sex therapist, or in a more enlightened society, a sex educator, could have said the identical words, but the context--playful, normalized and semi-public--would not have been the same. A miniature culture, as transient and self-contained as a dewdrop, was being formed. For a handful of days, as the couples strolled the Esalen grounds above the Pacific, moving from cabin to hot tub to class, nobody was too busy or too tired to have sex. Nobody read anything about Kenneth Starr, or looked at the Sports Illustrated swimsuit issue or downloaded pornography from the Internet. Every night, in their TV-free, phone-free cabins, they looked at and touched each other's flesh-and-blood bodies rather than electronic images and paper dreams.

In class, Muir held out to them the possibility that sex could be more than a source of pleasure: it could be a source of intimate bonding as well. He taught them how to lie together spoon-fashion and breathe in unison. Sex, he said, could be more even than emotional intimacy: it could be an interplay of invisible energies that coursed through each lover's body and radiated beyond it. Every day, he led participants in yogic breathing and stretching, and then asked them whether they could feel an "energy hand" the size of an oven mitt growing beyond their flesh-and-blood hands. He had them fluff and clean their "auras" by sweeping their hands in circles a few inches from the body.

He acted not only as sex educator and yoga teacher, but priest. He taught them to chant one-syllable Sanskrit mantras designed to activate each of the body's seven chakras or energy centers that are believed to ascend the body's core. And he formed them into slow Tantric circle dances in which the men and women stared into the eyes of partner after partner while visualizing sending love and healing to virtual strangers.

If the West has defined male sexuality as the norm and female sexuality as the problem, Tantra glorifies the female: a woman's orgasms are said to increase her capacity to act as a channel for the flow of shakti, the universal female energy that powers the universe. And by deemphasizing the moment of ejaculation and emphasizing energy and context, the workshop provided the women with more of what they often complain is missing from standard-issue sex--love, sensuous touching and intimacy.

Under Muir's tutelage, lovemaking was not, as some feminists put it, a recapitulation of the power inequalities of rape, but a worship of the female and a reenactment of the drama of Shiva and Shakti, the Hindu god and goddess whose lovemaking created the universe. Partners were to see in themselves the flow of divine fundamental energies; the act of love as reproducing the first stages of the creation of the world.

Women, Muir declared, could and should have multiple orgasms, while men were depleted by ejaculation and should sometimes try the "valley orgasm"--orgasm without ejaculation. And he transcended the no-win squabble Freud started over the virtues of clitoral versus vaginal orgasms by teaching effective techniques for vaginal stimulation of the G-spot; he declared that women, too, could ejaculate when sufficiently stimulated.

This is a tall order for a culture in which 24 percent of women surveyed say that they, like Paula, have not had an orgasm during the previous year. A complex history lies behind this statistic. If the sexual lives of many men begin with repeated sexual rejection and shame, the sexual lives of many women begin in choicelessness: breasts stroked in a laundry room by a best friend's father; the struggle lost in a back seat; the unwanted kiss from uncle, teacher, boss or neighbor. When women sleep with men they sleep as well with their fear or memory of the peeper, the flasher, the child molester, the rapist, the Don Juan, the womanizer, the sexual predator, the horrible first husband and the just plain jerk. Women, too, have a double standard: we divide men not into virgins and whores, but into predators and marriage material. In a reverse of the fairy tale, we fear that while we lie in bed, our lovers will metamorphose from Beauty to the Beast.

Such memories and fears, Muir suggested, are embedded not only in the brain, but in the cells of the body. His cure was a sexual ceremony to be held in the privacy of each couple's bedroom on the third night of the workshop. In a men-only meeting beforehand, he showed videotapes and coached each man on how to do for his lover what no therapist or body worker could do--massage her "Sacred Spot," the G-spot inside her vagina.

The G-spot, Muir said, is a little known and widely misunderstood area of sexual sensitivity--a raised, furrowed area of tissue about the size of a quarter, an inch and a half inside the front wall of the vagina, against the pubic bone. When stroked, it can become erect, firm and responsive and can trigger vaginal orgasms and ejaculation of a clear liquid. But it is also the dark closet in which old sexual pain is stored. "Sacred Spot" massage, he said, might release ecstatic sexual pleasure. It might also release old memories: the women might complain of numbness or bruising, or explode in fear, sobbing or rage. "This is Tantra kindergarten," he said, coaching the men to simply be loving and to be there, no matter what. "You get an A just for showing up."

After supper, before the ceremony began, the men fanned out to their cabins all over Esalen to take on the traditionally female task of "preparing the space" for the ceremony. While Liz and the other women relaxed and giggled in the Esalen hot tubs, Russ cleaned their cabin, combed his white hair and took a shower. In another cabin, one of the construction managers lit incense and paced his room. On the other side of the garden, one of the lawyers scattered rose petals on the sheets. Carlos, the Latin American academic, arranged a vase full of flowers he had cut from the Esalen garden, cued up a CD on his laptop, lit candles, put on a formal Mexican shirt called a guayabera , turned back the sheets and waited for Paula.

When the couples shared their experiences in the group the next day, it was almost as though the sexes had exchanged roles. "Carlos massaged me so gently so tenderly," Paula said. "The other times he had massaged me it was like, let's hurry up and get this over with." After an hour or so, she said, Carlos had turned her over and asked permission to stroke her "sacred spot" with his finger. Not long afterward, she had her first orgasm in a year. "I just had a whole strand of pearls full of climaxes," she said. "It kept going on and on, the pleasure."

One woman--whose husband had left her for another woman 14 months earlier--was floored by the tide of anger and fear the exercise released. It was, she said, "like a bad acid trip." Other women came close to bragging about having multiple orgasms and ejaculations (one woman had 22 over an hour and a half), while their men were quiet, tearful and open. The men had taken on the traditionally feminine role of focusing wholeheartedly on the pleasure of another, and it had changed them. The construction manager cried, describing how he'd waited nervously for his girlfriend, terrified that he wouldn't measure up. Another man told the group that whenever he'd made love before, his consciousness had zigzagged back and forth, first checking in on his own erection and then checking in on his partner. "Last night, my presence was so totally focused on Andrea that I didn't have to worry about myself at all," he said. "When she came, I was wailing with her like I was having the biggest orgasm of my life, and I was totally limp."

Here, in a context where differences between men and women were not only acknowledged but glorified and mythologized, and where men's performance fears were out in the open, women were getting what they wanted.

The next evening came the turnabout. After supper, Muir took off his amethyst crystal pendant, blue silk shirt and oatmeal jeans. He lay on pillows on the floor in his boxer shorts, holding a clear black plastic wand from a magic store at his groin like a surrogate penis. One man pushed his girlfriend to the front of the crowd. "I don't want you to miss any of this," he said.

Diane Greenberg knelt between Muir's legs and showed the women an unbelievable range of ways to pleasure a man's penis. She was competent and sure. She twirled her fingers around the wand like a feathery screw. She squeezed it at both at the top and the bottom, explaining that this way the blood wouldn't be forced out. She slapped it and tapped it and pretended to use it like a microphone. She clasped her fingers and encircled the wand, running her thumbs in circles up and down the frenulum as though winding a bobbin.

She was leading the women into the dangerous territory of the slut goddess. If some women's sexual lives begin in choicelessness, others begin with an inner war: lying on a blanket on a hill on a warm night, grabbing at the hands that give such pleasure and pulling them away, worrying what the owner of these hands will call her to his friends the next day-- slut, pig, whore. There are years of this, and then the rings are exchanged, the rice is thrown, the church doors open and the woman is expected to become as sexy and free as the bad girl she struggled for years not to be. Fear of taking on the slut archetype can persist through years of financial independence and supposed liberation, narrowing the range of pleasure a woman dares to give a man in the bedroom. By way of antidote, Muir and Greenberg spoke of Uma, a Hindu female divinity who "wears her sexuality on the outside." They lauded Hindu temple dancers and sacred prostitutes, and urged the women to try on this aspect of the powerful divine feminine. They encouraged the couples to let loose with noise--Esalen had heard lots of it, they said, and if couples got too self-conscious, they could shout or wail into a pillow.

Then Greenberg coached the women on the coming evening's ceremony. This time, the women would "honor" the men, first massaging their bodies and their penises. ("First get him hard, ladies," Muir interjected. "Then he'll agree to anything.") Next, Greenberg said, the women were to insert one finger into their man's anus and stroke and stimulate the exquisitely sensitive "sweet little hollow" at the base of the prostate. This, she cautioned, was a delicate business. "Rather than me entering him, I'll have him sit on my finger," she explained.

Then Greenberg turned to the men. "You're going to be penetrated, guys" she said, "as we are penetrated."

As Greenberg pulled the women into new territory, Muir took the men into the unknown as well. "Every man has gone through a war of his own that has robbed him of his yin [female aspect]," he said. "Each young boy is taught that men don't cry, don't feel. The job of reclaiming your yin is sweet. You won't wake up the same guy in the morning. Tonight, you get to be the illogical one. You get to have feelings tonight. Ladies, I want you to show up big. He may test you, he may be irrational. He may become terrified.

"You give and you're strong and you fix things." he said, turning to the men. "You're gigantic. How much can you let yourself be small and feel? Allow yourself to be penetrable and vulnerable? Five million homosexuals can't be wrong. There must be something up there that's good."

When Carlos and Paula described their night's experience in the group the next morning, Carlos was in tears--deep, strong tears. During the ceremony, he had reexperienced being raped and tortured in a South American prison and had not "left his body," as he had when having flashbacks before. He had also experienced something beyond the personal as though a great wind were blowing through him and breathing his body for him. And Paula had faced something she'd once held at arms' length. "Being raised Mexican Catholic, women who do that are sluts," she said, referring to the way she'd stroked Carlos' penis and penetrated his anus. "I gave myself permission not just to touch it with my eyes closed, but to look at it and be there in all my glory, and I felt pure."

On the last day of the workshop, Muir urged the couples to try a "10-day test drive"--to connect somehow sexually, physically and emotionally for at least 10 minutes every day. By the time the couples were packing their bags, few of the men displayed the sexual bravado they'd come in with--the bravado this culture trains them for. One man, a lawyer, had told the group the first night that he'd come to the workshop because he wanted to experience a 30-minute orgasm. He left muttering about "Tantra kindergarten."

His desires had become simpler and more ambitious: to only connect with his wife of 22 years. One busy day he left work, met his wife at their son's soccer game and drove with her to the far end of the field, where they kissed and held each other for 10 minutes in the car.

Some couples--like the pair who told me brightly that they wanted to put the "pizzazz" back in their marriage--left with little. Others took away all the bells and whistles you'd expect from a sex workshop: sobbing, wailing, energy releases, multiple orgasms, female ejaculations. Others left with something perhaps more precious: the understanding that good sex--wholesome, healing and holy--is an accumulation of small mercies, beginning with whatever mercy you need right now. Like being able to take off all your clothes in front of your lover, and touch his penis in all your glory and feel pure.

They went home--to San Diego and Cleveland and Denver, to the impeachment hearings and football games and a larger culture reverberating, more publicly than usual, between sexual obsession and sexual shame. Ghosts inevitably reentered their bedrooms. Old marital squabbles reared their ugly heads again. But sometimes old disappointments were held in a new way.

If anyone had come to understand the meaning of small mercies, it was Liz and Russ. On the night that Russ had pleasured her, Liz had come to their cabin door and found him still in the shower. Something about that melted her heart. "I brought to last night 40 years of lack of trust and feeling I'm not seen as a woman," she had said in the group next day. "I've stayed in the relationship oftentimes with doubt."

"I was so touched Russ was washing his body for me, that he would even be late to do this," she said. "All the resentment and fear was gone. I felt like a woman. It was enough."

"He put on a Japanese robe," she told the group, turning to her husband. "You looked very manly in it. I wore a white silk Dior nightgown and felt like a bride. When we slipped it off, I loved the look of my body. If we had only done this on our honeymoon, what a difference it would have made."

"She could have said, 'This is your obligation,'" said Russ. "But she dismissed all that. We didn't shout and cover our faces with pillows, but it's nice to know that it's possible. We take away the hopes and stories we've been told. I pray that we will remember."

"It was enough." said Liz. "Russ was willing, after 40 years of marriage, to try something. That was enough."

When they returned home, they followed Muir's suggestions for the "10-day test drive." Every day, she and Russ lay down with each other in the morning and the evening, and snuggled and held each other. "It's been wonderful," Liz told me. "There's been no anxiety, no repulsion. It's not about making love. It's about breathing together, holding hands, the eye contact, touching the heart, the forehead. We are doing our homework. But I'm not sure we're doing it right."

In her last sentence, I heard the reverberations of our culture's sexual perfectionism. She and Russ had returned to a society with bigger work to do than any person or couple can do alone. Yet they had grasped the essence of classical Tantra as practiced in India nearly two thousand years ago, and that essence is not purely sexual. At its base, it involves welcoming and transforming all energetic and powerful states, even negative and difficult ones, by holding them in a different context.

That context involves knowing that Saint Augustine and all his intellectual and spiritual heirs, including our parents and Larry Flynt and Kenneth Starr, were wrong: Sex is neither a nasty secret pleasure nor a sin, but a part of the pattern of the universe. To put it one way, the desire to make love, connect, procreate and survive has been programmed, along with pleasure, into our genes and dreams. To put it another: Sex is sacred--intricate and dangerous and pleasurable and utterly ungraspable.


Networker associate editor Katy Butler, a former reporter for The San Francisco Chronicle, has contributed to The Los Angeles Times, The New Yorker, The New York Times Book Review and The Washington Post. For more information on Charles Muir, write to P.O. Box 69, Paia, HI 96779. Correspondence to Katy Butler may be sent to the Networker .

 

Passionate Marriage

Helping Couples Decode the Language of Their Sexuality

by David Schnarch

Betty, a designer in a high-powered advertising firm, and Donald, a college professor bucking for tenure, had been married for 15 years. They spent the first 10 minutes in my office invoking the standard litany of our times as an explanation for their lousy sex life they were both just too busy. Not that this focus precluded blaming each other for their difficulties.

"Betty gets home from work so late that we barely see each other anymore, let alone have sex," said Donald resentfully. "We're collaborators in child raising and mortgage paying, but we're hardly lovers anymore. I've taken over a lot of the household chores, but she often doesn't get home until 9 p.m. and most nights, she says she's just 'too tired' for sex."

Betty sighed in exasperation. "Sometimes I think Donald wants me to leap from the front door to the bedroom and take care of him," she said. "But I'm being swallowed up by a sea of obligations my boss, the kids, the house, the dog, Donald, everybody wants a big chunk of me. Right now, I feel there's nothing left of me for me, let alone for him. He just doesn't get it that I need more time for myself before I'm interested in sex."

I asked them to be specific about how the stress from their very demanding lives revealed itself in bed exactly what happened, and in what order, when they had sex. Several moments of awkward silence and a number of false starts ensued before another, much more intimate, level of their marital landscape revealed itself.

Betty looked hard at Donald, then at me. "The fact of the matter is, he doesn't even know how to kiss me!" she said grimly.

"How would you know? It's been so long since you let me kiss you!" hissed Donald.

When I asked them to describe their foreplay, Betty looked embarrassed and Donald sounded frustrated. "During sex, she turns her face to the side and I end up kissing her cheek. She won't kiss me on the mouth. I think she just wants to get sex over with as fast as possible. Not that we have much sex." Betty shook her head in distaste. "He always just rams his tongue halfway down my throat I feel like I can't breathe. Besides, why would I want to kiss him when I can't even talk to him! We don't communicate at all."

Over the years, I've worked with many couples who complain bitterly that the other kisses or touches, fondles, caresses, strokes the "wrong" way. I used to take these complaints at face value, trying to help the couple solve their problems through various forms of marital bargaining and forbearance listen empathically, give a little to get a little, do something for me and I'll do something for you teach them the finer points of sexual technique and send them home with detailed prescriptions (which they usually didn't follow) until I realized that their sexual dissatisfactions did not stem from ignorance, ineptitude or a "failure to communicate." On the contrary, "communicating" is exactly what Donald and Betty were already doing very well, only neither much liked the "message" the other was sending. The way this couple kissed each other, indeed their "vocabulary" of foreplay, constituted a very rich and purposeful dialogue, replete with symbolic meanings. Through this finely nuanced, but unmistakable language, both partners expressed their feelings about themselves and each other and negotiated what the entire sexual encounter would be like the degree and quality of eroticism, connection and intimacy, or their virtual absence.

Donald and Betty had tried marital therapy before, but their therapist had taken the usual approach of dealing with each complaint individually job demands, parenting responsibilities, housework division and sexual difficulties as if they were all separate but equal situational problems. Typically, the clinician had tried to help Donald and Betty resolve their difficulties through a skill-building course on compromise, setting priorities, time management and "mirroring" each other for mutual validation, acceptance and, of course, better communication. The net result of all this work was that they felt even worse than before, even more incompetent, inadequate and neurotic, when sex didn't improve.

Knowing that Betty and Donald were most certainly communicating something via their gridlocked sexual styles, I asked them, "Even if you are not talking, what do you think you might actually be 'saying' to each other when you kiss?" After a minute, Donald said resentfully, "She's telling me I'm inadequate, that I'm not a good lover, I can't make her happy and she doesn't want me anyway." Betty defensively countered, "He's saying he wants me to do everything exactly his way and if I don't just cave in, he'll go ahead and do what he likes, whether /like it or not!" I asked her why she was willing to have intercourse at all if she didn't even want to kiss him. "Because he is such a sullen pain in the ass if I don't have sex," Betty replied without hesitation. "Besides, I like having orgasms."

Donald and Betty perfectly illustrated the almost universal, but widely unrecognized, reality that sex does not merely constitute a "part" of a relationship, but literally and metaphorically embodies the depth and quality of the couple's entire emotional connection. We think of fore-play as a way couples establish connection, but more often it's a means of establishing (^connection. Betty was a living rebuttal of the common gender stereotype that all women always want more foreplay; she cut it short so they could get sex done with as quickly as possible and Donald understood. Donald returned the compliment by "telling" Betty he knew she didn't like him much, but he was going to get something out of her anyway with or without her presence, so to speak.

Clearly, foreplay for this couple was not simply a mechanical technique for arousal, amenable to the engineering, skill-building approach still dictated by popular sex manuals. Nor were they likely to improve sex just by being more "open" with each other, "asking for what they wanted" another popular remedy in self-help guides and among marital therapists as if they weren't already "telling" each other what each did and did not want, and what each was or was not willing to give. Instead of trying to spackle over these normal and typical "dysfunctional" sexual patterns with a heavy coat of how-to lessons, I have learned that it makes much more sense to help the couple analyze their behavior, to look for the meaning of what they were already doing before they focused on changing the mechanics.

Rather than "work on their relationship" as if it were some sort of hobby or home-building project, Betty and Donald, like every other couple I have seen, needed to understand that what they did in bed was a remarkably salient and authentic expression of themselves and their feeling for each other. The nuances of their kissing style may have seemed trivial compared to the screaming fights they had about money or the long days of injured silence, but in fact it was an open window into their deepest human experience who they were as people, what they really felt about each other, how much intimacy they were willing to risk with each other and how much growing up they still had to do.

As in any elaborate and nuanced language, the small details of sex carry a wealth of meaning, so while Donald and Betty were surprised that I focused on a "little thing" like kissing, rather than the main event frequency of intercourse, for example they were startled to find how truly revealing it was, about their personal histories as well as their marriage. I told Betty I thought she had probably come from an intrusive and dominating family that never dealt openly or successfully with anxiety and conflict. "So now, you have a hard time using your mouth to tell Donald not to be so overbearing, rather than turning it away to keep him from getting inside it. You've become very good at taking evasive action to avoid being overwhelmed," I said. "You're right about my family," Betty said softly, "we kids didn't have any privacy or freedom in my family, and we were never allowed to complain openly about anything just do what we were told, and keep our mouths shut."

On the other hand, I said, I imagined Donald had never felt worthwhile in his family's eyes. He had spent a lot of time trying to please his parents without knowing what he was supposed to do, but he got so little response that he never learned how to read other people's cues he just forged blindly ahead, trying to force his way into people's good graces and prove himself without waiting to see how he was coming across. "Come back here and give me a chance to prove myself!" his behavior screamed. "Are you so used to being out of contact with the people you love that you can successfully ignore how out of sync you are with them?" I asked. To Donald's credit, he didn't dodge the question, though he seemed dazed by the speed with which we'd zoomed in on such a core issue.

Nevertheless, Donald and Betty discovered that their discomfort in describing, in exact detail, what was done by whom, when, how and where, was outweighed by their fascination at what they were finding out about themselves far more than was remotely possible from a seminar on sex skills. Betty, for example, had suggested that once kissing had stopped and intercourse had started, her sexual life was just fine after all, she had orgasms and she "liked" them. But when I asked her to describe her experience of rear-entry intercourse a common practice with this couple she did not make it sound like a richly sensual, erotic or even particular-pleasant

encounter. During the act, she positioned herself on elbows and knees, her torso held tense and rigidly parallel to the mattress while she protectively braced her body for a painful battering. Instead of moving into each thrust from Donald, she kept moving away from him, as if trying to escape. He, on the other hand, clasped her hips and kept trying to pull her to him, but never got a feeling of solid physical or emotional connection.

In spite of the fact that both were able to reach orgasm widely considered the only significant measurement of successful sex- Betty and Donald's minute-by-minute description of what they did made it obvious that a lot more was happening than a technically proficient sex act. I told Betty I was glad she had told me these details, which all suggested that she thought it was pretty hopeless trying to work out conflicts with people she loved. "I suspect you've gotten used to swallowing your disappointment and sadness without telling anybody, and just getting along by yourself as best you can," I said. "It sounds very lonely." At that point, much to Donald's shock, Betty burst into tears. I said to Donald that he still seemed resigned to chase after people he loved to get them to love and accept him. "I guess you just don't believe they could possibly love you without being pressured into it. In fact, I think both of you use sex to confirm the negative beliefs you already have about yourselves."

For several seconds Donald looked at his lap, while Betty quietly cried in the next chair. "I suppose we must be pretty screwed up, huh?" Betty snuffled. "Nope," I said. "Much of what's going on between you is not only understandable, it's predictable, normal and even healthy although it doesn't look or feel that way right now." They were describing the inevitable struggle involved in seeking individual growth and self-development within the context of marriage.

Betty said she used to enjoy sex until she became overinvolved with her job, but I suggested that the case was more likely the reverse that the demands of her job gave her a needed emotional distance from Donald. Her conscious desire to "escape" from Donald stemmed from emotional fusion with him she found herself invaded by his worries, his anxieties, his insecurities

and his needs as if she had contracted a virus from him. 'You may feel that you don't have enough inside you to satisfy his needs and still remain a separate, whole person yourself," I said. 'Your work is a way of keeping some 'self for yourself, to prevent being absorbed by him. That's the same reason you turn your head away when he tries to kiss you."

I suggested that Donald's problem was a complementary version of the same thing: in order to forestall the conviction that he had no worthwhile self at all, he felt he had to pressure Betty, or anybody he loved, to demonstrate they loved him over and over. Donald, of course, did not see that he was as important to Betty as she-was to him, but their mutual need for each other was really a function of two fragile and insecure selves shoring each other up.

Like most of us, neither Betty nor Donald was very mature when they married; neither had really learned the grownup ability to soothe their own emotional anxieties or find their own internal equilibrium during the inevitable conflicts and contretemps of marriage. And, like most couples after a few years of marriage, they made up for their own insecurities by demanding that the other provide constant, unconditional acceptance, empathy, reciprocity and validation to help them each sustain a desired self-image. "I'm okay if, but only if, you think I'm okay," they said, in effect, to each other, and worked doubly hard both to please and be pleased, hide and adapt, shuffle and dance, smile and agree. The more time passes, the more frightened either partner is of letting the other know who he or she really is.

This joint back-patting compact works for a while to keep each partner feeling secure, taut eventually the game becomes too exhausting to play. Gradually, partners become less inclined to please each other, more resentful of the cost of continually selling themselves out for ersatz peace and tranquility, less willing to put out or give in. To the extent that neither partner has really grown up and is willing to confront his or her own contribution to this growing impasse, however, both would prefer to fight with or avoid the other. It's less frightening to blame our mates than to face ourselves. The ensuing "symptoms" low sexual desire, sexual boredom, control battles, heavy silences often take on the coloring of a deathly struggle for selfhood, fought on the implicit assumption that there is only room for one whole self in the marriage. "It's going to be my way or no way, my self or no self!" partners say in effect, in bed and out leading to a kind of classic standoff.

Far from being signs of a deeply "pathological" marital breakdown, however, as Donald and Betty were convinced, this stalemate is a normal and inevitable process of growth built into every marriage, as well as a golden opportunity. Like grains of sand inexorably funneling toward the "narrows" of an hourglass, marriage predictably forces couples into a vortex of emotional struggle, where each dares to hold onto himself or herself in the context of each other, in order to grow tip. At the narrowest, most constricting part of the funnel where alienation, stagnation, infidelity, separation and divorce typically occur couples can begin not only to find their individual selves, but in the process acquire a far greater capacity for love, passion and intimacy with each other than they ever thought possible.

At this excruciating point in a marriage, every couple has four options: each partner can try to control the other (Donald's initial ploy, which did not succeed), accommodate even more (Betty had done so to the limits of her tolerance), withdraw physically or emotionally (Betty's job helped her to do this) or learn to soothe his or her own anxiety and not get hijacked by the anxiety of the other. In other words, they could work on growing up, using their marriage as a kind of differentiation fitness center par excellence.

Differentiation is a lifelong process by which we become more uniquely ourselves by maintaining ourselves in relationship with those we love. It allows us to have our cake and eat it too, to experience fully our biologically based drives for both emotional connection and individual self 1 direction. The more differentiated we are the stronger our sense of self-definition and the better we can hold ourselves together during conflicts with our partners the more intimacy we can tolerate with someone we love without fear of losing our sense of who we are as separate beings. This uniquely human balancing act is summed up in the striking paradox of our species, that we are famously willing both to die for others, and to die rather than be controlled by others.

Of all the many schools of hard experience life has to offer, perhaps none but marriage is so perfectly calibrated to help us differentiate if we can steel ourselves to take advantage of its rigorous lessons, and not be prematurely defeated by what feels at first like abject failure. Furthermore, a couple's sexual struggle what I call the sexual crucible is the most powerful route both to individual maturity and the capacity for intimate relationship, because it evokes people's deepest vulnerabilities and fears, and also taps into their potential for profound love, passion, even spiritual transcendence.

In the typically constricted sexuality of the mid-marriage blues, Betty and Donald's sexual repertoire consisted of "leftovers" whatever was left over after eliminating every practice that made one or the other nervous or uncomfortable. The less differentiated a couple, the less they can tolerate the anxiety of possibly "offending" one another, the more anxiety they experience during sex and the more inhibited, rigid and inflexible their sexual style becomes: people have sex only up to the limits of their sexual and emotional development. Unsurprisingly, Donald and Betty's sexual routine had become as predictable, repetitious, unadventurous and boring as a weekly hamburger at McDonald's. This is why the standard advice to improve sex by negotiating and compromising is doomed to failure most normally anxious couples have already long since negotiated and compromised themselves out of any excitement, variety or sexual passion, anyway.

And yet, it would have been pointless and counterproductive to march Donald and Betty through a variety of new sexual techniques. Using sex as a vehicle for personal and relational growth is not the same as just doing something new that raises anxieties. Rather, it depends on maintaining a high level of personal connection with someone known and loved during sex allowing ourselves to really see and be seen by our partners, feel and be felt, know and be known by them. Most couples have spent years trying not to truly reveal themselves to each other in order to maintain the illusion of complete togetherness, thus effectively smothering any true emotional connection, with predictably disastrous effects on sex.

Donald and Betty were so obsessed with sexual behavior, so caught up in their anxieties about who was doing or failing to do what to whom in bed, that they were not really emotionally or even physically aware of each other when they touched. Like people "air kissing" on social occasions, they were going through the motions while keeping a kind of emotional cordon sanitaire between them. Their sex was more like the parallel play of young children than an adult interaction except that they each watched the other's "play" with resentment and hurt feelings. Betty complained that Donald touched her too roughly "He's crude and selfish!" she said, "and just uses me to please himself." Her complaint undercut Donald's sense of self, and he defensively accused her of being a demanding bitch, never satisfied and fundamentally unpleasable thereby undermining her sense of self.

In order to help them each find a self and each other, I had to redirect their gaze away from their obsession with mutually disappointing sexual behavior, and encourage them to "follow the connection" rediscover or establish some vital physical and emotional link as a first building block to greater intimacy. To consciously "follow the connection," however, requires the full presence and consent of both partners, each purposely slowing down and giving full attention to the other, feeling and experiencing the other's reality. For example, I suggested that Betty and Donald, who couldn't come up with even one way in which they made some sort of vital contact, might simply caress each other's hands and faces while attending to what they were doing and feeling.

The next session, Donald reported that he now understood why Betty felt he was too "rough"; he said the experience made him realize that he usually touched her with about as much care and sensitivity as if he was scouring a frying pan! But slowing down to really become conscious of what he was doing made him experience a sudden jolt of emotional connection with Betty. This awareness was an unnerving sensation for someone who had spent his life performing for other people (including his wife rather than actually being with them.

Betty, too, was shaken by the jarring reality of their connection. She hadn't liked being touched roughly, but the concentration and attention in Donald's hands as he really felt and got to know her body was deeply disturbing; she found herself suddenly and unexpectedly sobbing with grief and deprivation for the warmth and love she'd missed as a child, and that she had both craved and feared in her marriage. Donald managed to keep his own anxiety in check during Betty's unexpected reaction, holding her hand while she cried her eyes out and gradually calmed down on her own. Later that night, they had the best sex they had experienced in a very long time.

Buoyed by this first success, more hopeful about their future together, they both wanted to know how they could enhance this new and still tentative sense of connection. I suggested they try something called "hugging till relaxed," a powerful method for increasing intimacy that harnesses the language and dynamics of sex without requiring either nudity or sexual contact. Hugging, one of the most ordinary, least threatening gestures of affection and closeness, is also one of the most telling. When they hugged, Betty complained that Donald always leaned on her making her stagger backward while Donald accused Betty of pulling away from him, letting go "too soon," and leaving him "hugging air."

I suggested that Betty and Donald each stand firmly on their own two feet, loosely put their arms around each other, focus on their own individual experience and concentrate on quieting themselves down while in the embrace neither clutching nor pulling away from or leaning on each other. I never tell clients how long to hug, but few initially can take more than four or five seconds before they experience a kind of emotional "jolt" when the connection threatens to become too intimate for comfort. Once both partners can learn to soothe themselves and maintain their individual equilibrium, shifting their own positions when necessary for comfort, they get a brief, physical experience of intimate connection without fusion, a sense of stability and security without overdependency.

While practicing hugging until relaxed with Donald, Betty found that as she learned to quiet her own anxiety, she could allow herself to be held longer by Donald without feeling claustrophobic. Just relaxing in the hug also made her realize that she normally carried chronic anxiety like a kind of body armor. As Betty calmed down and began to melt peacefully into the hug, not pulling away from fear that Donald would, literally, invade her space, he noticed his own impulse to break it off before she wanted to. After they had spent several weeks working on hugging till relaxed, they began to feel more centered within themselves when they did it; each no longer anxiously watched for the least little twitch in the other, or wondered what the other was thinking, or worried about doing it "wrong." When they each could settle down in the hug, they discovered that together they eventually would enter a space of great peace and tranquility, deeply connected and in touch with each other but secure in their self.

Soon, they could experience some of the same kind of deep peace during sex, which not only eliminated much of the anxiety, resentment and disappointment they had felt before, but vastly increased the eroticism of the encounter. Now that they knew what they were looking for, they could tell when it was absent. It was as if each had let slip away a hard, tough carapace, and allowed something tender and vulnerable to emerge. Later, in my office, while Betty gently stroked his arm, Donald teared up as he told me about the new sense of quiet but electric connection he felt with her. "I just had no idea what we were missing; she seemed so precious to me that it almost hurt to touch her," he said, his voice thick with emotion.

This leap in personal development didn't simply occur through behavioral desensitization. Sometimes, Betty and Donald got more anxious as their unresolved issues surfaced in their physical embrace. At times, when Betty dared to shift to a more comfortable position, Donald felt she was squirming to avoid him. It was my job to help them see how this reflected the same emotional dynamics present in other aspects of their marriage. Betty was attempting to "hold onto herself while remaining close to someone she loved, and likewise, Donald was refusing to chase after a loved one to get himself accepted. Insight alone didn't help much; a lot of self-soothing was required. Ultimately, they stopped taking each other's experience and reaction as a reflection on themselves and recognized that two separate realities existed even during their most profound physical union.

Building on their new stockpiles of courage earned in these experiments with each other, I suggested that Donald and Betty consider eyes-open sex, the thought of which leaves many couples aghast. Indeed, Donald's first response to the suggestion was that if he and Betty tried opening their eyes during sex, they wouldn't need birth control because the very thought made him so anxious he could feel his testicles retreating up into his windpipe! But eyes-open sex is a powerful way of revealing the chasm between sensation-focused sex and real intimacy. Most couples close their eyes in order to better tune out their partners so that they can concentrate on their physical feelings; it is a shocking revelation that to reach orgasm supposedly the most intimate human act most people cannot tolerate too much intimacy with their partners, so they block the emotional connection and concentrate on body parts.

Eyes-open sex is not simply a matter of two pairs of eyeballs staring at each other (indeed, people can hide behind a blank stare), but a way to intensify the mutual awareness and connection begun during foreplay; to really "see" and "be seen" is an extension of feeling and being felt when touching one another. But if allowing oneself to be known by touch is threatening, actually being seen can be positively terrifying. Bravely pursuing eyes-open sex in spite of these misgivings helps couples not only learn to tolerate more intimacy, it increases differentiation it requires a degree of inner calm and independent selfhood to let somebody see what's inside your head without freaking out. "It scares me," said Betty, speaking many people's experience. "I don't like my body much, and I don't like a lot else about myself, and I don't really expect him to, either."

But the experience was also exhilarating. As Donald and Betty progressed from shy, little, peekaboo glimpses into each other's faces to long, warm gazes and soft smiles, each found their encounters more deeply moving. Betty slowly realized that whereas before she had wanted to escape from Donald, now she yearned to see all of him, and for him to see all of her. "I felt so vulnerable, as if he could see all my inadequacies, but the way he looked at me and smiled made all that unimportant." Donald gradually relinquished the self-image of a needy loser; he no longer needed to pursue Betty for reassurance and found, to his delight, that she wanted him a breathtaking experience. "Her eyes are so big and deep, I feel I could dive into them," he said in wonder.

Both began to experience an increasing sense of self-acceptance and personal security. "We're having better sex now than we've ever had in our lives," Betty reported, "And I thought we were getting to be too old and far too married for exciting sex." Donald agreed. Betty and Donald, like society at large, were confusing genital prime the peak years of physical reproductive maturity with sexual prime the specifically human capacity for adult eroticism and emotional connection. "Are you better in bed or worse now than you were as an adolescent?" I asked them. "Most people definitely get better as they get older, at least potentially. No 17-year-old boy is sufficiently mature to be capable of profound intimacy he's too preoccupied with proving his manhood; and a young woman is too worried about being 'used' or too hung up about romance and reputation to really experience her own eroticism. Most 50-year-olds, on the other hand, have a much better developed sense of who they are, and more inner resources to bring to sex. You could say that cellulite and sexual potential are highly correlated."

"So that's why I have such incredible erotic talents!" said Betty.

As far as issues of gender equality are concerned, both men and women become more similar as they age and approach their sexual potential. Men are not as frightened of letting their partners take the lead in making love to them, and they develop far greater capacity and appreciation for emotional connection and tenderness than they had as young men. Women, on the other hand, become more comfortable with their own sexuality, more likely to enjoy sex for its own sake and less inclined to apologize for their eroticism or hide behind the ingenue's mask of modesty. As they age, women feel less obligated to protect their mate's sexual self-esteem at the cost of their own sexual pleasure.

Once a couple's sexual potential has been tapped, partners are no longer afraid to let their fantasies run free with each other. Donald, for example, let Betty know that he dreamed of her tying him up and "ravishing" him sexually so one day, she bought four long, silk scarves and that night, wearing three-inch high heels and a little black lace, she trussed him to the bed and gave him what he asked for, astounding him and surprising herself with her own dramatic flair. Betty had always secretly cherished a fantasy of being a dangerous, sexually powerful femme fatale, but Donald's clingy neediness had dampened her enthusiasm for trying out the dream also she had been afraid it would make him even more demanding. But now, knowing he was capable of being himself regardless of what she did or did not do, Betty felt much more comfortable expressing her own sense of erotic play.

The Sexual Crucible Approach encourages people to make use of the opportunity offered by marriage to become more married and better married, by becoming more grown-up and better at staking out their own selfhood. But the lessons learned by Betty and Donald, or any couple, extend far beyond sex. The same emotional development that makes for more mature and passionate sexuality also helps couples negotiate the other potential shoals of marriage money issues, childrearing questions, career decisions because differentiation is not confined to sex. In every trouble spot, each partner has the same four options: dominate, submit, withdraw or differentiate. Differentiation does not guarantee that spouses can always have things their own individual way and an unfailingly harmonious marriage besides. Marriage is full of hard, unpleasant choices, including the choice between safety, security and sexual boredom, on the one hand, and challenge, anxiety and sexual passion, on the other.

But spouses who have learned to stand on their own two feet within marriage are not as likely to force their own choices on the other or give in or give up entirely just to keep their anxiety in check and shore up their own frail sense of self. Learning to soothe ourselves in the middle of a fight with a spouse over, say, the choice of schools for our child or a decision to move, not only helps keep the discussion more rational, but makes us more capable of mutuality, of hearing our partner, of putting his or her agenda on a par with our own. The fight stops being, for example, a struggle between your personal needs and your spouse's personal needs, often regarded by each as my "good idea" and her/his "selfishness," but which is really often my fragile, undeveloped self versus his/her equally fragile, undeveloped self. Instead, we can begin to see that the struggle is inside each of us individually, between wanting what we want for ourselves personally, and wanting for our beloved partner what he or she wants for himself or herself. Becoming more differentiated is possibly the most loving thing you can do in your lifetime for those you love as well as yourself. Someone once said that if you're going to "give yourself to your partner like a bouquet of flowers, you should at least first arrange the gift!

There is no way this process can be foreshortened into a technical quick-fix, no matter how infatuated our culture is with speed, efficiency and cost containment. Courage, commitment, a willingness to forgo obvious "solutions," tolerating the anxiety of living without a clear, prewritten script, as well as the patience to take the time to grow up are all necessary conditions, not only for a good marriage, but for a good life. At the same time, reducing all marital problems to the fallout from our miserable childhoods or to gender differences not only badly underestimates our own ability to develop far beyond the limitations of our circumstances, but misjudges the inherent power of emotionally committed relationships to bring us (drag us, actually, often kicking and screaming) more deeply and fully into our own being. Marriage is a magnificent system, not only for humanizing us, maturing us and teaching us how to love, but also perhaps for bringing us closer to what is divine in our natures.

David Schnarch, Ph.D., is the founder of the Sexual Crucible Approach and director of the Marriage and Family Health Center in Evergreen, Colorado. His books include Passionate Marriage: Sex, Love, and Intimacy in Emotionally Committed Relationship and Constructing the Sexual Crucible: An Integration of Sexual and Marital Therapy. Address: 2922 Evergreen Parkway, Suite 310, Evergreen, CO 80439. Website: www.passionatemarriage. com

 

Bad Couples Therapy

Betting Past the Myth of Therapist Neutrality

by William Doherty

I want to propose a new competition for therapists: awards for the worst experiences doing couples therapy. My own entry would be in the category of a worst experience as a new couples therapist in the first session. It was 26 years ago, but as they say, it feels like yesterday. As a graduate student, I'd done individual counseling before, and had worked with parents and kids, but had never worked with a couple. Thirty minutes into the first session, when I was lost in the midst of a meandering series of questions, the husband leaned forward and said, "I don't think you know what you are doing." Alas, he was right. Naked came the new couples therapist.

Since then, as we say in Lake Wobegon, I like to think I've become an above-average couples therapist, but that might not be much of a distinction. A dirty little secret in the therapy field is that couples therapy may be the hardest form of therapy, and most therapists aren't good at it. Of course, this wouldn't be a public health problem if most therapists stayed away from couples work, but they don't. Surveys indicate that about 80 percent of therapists in private practice do couples therapy. Where they got their training is a mystery, because most therapists practicing today never took a course in couples therapy and never did their internships under supervision from someone who'd mastered the art. From a consumer's point of view, going in for couples therapy is like having your broken leg set by a doctor who skipped orthopedics in medical school.

What's my evidence for these assertions? Most therapists today trained as psychologists, social workers, professional counselors, or psychiatrists. None of these professions requires a course in marital therapy. At best, some programs offer an elective in "family therapy," which usually focuses on parent-child work. Only the professional specialty of marriage and family therapy, which constitutes about 12 percent of psychotherapy practitioners in the United States, requires coursework in couples therapy, but even there you can get a license after working only with parents and kids. After coursework, few internship settings in any field give systematic training in couples therapy, which isn't ordinarily a reimbursable service.

The result is that most therapists learn couples therapy after they get licensed--through workshops and by trial and error. Most specialize in individual therapy, and work with couples on the side. Most have never had anyone observe or critique their couples work. So it's not surprising that the only form of therapy that received low ratings in a famous national survey of therapy clients, published in 1996 by Consumer Reports, was couples therapy. The state of the art in couples therapy isn't very artful.

Why is couples therapy a uniquely difficult form of practice? For starters, there's an ever-present risk of winning one spouse's allegiance at the expense of the other spouse's. All your wonderful joining skills from individual therapy can backfire within seconds with a couple. A brilliant therapeutic observation can blow up in your face when one spouse thinks you're genius and the other thinks you're clueless--or worse, allied with the enemy. After all, one spouse who agrees with you too vociferously can dramatically undercut your effectiveness.

Couples sessions can be scenes of rapid escalation uncommon in individual therapy, and even in family therapy. Lose control over the process for 15 seconds and you can have spouses screaming at each other and wondering why they're paying you to watch them mix it up. In individual therapy, you can always say, "Tell me more about that," and take a few minutes to figure out what to do next. In couples therapy, the emotional intensity of the couple's dynamics doesn't give you this luxury.

Even more unnerving is the fact that couples therapy often begins with the threat that the couple will split up. Often, one spouse is coming just to drop off his or her partner at a therapist's doorstep before exiting. Others are so demoralized that they need an intense infusion of hope before agreeing to a second session. Therapists who prefer to take their time doing their favorite lengthy assessment instead of intervening immediately may lose couples who arrive in crisis and need a rapid response to stop the bleeding. A laid-back or timid therapist can doom a marriage that requires quick CPR. If couples therapy were a sport, it would resemble wrestling, not baseball--because it can be over in a flash if you don't have your wits about you.

As in any sport or art form, there are beginners' mistakes and advanced practitioners' mistakes. Inexperienced and untrained couples therapists don't manage sessions well. They struggle with the techniques of couples therapy, and clients often sense that these therapists aren't skillful. More advanced therapists can manage sessions well with challenging couples, but they make subtler mistakes, of which neither they nor their clients may be aware. I'll start with beginners' mistakes and then describe how couples therapy can go south, even in the hands of experienced therapists.

Beginners' Mistakes

Mistake No. 1--Lack of Structure: The most common mistake made by inexperienced couples therapists is providing too little structure for the sessions. These therapists let spouses interrupt each other and talk over each other. They watch and observe as spouses speak for each other and read each other's minds, making attacks and counterattacks. Sessions generate a lot of energetic conversation, but little learning or change. The partners simply reproduce their familiar patterns in the office. The therapist may end the session with something blandly reassuring like, "Well, we've gotten a number of the issues on the table," but the couple leaves demoralized.

Screenwriters are onto this fundamental clinical mistake. In the movie The Ref, Kevin Spacey and Judy Davis are a warring couple in a therapist's office. At one point, they turn to the therapist, almost pleading for him to intervene in their bickering. He says reflexively, "What I can say is that communication is good." Later, he adds, "I'm not here to give advice or to take sides," whereupon Davis shoots back, "Then what good are you anyway?" When the therapist loses control completely and begs the couple to lower their voices, they shout back, "Fuck you!" in unison--the first time they've agreed on anything in the session.

Sometimes a therapist who doesn't create a clear structure for the sessions will conclude that some clients aren't good candidates for couples therapy because they're too reactive in each other's presence. The upshot is a referral, splitting up the partners for individual therapy, which might further erode the marriage. I once saw a tape of an inexperienced couples therapist who announced that the sessions didn't seem "safe enough" for the angry spouses. (There was no evidence of physical violence or emotional cruelty in the relationship.) The real issue wasn't the couple's ability to handle the joint sessions--it was the therapist's ability. She was the one who didn't feel safe.

I remember when I first realized that I had to ratchet up my structuring skills. I was working with a couple in which the husband was Israeli and the wife American. David was opinionated and assertive, but loving and committed. The challenge I faced in the early sessions was his tendency to interrupt his wife, Sarah. I tried to keep him at bay with my standard armamentarium of diplomatically crafted "I-statements." "David," I'd say, "I'm concerned about your interrupting Maria, which means she can't finish her thought. I'd like to reinforce the ground rule that neither of you interrupts the other. Is that something you're willing to commit to?" He'd agree, be cooperative for a while, and then start interrupting again when she got his goat. Finally, I fell back on my working-class Philadelphia roots, bluntly instructing him, "David, stop interrupting your wife. Let her finish." He looked as though he was taking in my message for the first time. "Okay," he replied meekly. Thereafter, when he'd start to interrupt, I'd keep looking at Sarah while waving my arm in his direction, shooing his comments away. He cut it out, the therapy progressed, and I realized I'd reclaimed a piece of my Philly street past that I could use when the occasion required.

Mistake No. 2--No Plan for Change: After lack of structure, the most common complaint I hear is that many therapists don't recommend changes in the couple's day-to-day relationship. Some therapists act as if insight alone is enough to help couples change intractable patterns of thinking and acting. But we all know that certain dynamics within a relationship have a life of their own. I start emotional, you start rational, I get angrier, and you get more controlled. Then I mention your mother and you blow up, which pleases me immensely. Just pointing out this dynamic isn't enough to change it. All empirically supported forms of couples therapy require active interventions aimed at teaching couples new ways to interact. Most involve homework assignments. Of course, just making interventions isn't enough if they're too global or generic. If my wife and I are fighting continually over her mother, saying to us, "Remember to paraphrase and use your other communication skills" won't take us very far. Good therapy addresses the way couples actually do their own particular dance, both during the session and back at home.

Mistake No. 3--Giving Up: The third common mistake of inexperienced therapists is giving up on the relationship because the therapist feels overwhelmed with the couple's problems. I've heard enough stories about therapists who abandoned ship too soon to be confident that this is a common mistake. In one case, the therapist did an assessment during the first session, and in the second session pronounced that the couple was incompatible and weren't candidates for couples therapy--without ever trying to help them. In another case, a woman whose husband was becoming emotionally abusive as his Parkinson's disease progressed told me that, at the end of the first session, the therapist had said, "Your husband will never change, so you have to accept what he's doing or get out." Translation: "I don't have a clue about Parkinson's disease or how to help an elderly couple with serious marital problems, so I'm pronouncing yours a hopeless case." This also kept the therapist's average length of treatment in favorable territory with his managed-care employer.

Some therapists survive the early sessions but get frustrated later and actively advise couples to separate. When deciding that the couple isn't amenable to treatment, they don't seem to factor in their own skill level. They may further reduce their own sense of responsibility by making a delayed diagnosis that one of the spouses has a personality disorder. This often means nothing more than "I can't work with this person." Giving up this way is akin to a primary care physician's pronouncing a patient incurable without referring the patient to a specialist in his or her life-threatening condition. I once worked with a young family physician who had a rule that no one should be allowed to die without a consultation from a specialist in what is killing them. I would argue the same for couples: treatment failures, especially those that lead to divorce, shouldn't be accepted without a consultation or referral to a competent, experienced therapist who specializes in working with couples.

Experienced Therapists' Mistakes

Mistake No. 1--Thinking All Couples Are Equal: Advanced practitioners' mistakes are more about strategy than technique, more about missing the context than specific relational dynamics, and more about unacknowledged values than lack of knowledge. I'll focus on two areas of poor couples therapy by experienced therapists: working with remarried couples and working with couples deciding whether to work on their marriage or divorce.

Remarried couples with stepchildren are a minefield, even for experienced therapists, because the partners almost always come with parenting issues, not just couples problems, and because many therapists miss the nuances of stepfamily dynamics. Therapists who specialize in adult relational work but aren't skilled at parent-child therapy will fail with these families. Experienced therapists who treat remarried couples like first-marrieds usually manage the individual sessions well, but use the wrong overall strategy.

I remember my own awakening on therapy with remarried couples almost as clearly as I remember my first session of couples therapy. It was in the spring of 1985, and I'd been trying to get Dave and Diane to reduce conflict in their two-year-old marriage by being equal parents with Kevin, Diane's challenging, 14-year-old son from a previous marriage. It was a familiar coparenting problem. Dave thought that Diane was too soft on the boy, and Diane thought Dave was too strict. They'd sometimes  reach a "compromise," but Diane wouldn't follow through on it. I'd helped many couples with this kind of bread-and-butter problem in family therapy, but I was stuck here. I can feel the chair I was sitting on when I said to myself something like, Bill, why are you insisting that this woman share parenting authority equally with this man? He didn't raise Kevin, Kevin doesn't see him as a father, and Dave doesn't have the same investment as Diane does. She can't treat Dave as an equal here, so stop beating up on her for not succeeding.

I realized that I was misapplying a norm about coresponsibility in biological coparenting to a family structure where it didn't apply in the same way. I then told the couple that I could understand why Diane couldn't give Dave equal say in disciplining her son--the fact was that Diane was the parent. With so many years invested in her son and Dave's relationship with Kevin so new, she couldn't share authority 50-50. I introduced a metaphor that I would come to use often with stepfamilies: in the parenting domain with her child, Diane was the "first violinist" and Dave "second violinist." Diane immediately was relieved, and Dave immediately was alarmed. There was a lot of work ahead, but they did achieve a workable coparenting relationship based on Diane's leadership with her son. Shortly thereafter, I read Betty Carter's work on stepfamilies in which she argued for treating the spouses as having different roles with the children, and then I came across new research by Mavis Hetherington making the same point. Stepfamilies are a different species, and couples in these families have to be treated with different approaches. Many experienced couples therapists still don't know this--or even if they do know it, still lack a viable treatment model.

Beyond coparenting leadership issues, couples in stepfamilies swim in a sea of divided loyalties, which even experienced therapists sometimes miss. I once consulted on a case of a recently married couple in which the wife had three children and the husband none. One thorny issue was that the husband felt left out of the wife's emotional world because they had little time alone together. The wife agreed, and she told the therapist how torn she felt about this. She loved her husband and wanted the marriage to work, but her three school-age children required nearly all of her time after work and in the evenings. She helped them with their homework every night, and they had the kind of extracurricular activity schedules that render contemporary parents part-time chauffeurs and full-time activity directors on the family cruise ship. Weekends were spent doing errands and driving the kids to their traveling soccer games.

In one of the early sessions, the therapist, who was highly experienced in couples work, empathized with the wife's feeling caught between the needs of her husband and those of her children, and supported the wife's decision to prioritize the children. The therapist explained that these years of raising school-age children are ones in which the children's time demands are huge, and the marital relationship inevitably has to take a back seat. She said that, as a wife and mother, she herself knew about these demands, which ease when children get older. In other words, the therapist normalized the marital gap in terms of the family life cycle, recognizing especially the unique strain on a wife who couldn't meet everyone's needs. The wife burst into tears at feeling so deeply understood and accepted. The therapist then turned to the husband and gently asked him for his feelings and thoughts as he'd followed the conversation and seen his wife's pain and tears. The husband, a "good guy," who didn't like conflict, owned that he'd been selfish and pledged to back off on his demands for more time with his wife, promising he'd be more understanding in the future.

The session ended with a warm glow. The couple agreed to continue working on other issues that had brought them to therapy. The therapist was pleased at how she'd been able to combine her clinical skills and her own experience as a wife and mother to help this couple. A few days later, the husband called to end the therapy, saying tersely that they'd decided to continue to work on things by themselves.

The therapist was stunned and consulted with me. I helped her see that she'd missed that there were two distinct family developmental stages at work in this case. Yes, the parent-child development stage was one of intense time demands (leaving aside for the moment the overscheduling supported by the wider culture), but the marital-developmental stage had its own pacing needs: a puppy marriage needs time for play and nurturing. To put aside their new marriage for years on end is dangerous. Of course, it's dangerous even in long-term relationships, but at least there may be a strong foundation and memories of good years. The husband was appropriately worried about the viability of a neglected new marriage. What struck me was how even a skilled, experienced couples therapist had misunderstood the special needs of a remarried couple.

Mistake No. 2--Not Standing by Marriage: If beginners give up on couple relationships because of lack of skill, experienced therapists sometimes give up on couples because of the values they hold about commitment in a troubled marriage. I've heard experienced therapists announce proudly, "I'm not here to save marriages; I'm here to help people." This split between people and their permanent, committed, intimate relationships (which is how I'm defining marriage ) has a superficial appeal. No one wants to save a marriage at the cost of great damage to a spouse or the children. But the statement reflects a troubling--and usually unacknowledged--tendency to value a client's current happiness over everything else.

One highly regarded therapist in my local community describes his approach to working with couples in this way: "I tell them that the point is to have a good life together. If they think they can have a good life together, then let's give it a try. But if they conclude that they can't have a good life together, then I tell them maybe they should move on." Again, at one level, this sounds like practical advice, but as a philosophy of working with marital commitment, it's lame. How does it differ from counseling someone about a job decision? If you think that your frustrating accounting job can eventually work out for you, then try to improve the situation; if not, move on. Most of us didn't stand up in front of our family, our friends (and maybe our God) and declare our undying loyalty and commitment to Arthur Andersen LLP, but we did so with our spouse.

In this way, the ethic of market capitalism can invade the consulting room without anyone's seeing it. Do what works for you as an autonomous individual as long as it meets your needs, and be prepared to cut your losses if the futures market in your marriage looks grim. There are legitimate reasons to divorce, but given the hopes and dreams that nearly everyone brings to a marriage, divorce is a wrenching, often tragic, event. I see divorce more like amputation than like cosmetic surgery. That's a different value orientation than that of one prominent family therapist who sees his job as helping people decide on their best option. "The good marriage or the good divorce," he told a journalist, "it matters not."

A lesbian therapist told me of how her own therapist wouldn't permit her to bring the children's needs into the therapy conversation when she was contemplating whether to stay with her partner. "This isn't about the kids," the therapist insisted. "It's about what you need and want." When the client objected that she had to weigh the kids' needs in her decision, and wanted to talk about it, the therapist balked, insisting that the client was avoiding dealing with her real issues. Finally, the client fired the therapist. Later, she told me that she and her partner had found a way to stay committed, improve their relationship, and raise their children together. The therapist in this case was a highly regarded professional, a "therapist's therapist" in the community.

It was an experience that happened to a couple who are close to my family that radicalized me about how today's therapists deal with commitment. It's a story like many others I've heard from clients, colleagues, and friends. Monica's life was thrown into chaos the day that Rob, her husband of 18 years, announced that he was having an affair with her best friend and wanted an "open marriage." When Monica refused, Rob bolted from the house and was found the next day wandering around aimlessly in a nearby woods. After two weeks in a mental hospital, diagnosed with an acute, psychotic depression, he was released to outpatient treatment. Though he claimed during his hospitalization that he wanted a divorce, his therapist had the good sense to urge him to not make any major decisions until he was feeling better.

Meanwhile, Monica was beside herself. She had two young children at home, held a demanding job, and was struggling with a serious chronic illness diagnosed a year before. Indeed, Rob had never been able to cope with her diagnosis, or with his own job loss six months later. (He was now working again.) In addition, the family had just recently moved to a new city.

Clearly, this couple had been through a lot of stress. For a former straight-arrow man with strong religious and moral values, Rob was acting in a completely uncharacteristic way. Monica was depressed, agitated, and confused. Being an intelligent consumer, she sought out recommendations and found a highly regarded clinical psychologist. Rob continued in individual outpatient psychotherapy, while living alone in an apartment. He still wanted a divorce.

As Monica recounted, her therapist, after two sessions of assessment and crisis intervention, suggested that she pursue the divorce. She resisted, affirming her hope that the real Rob would reemerge from his mid-life crisis. She suspected that the affair with her friend would be short-lived (as it was). She was angry and hurt, she said, but determined not to give up on an 18-year marriage after only one month of hell. The therapist, according to Monica, interpreted her resistance to "moving on with her life" as stemming from an inability to "grieve the end of her marriage." He then connected this inability to the loss of her mother when Monica was a small child. Monica's difficulty in letting go of a failed marriage, he claimed, stemmed from unfinished mourning over her mother's death.

Fortunately, Monica had the strength to fire the therapist. Not many clients would be able to do that, especially in the face of such expert pathologizing of their moral commitment. It was equally fortunate that Monica and Rob found a good marital therapist, who saw them through their crisis and onward to an ultimately healthier marriage. When I last saw them, Rob was more emotionally available than I'd ever seen him before. He and Monica had survived an intervention that I call therapist-assisted marital suicide.

The therapist's blundering in this case stemmed not from clinical incompetence in knowledge and technique, but from his values and beliefs. He simply didn't recognize the importance of a commitment made "for better or worse." Like attorneys who automatically fight their clients' opponents, some therapists encourage clients to rid themselves of currently toxic spouses, rather than working hard to see what can be salvaged and restored. This approach may be wrongheaded, even when it comes to individual well-being. Recent research by sociologist Linda Waite has found that the great majority of unhappy spouses who persevere in their (nonviolent) marriages for five years report marked improvements in their marriages, and that divorce, on average, doesn't make people in unhappy marriages any better off in personal well-being.

Ultimately, clinical skills aren't enough in couples therapy, because here, more than in any other form of therapy, our clinical skills and values intersect. Treating a client's depression or anxiety doesn't involve the kind of value judgments that working with couples does. Feminists were among the first to point out the inevitability of moral positions in couples work. You can't work with heterosexual couples without a framework that addresses justice and equality in gender relations. If you claim to be neutral, you'll enact whatever traditional value orientation you have about women and men and how they should make a life together. The same is true for race and sexual orientation. Not to have a moral framework is to have an unacknowledged one, and in mainstream American culture, that will probably be individualistic rather than relational or communitarian.

Just as clients who value gender equality won't be well served by therapists with traditional value orientations about gender, clients who cherish their moral commitment to their marriage, as Monica did, won't be safe in the hands of clinically skilled couples therapists who have individualistic orientations. Such clients need therapists who understand the wisdom of Thornton Wilder when he wrote: "I didn't marry you because you were perfect. I didn't even marry you because I loved you. I married you because you gave me a promise. That promise made up for your faults. And the promise I gave you made up for mine. Two imperfect people got married and it was the promise that made the marriage. And when our children were growing up, it wasn't a house that protected them; and it wasn't our love that protected them--it was that promise."

The biggest problem in couples therapy, beyond the raw incompetence that sadly abounds, is the myth of therapist neutrality, which keeps us from talking about our values with one another and our clients. If you think you're neutral, you can't frame clinical decisions in moral terms, let alone make your values known to your clients. That's partly why stepfamilies and fragile couples get such bad treatment from even good therapists. Stepfamily life is like a morality play with conflicting claims for justice, loyalty, and preferential treatment. You can't work with remarried couples without a moral compass. Fragile couples are caught in a moral crucible, trying to discern whether their personal suffering is enough to cancel their lifetime commitment, and whether their dreams for a better life outweigh their children's needs for a stable family. The therapist's moral values are writ large on these clinical landscapes, but we can't talk about them without violating the neutrality taboo. And for clients, there's the scary fact that what therapists can't talk about may be decisive in the process and outcome of their therapy.

In the end, we need to cultivate wise couples therapists, not just competent ones. Wise therapists see the whole context of people's lives, and can reflect openly and deeply on values and broader social forces influencing the profession. My wisdom won't be the same as yours, but we have to engage one another on the big questions, instead of hiding behind the wizard's veil of clinical neutrality. The philosopher Alasdair MacIntrye wrote that, in a world that seduces professionals into seeing their work as the delivery of technical services stripped of larger social context and moral meaning, the hallmark of a true profession is a never-ending argument about whether it's being true to its fundamental values, principles, and practices. In other words, becoming a competent couples therapist is just the first step in becoming a good one.

William Doherty, Ph.D., is professor and director of the marriage and family therapy program at the University of Minnesota. Address: Family Social Science, University of Minnesota, 290 McNeal Hall, St. Paul, MN 55108. E-mails to the author may be sent to bdoherty@che.umn.edu.

 

It Takes One to Tango

You Don't Need Both Partners to Do Couples Therapy

by Michele Weiner-Davis

In our first session, Lynn, a sullen looking 27-year-old, had plenty to complain about. Her husband, Jeff, had been extremely critical of late and seemed emotionally distant from both Lynn and their 18-month-old son, Jason. Lynn felt that Jeff spent too much time with friends after work and on the weekends, and when he was home, he constantly picked on her. With little help around the house, no assistance on the parenting front and virtually no affection from Jeff, Lynn felt desperately unhappy, Lynn longed ' for things to be the way they had once been. "We were better friends back then," she recalled. "We spent a lot of time together and it really didn't matter what we were doing, as long as we were together." I asked, "Lynn, when your relationship was more loving, how was Jeff different?" Without hesitation, she replied, "He was thoughtful and very sensitive to my needs. He had a great sense of humor and was lots of fun to be with." "And how were you different, Lynn?" 1 asked. "I was a much happier person back then, no doubt about it."

"When you were a happier person, how were you different with Jeff?"

Lynn admitted that, because she was so unhappy, she was "crabbier" than she had been in the past. "I guess I used to be a lot nicer to him." She offered a long list of endearing acts of kindness, like putting love notes in Jeff's lunches or calling him at work just to let him know that she was thinking of him. She often used to initiate lovemaking, something she never did anymore. After thinking about the "old Lynn," she wistfully admitted that she liked herself more back then and disliked the angry, resentful person she had become much of the time.

As Lynn described the problems in her marriage, the circular nature of her interactions with Jeff became apparent. Were Lynn's crabbiness and standoffishness a result of Jeff's long absences from home and/or his criticisms of her, or were Jeff's absences and critical tone a result of Lynn's moodiness and withdrawal from him? Knowing that the correct answer was probably "both," I suggested an escape route out of their marital merry-go-round. "Starting tonight, no matter what you're thinking or feeling about Jeff, act like the old Lynn. Do the things you used to do when you liked yourself more, and watch Jeff very closely to see how he responds."

When she returned for our next appointment two weeks later, Lynn was eager to tell me about her experiment with Jeff. Right after our session, he had come home in a grouchy mood and made a critical comment during dinner. But instead of getting angry and defensive, Lynn simply agreed. She said that Jeff actually looked up at her in amazement and that the rest of the meal went without incident. In fact, Jeff discussed a situation at work that had been troubling him, something he hadn't done in months. When Lynn offered her opinion, he seemed unusually receptive. Lynn felt encouraged.

Later that week, Lynn realized that they hadn't spent time alone for months and reminded herself that she used to be a "social coordinator" of sorts in their marriage, and that Jeff seemed to appreciate this quality in her. So, despite the fact that she wasn't completely certain of how things would turn out, she arranged for a babysitter and made dinner reservations at one of Jeff favorite restaurants. Their evening went extremely well and when they got home, they stayed up late talking.

In the days that followed, Jeff seemed more relaxed and less critical of Lynn.

Nevertheless, the time between sessions was not without its rough spots. On a couple of occasions when Jeff made inflammatory comments, Lynn responded in kind and the tension between them escalated. Although Lynn felt discouraged when this happened, she was beginning to understand how her actions during these tension-filled times impacted on Jeff's when she allowed her buttons to get pushed, their unpleasant interactions got even more unpleasant.

She also recognized that no matter what Jeff did or said, no matter how his comments or actions "made her" feel, she was still in control of how she responded. She felt empowered by this realization, and in tense situations asked herself, "What's my goal here? What do I want to have happen?" and then quickly assessed whether what she was about to do would achieve those ends.

I asked Lynn to rate how well things were going in her relationship on a 1 to 10 scale, with 10 being great and 1 being the pits. She replied, "Four weeks ago I would have told you 2. In these last two weeks, I'd have to say 7. Then I asked, "Where on the scale would you need to be to feel satisfied?" She said 8 or 9. So I asked "What would be one or two things that could happen in your relationship that would bring you up to an 8?" and she said, "He would have to say, 'I love you' again and we'd have to make love." I urged her to keep being the "old Lynn," and take note of Jeff's reactions. We scheduled a third meeting and she left.

Two weeks later a very happy Lynn greeted me at the door. "Well, it happened. We made love and right after we were done, he turned to me and said, 'Lynn, I really love you.' It felt great because he hasn't said that in a long time. I can't believe he's changed so much so quickly." Lynn described quite a few things she had done to maintain the changes and divert unnecessary arguments in the last few weeks. As she spoke, I felt confident that she understood the "magic" behind the "new Jeff." To help her plan for future challenges, I said, "You will undoubtedly hit bumps in the road in the future. If things between you and Jeff start to go downhill, what will you do to get back on track?" With a huge smile on her face Lynn replied, "I'd remember everything we talked about here that I got things on track all by myself the first time, and that I can do that again." Lynn's look of confidence was striking. That was the last I saw of her.

From my perspective, there is nothing remarkable about this case. I helped Lynn figure out what she needed to do differently to spark a change in Jeff and in their relationship, and assumed that a positive change in Jeff would be so reinforcing that it would be the beginning of a solution avalanche. It was Systems Theory 101 "A change in one part of the system leads to changes in other parts of the system." Yet, when I discuss Lynn's case and others like it in the workshops I give on solution-oriented therapy, working with one partner to elicit relationship change isn't as mainstream a practice as I once believed. Many therapists question whether Lynn's reports of change were real. Some worry whether, since Jeff hadn't participated in therapy, the changes will stick. Others argue that the burden for relationship change should not have been left solely on Lynn's shoulders. But the most burning question turns out to be the most basic "How is it possible to do couples therapy with just one partner?"

This question stems from the fact that many therapists define the type of therapy they practice by taking a head count: if one person is present, they're practicing individual therapy; if two or more people are present, it's couples or family therapy. I believe this is misguided the key to determining which brand of therapy is in use at any given point lies in the therapist's orientation and focus, not the number of people occupying space in the room.

Individual therapy and couples therapy are based on very different premises and require completely different clinical skills. Individual therapists delve into intrapsychic processes. They help clients gain insight into themselves, their family of origin and how these childhood experiences have impacted on their present behavior, attitudes and feelings. It is the individual therapist's belief that insight is the vehicle for change; that is, once clients understand why they do what they do, they will then be able to change.

Couples/family therapists, on the other hand, are focused on the observable connections between people in the here and now. They're interested in patterns of interaction what people say and do with one another. According to this theoretical orientation, change is brought about not by going inward, but by changing observable interactions among people.

Another reason some therapists can't fathom doing couples therapy with individuals is that they are trained to believe that relationship problems are best resolved by helping people identify, process and express their feelings to one another. With this perspective as a starting point, it's easy to see why one would be skeptical about the possibilities for positive relationship change when only one partner is present. Teaching active listening skills to just one person in the relationship is like listening to the sound of one hand clapping.

But couples therapy with individuals is based on different premises. Although good communication skills go a long way toward creating healthy relationships, talking things out isn't the only, nor necessarily the best, way to resolve recurring problems. While we are affected by what our partners say to us, we are also greatly affected by what they do. For instance, although Lynn had tried for months to convince Jeff to be more loving toward her, nothing she said ever made a difference. It wasn't until she stopped talking and started changing her actions that Jeff became more responsive.

There might be a familiar ring to Jeff's tuning out Lynn's words, but not her actions. During the last few years, we've learned a lot about gender differences. In particular, we've become aware that women, in general, are more verbal than men, who tend to favor action over words. That's why when women tell me, "I talk until I'm blue in the face" or "I've told him a million times," instead of teaching them new and better ways to express themselves, I encourage them to say less and do more. And, since women are much more likely to come in to therapy solo, teaching action-oriented techniques should be tops on therapists' lists of things to do.

The fact that action-oriented techniques may work better with women under certain circumstances is no consolation to therapists who feel that doing couples therapy with women is a bad idea because it places all the burden of improving relationships on women's shoulders. "Why should women have to dream up ways of approaching men? Why can't men take responsibility for finding more creative ways of reaching women?" This position, in my opinion, stems from a lack of understanding of the systemic laws governing change. Change is like a chain reaction. She tips over the first domino, then he changes. When a woman who is dissatisfied in her relationship decides to change her method of getting through to her partner, she isn't doing "all the work." Assuming responsibility for creating positive change in life isn't working harder, it's working smarter.

Despite my emphasis on the merits of this approach with women, it's important to point out that I practice couples therapy with men, with similar results. Even when the marriage teeters dangerously on the brink of divorce, there is much therapists can do when the man is willing to change.

For example, Ben's wife had asked him to leave the house a week before she filed for divorce. When he scheduled an appointment, he had moved out and was desperately unhappy. He didn't want their 20-year marriage to end and wanted to know if there was anything he could do to make her change her mind.

I asked Ben, "If your wife were here now, what would she say you've been doing recently in regard to your marriage?" He said, "She would tell you that I've been pressuring her all the time and that she can't stand it anymore. I've been calling her several times every day and begging her to change her mind. I've been reminding her about all the good times we've shared and have sent her flowers four times. I leave Hallmark cards for her around the house." I asked if this was working, and he said, "No, I've been making things worse."

I explained to Ben that relationships are like seesaws the more of something one person does, the less the other person does of it. "If you do all the longing for your marriage, it allows her to focus only on the bad points. If you are the emotional one, it gives her room to be cold and withdrawing. So, if you want her to stop pulling away from you, you're going to have to stop pushing her."

I then asked him, "What could you do or say that would make Lois sit up and take notice?" Ben responded, "I guess I should stop calling her every day. I should stop saying 'I love you,' because I know it only makes her mad. I should stop asking her if she's changed her mind." I told Ben that he was on the right track and wondered what else he could think of to turn things around. He said, "I'm always so depressed around her. I guess that's not too attractive. If I were more upbeat, and even somewhat enthusiastic about anything in my life, she would really be shocked. That would be noticeable instantly."

I sent Ben home with the following-instructions. "Start experimenting by changing how you act when you are in Lois's presence. Do all the things you discussed here today. When you do, one of two things might happen. The first is nothing. When you change, it might not make a difference at all. That's a real possibility. Or she might be intrigued by your changes and start to show some interest in being with you. But I'm warning you, if you get overly enthusiastic and try to get her to move along quickly, she will definitely back off. You must move slowly. Don't discuss the future of your marriage at all for now. And don't move back home until the issues that separated you have been worked out."

Ben was lucky. When he gave Lois some breathing room, she did show interest in revitalizing their relationship. It was a slow process and required a lot of support on my part to keep Ben from becoming impatient. But in the end, without having Lois ever come in for therapy, they resolved some long-standing issues and he did return home. As far as I know, they are still living happily ever after.

My couples work. With individuals can be broken down into three simple steps. First, I help clients figure out what they really want from their partners by establishing clear, concrete goals that always remain in our peripheral vision. I urge clients to talk about what their partners will be doing differently when the relationship is more satisfying. I help clients picture a new, more positive relationship by asking questions such as, "When you start to feel closer and more connected to your husband, what will he be doing differently?" and "If I were a fly on the wall, what would I see the two of you doing differently when your relationship improves?" I emphasize observable actions rather than subjective feelings, to help clients develop clearer signposts for change.

The next item of business is to help my clients become "solution detectives." I want people to view their relationships as a trial-and-error process: when there's a problem, they do something to solve it. They then should watch closely for the results. If what they do is working, they should keep doing it. If not, they should switch gears.

Although simple in theory, this is not so simple in practice. People get glued to their favorite problem-solving strategies, believing that whatever they're doing to improve their relationships is the right thing to do. In fact, they think miserable results often signal the need to crank the particular strategy up a notch, i.e., do it one more time, with feeling.

Once we establish goals, the third step is to investigate what my clients have done in the past to accomplish these goals. I want to access what's worked and what hasn't. A trademark of the solution-focused therapy approach is to ask clients about problem-free times or periods that are the exceptions. For example, I might say to a client, "Tell me, I know you've been fighting a lot lately, but there must be times when you get along better. What's different about the times the two of you are more at peace with each other? What does he do differently then? What do you do differently then?" We begin to weed through the frustration and anger provoked by the problems in their relationships and discover what can be learned from the times they get along well. As clients identify what's different about the times things go well, the solution comes into view. My clients can then begin to do what works the moment they leave my office.

Although analyzing the good times is uplifting and informative, I also want to know what hasn't been working. To help clients ascertain dead-end strategies, I ask, "If your partner were here now and you weren't, and I asked, 'What does she do that drives you nuts,' what would he say?" I show them how their actions, no matter how effective they "should" have been in theory, have, in reality, caused their partners to dig in their heels even further. In other words, I train clients to pay attention to "what is" as opposed to "how things should be." Once we identify what would constitute a new and different approach to the ongoing problem, I send clients home to experiment.

In contrast to therapists who question the value of doing couples therapy with individuals, this approach is often my method of choice for a variety of reasons. I find it can empower people by showing them that they no longer have to play the waiting game of "I'll change if you change first."

Instead, they find themselves back in the driver's seat of their own lives. This is no small feat, given the helplessness arid hopelessness people feel when their partners present impenetrable walls.

Secondly, working with only one partner allows me to both join with arid confront that person in ways that wouldn't be possible if the other partner were present. For example, I can let my client know how well I understand what he or she is feeling about the relationship or about the other partner. It allows me to connect with the person without alienating the partner. On the other hand, because I'm perceived as an ally, I am at liberty to be bolder, more challenging and, at times, less balanced than would be the case if the other partner were present.

Furthermore, working with only one partner can avoid the unfortunate "ping-pong effect" in therapy, whereby one partner escalates his point of view, triggering the other partner to do the same and so on, until they're completely polarized. It has been my experience that when seen alone, many people are quite willing to take a closer look at their partners' points of view, since they don't feel coerced or that they're losing face. Once they put themselves into their partners' shoes, they're usually more conciliatory. Working with one partner doesn't work all the time, even in less challenging situations. This method is not a therapeutic panacea. There are times when one person changes and the other doesn't notice or, worse yet, doesn't care. Sometimes the relationship changes aren't in the desired direction or of the hoped-for magnitude. Occasionally, your client won't stop blaming his or her partner long enough to switch gears. But nothing works all the time. When my clients and 1 aren't getting positive results, we try something else. Working with one partner is only a good strategy if it works.

In the spirit of sharing what's worked for me, I want to encourage the skeptics I've encountered, and those I have not, to do a few things. First of all, stop telling clients, "Unless he/she joins us, therapy won't work" or, "If your husband isn't willing to come in, it means he's not committed to working on your relationship." Some people who are totally committed to their partners wouldn't dream of stepping into a therapist's office. (My own husband of 20-something years happens to be one of them.) Ascribing negative intent to those who prefer to steer clear of therapy is unfair, often incorrect and almost always hurtful to those who wish their partners would share their enthusiasm about the benefits of therapy. They end up blaming their partners even more intensely.

Furthermore, make a commitment to temporarily suspend judgment about the viability of working with individuals on relationship issues. Therapists who agree to work with individuals whose partners won't come in, but see it as a second-rate approach, worry me. We clinicians communicate our presuppositions about people and how they change when we do our work. If we begin therapy with a "this is better than nothing" attitude, we undoubtedly broadcast a pessimistic message about the possibilities for change.

Instead, the next time you hear, "My partner won't come in," try viewing the situation as an opportunity rather than a relationship death-sentence. Act as if you expect your work with your client to be successful. The results might be surprising! A change in you might just be a powerful catalyst for change in your clients.

Michele Weiner-Davis, M.S.W., is in private practice in Woodstock, Illinois. Her books include In Search of Solutions, Divorce Busting and most recently A Woman's Guide to Changing Her Man. Address: The Divorce Rusting Center, P. O. Box 197, Woodstock, Illinois, 60098; web site: www.weiner-davis.com; e-mail: Dbusting@aol.com

 

The Good, the Bad and the Ugly

Turning Ambivalence into Possibility

by Bill O'Hanlon

Nearly a decade ago, I treated a man named Abel, who was severely obsessive. He taught in a college communications program and loved words, but he'd become so obsessed with how human beings communicate that he could no longer put together words and meanings. He loved to read, but he could no longer concentrate because he obsessed about page margins and typefaces. He obsessed about art, sex, and his own writing. If one obsession went away, another took its place, from the moment he woke up till the moment he went to sleep. Nothing he tried brought any relief.

I thought hypnosis might help with his symptoms, but Abel, who'd unsuccessfully tried practically every form of therapy, including hypnosis, didn't think so. I assured him that I used a different approach to hypnosis, and he agreed to give it a try. During our second hypnosis session, he was symptom-free for about 15 minutes, and he continued to be for about 2 hours afterward. Even though he didn't entirely believe he'd been in trance, he was impressed and happy that something finally had helped.

In the third session, I began once more with hypnosis: "Okay, you can keep your eyes open, or you can close them, or they might open and close on their own," I said. Abel closed his eyes. "And as you're sitting there, you may be thinking you're not going to be able to go into trance. You can have that thought--that's okay. You may be thinking that this trance isn't going to work. You can think that--that's okay. You may be distracted by one of your symptoms, maybe by the tension in your jaw or your neck. You may even think you're too tense to go into trance--that's okay. You can be tense and you can still go into trance and you might relax as the moments go on. You don't have to relax to go into trance. You may be obsessing--that's okay. You can just let yourself feel what you feel, think what you think, experience what you're experiencing, and not think what you don't think, not experience what you don't experience, not feel what you don't feel, and you can still go into trance."

At that point Abel's eyes popped open. "That's it," he said. "Do more of that. That's what helped me last time."

"You mean do more trance?" I asked.

"No, no. I don't think I'm going into trance. But what you're doing now is exactly what I need. Do more of that."

"What do you mean?" I asked again.

"The way you're talking now is what's helping me. Because, somehow, when you talk that way, I get the sense I can't do anything wrong. It's the only time in my life when I can't do anything wrong. I long for that sense."

While Abel's symptoms didn't completely disappear, from this point on, he began to make progress in therapy. For the first time in years, he could relax his obsessive vigilance and begin to live his life instead of endlessly worrying about the details around life's edges.

Erickson and Not-Doing

I first learned this permissive approach watching Milton Erickson's work in the late 1970s, particularly the way Erickson used hypnosis and challenged standard ideas about hypnotic techniques and affects. Many considered hypnosis a rigid procedure, which could be effective only if certain exacting conditions were met: a person had to be physically and mentally relaxed to go into a trance; once in a trance, the person was supposed to be unaware of his or her surroundings except for the hypnotist's voice. So rigid were the requirements for succeeding at being hypnotized that many people believed they didn't have the ability to "go under" the hypnotist's spell.

Erickson's view was different. For him, trance was more of a not-doing than a doing. He understood that the hypnotist had to take the pressure off people, and make them realize that they didn't have to experience specific mental and physical stages in a particular order to go into trance. He invited people to just allow their own experiences to happen as they happened, without having to force anything. He used language that neutralized the mind's tendency to break experience down into dualistic opposites--this or that, right or wrong, correct or incorrect.

In a sense, he gave his clients permission to experience simultaneously or in rapid succession contradictory emotions and states of mind and body, emphasizing that no reaction excluded any other, and that all were "right." From Erickson, I learned to make statements like: "You can listen to and hear everything I say and you don't have to. You may remember what I say and you may not. You don't have to believe anything about this."

Abel's response to this approach--that it made him feel he couldn't do anything wrong--crystallized something for me. Here was a way to break up unconscious logjams; permissions enabled clients to experience two seemingly contradictory states simultaneously. The structure of hypnotic language freed people from the tyranny of having to choose, and choose correctly, what to feel and how to proceed. I began to appreciate the extraordinary power of permission, with or without hypnosis, particularly with my most challenging cases.

So I began focusing on how to most productively include the good, the bad, the ugly, and the in-between of my clients' experience to help them expand their sense of possibilities in life. But this was the mid-1980s, the height of the popularity of various forms of solution-based therapy, and people would sometimes come up to me at my workshops and say, "I really like your positive approach," thinking they were complimenting me, in spite of the fact that I wasn't particularly interested in accentuating the positive.

Around the same time, therapist David Nylund told me that the staff at his clinic had noticed a problem with therapists who were too focused on highlighting the positive. As they watched from behind the one-way mirror, they were struck by how often they saw therapists straining relentlessly to keep clients focused on solutions and solution-talk. Often, the effect was that clients became more and more frustrated and alienated, while the oblivious therapists continued asking about what was going better. Nylund and his colleagues named this phenomenon solution-forced therapy.

So, in my training workshops, I began emphasizing the importance of not excluding those thoughts and feelings that didn't look like solutions to anything. As valuable as it is to help people focus on solving their problems, it's equally important to validate people's experiences, however negative. The essence of good therapy is to be able to descend with people into their hell and at the same time keep one foot in the land of hope and possibility. I once heard a radio interview about research conducted with people who'd survived jumping off the Golden Gate Bridge. The only common factor among them seemed to be that on the way down each of them had had more or less the same thought: Hmmm. Maybe this wasn't such a good idea.

As therapists, we must recognize the complexity and ambivalence at the core of human experience. Inevitably our therapy theories invite us to oversimplify, and solution-focused therapists aren't the only ones guilty of that: the client's problem is "cathected introjects"; she needs to "express her feelings"; he needs to "take responsibility for his life"; clients have to "reexperience their abuse to heal from it." Whatever ideas we therapists get are going to be helpful in some situations with some clients, but they necessarily diminish and impoverish our clients' inner realities. Recognizing this, we need to remind ourselves that whatever conclusions we come to about our clients, it's always more complicated than that.

The Power of Permission

People run into problems when their lives are dictated by rigid beliefs that make the stories they're living out too restrictive. One common set of beliefs is about what you must or should do. For example: "I must always be perfect," or "I should always smile and be happy," or "Females should take care of others' needs." Another common set of beliefs is about what you can't or shouldn't do: "I can't be angry," or "Big boys don't cry."

Permission counters these commands and prohibitions. The therapist who offers permission goes beyond accepting clients as they are and moves into encouraging them to expand their life stories and their sense of themselves. In effect, the therapist who offers permission is saying, "There's more to you than this story you've lived out up to this point." Permissions can introduce choice and possibilities into circumstances that have been limited by necessity and impossibility.

How do permissions work in practice? Some years ago, I worked with a woman who'd been sexually abused by a cousin in childhood. He routinely brought her to orgasm, which she liked and felt bad about--because she didn't like him and felt manipulated and coerced by him. As an adult, she never got sexually excited or had orgasms until she became involved in S&M in her early twenties. After a frightening experience in which she was almost killed, she left the S&M scene.

Now, after many years of therapy, she lived with her fiance and was still unresponsive sexually. She'd begin to get sexually excited, and then get frightened and go numb. She'd accepted that this was the way things were with her. Once, at a professional conference, she'd started chatting with a fellow attendee and had gone into an elevator with him. As the doors closed, sparks seemed to jump between them and they had sex in the elevator. She was surprised that she was doing this wild thing, and even more surprised to have an orgasm during the short encounter.

In our therapy, she realized she was operating under two beliefs: "You shouldn't enjoy sex, because it's bad," or, "You're bad if you're sexually excited or have an orgasm." Because she'd been coerced to be sexually aroused, she'd developed the idea that she had to be sexually aroused and have orgasms in any sexual situation, whether she felt like it or not. I gave her two permissions: "It's okay to have sexual pleasure and not be punished. It's also okay not to be sexually aroused and okay not to have sex." I started interspersing into our conversations permissions such as, "You can be a good person and be sexual." And "You don't have to be bad to be aroused." But also, "You don't have to have sex, if you don't feel like it." And, "You don't have to have orgasms when you have sex."

How did she begin putting these permissions into practice? She decided to let her partner know she became afraid or numb when they were having sex. She'd tell him she needed to stop and talk, or not have sex right then. He was understanding and appreciated that she was honest with him, rather than just forcing herself to go through the motions. The fact that he responded so well confirmed for her that she did not have to have sex or have an orgasm. Her new freedom actually enabled her to have orgasms with her fiance more often.

Although you can give the permission to or the permission not to, giving both permissions at the same is often most effective: "It's okay to be sexual, and you don't have to be sexual." If you give only one permission for one type of response, clients may feel pressured to experience only one part of the equation, or they may find the other side emerging in a more compelling and disturbing way.

In certain situations, it's important to give permission for feelings, not actions. For instance, "It's okay to feel like cutting yourself, and you don't have to feel like cutting yourself." Needless to say, never give permission for harmful, destructive behavior.

Other times, it's helpful to give a client permission to do two things at once. Such was the case with Josie, whom I'd seen for a few sessions when she came in very agitated. She said she had something to tell me, but was terrified to talk about it. I told her it was okay not to tell me until she was comfortable enough to do so. Josie responded that she had to tell me, or she felt she'd be wasting her time and money in therapy. I told her to go ahead and tell me in whatever way felt right.

She seemed to struggle for a while and then said, "I can't tell you. I'm too afraid." We went back and forth like that until I began to understand Josie's dilemma and said, "Okay, I know this may not make sense, but what I'm going to say can be understood somewhere deep inside. You can find a way to tell me and not tell me at the same time."

In response, Josie closed her eyes and her hands began to move in elaborate movements that reminded me of "hand dancing" I had seen done by Thai performers. After some time, she opened her eyes and smiled, obviously relieved. "There," she said, "you were right. I told you and didn't tell you at the same time. My hands told you the whole story of my abuse. Now I can tell you in words."

"That's good," I thought to myself, "because I didn't get the hand thing at all." Josie went on to tell me what had happened to her. Although she knew it was irrational, she'd feared that if she told me, she'd somehow be responsible if I had a car accident or a heart attack. Telling her story was a great relief to her. Once she could find a way out of her bind, she could embrace the possibility of breaking her "curse."

The Power of Inclusive Thinking

Sometimes the key to helping someone who seems hopelessly stuck is to invite them to experience two seemingly contradictory feelings or states without putting them in conflict. What's central is the use of the word and: "You can feel tense, and you could relax. You might think you can't change, and you might be surprised to discover that you're changing. You want to change, and you're so afraid to change." This contrasts with how most people unconsciously put things together: "I have to feel this or feel that. I feel this, but I should be feeling that." Instead of reinforcing one-dimensional definitions of ourselves, such permissions go beyond mere acceptance to actively encouraging clients to simultaneously experience thoughts and feelings that they consider irreconcilable. It's as if the therapist is saying, "Your story has become too small for you. Give yourself permission to begin to envision and live out a larger story."

I remember doing therapy with a woman who'd been severely and persistently abused as a child. She lived six hours away and we met every month or so for three-hour sessions. She'd struggled with suicidal impulses for years, and the work we were doing was leaving her emotionally raw. She called one day and told me she couldn't go on in the therapy. "You're getting too close, and I feel too vulnerable," she said. "Plus you're too far away, and I can't come easily for an emergency appointment if I need one."

"I understand," I replied, "and I think this isn't a good time to end treatment. So let's talk for a minute and see if we can get you through until the next appointment. You can find a way to be vulnerable and protected. And you can regulate the distance and closeness to make it work for you. I can be right there with you while I'm here. You can be right here with me while you're there. I can be as far away as you need me to be and as close as you need me to be. And I can be far away and close at the same time." I went on in a similar vein for a few minutes--trying to establish in her a direct feeling sense that she could have her cake and eat it, too. It seemed to work. "Okay. You're right," she said. "I can do that. I'll see you next appointment."

As therapists, we must always be sensitive to the enormous life-restricting pull of either/or thinking. This abused client believed she had to be either vulnerable or safe. But there were situations in which this particular client had been able to be both vulnerable and safe. She said she felt that I was getting too close. I suspected just the opposite as well: she felt that I was too far away, emotionally as well as physically. So I included both possibilities, instead of one or the other.

Typically, when people are stuck, it's like two people trying to go through a door at once. The two are present simultaneously: I want to change, and I'm afraid to change. Inclusion expands the doorway, leaving room for both--and perhaps more--aspects of self to move freely. Merely giving language to this double presence by inviting people to recast their life stories to match their expanded sense of themselves, is often enough to free them from the insidious internal demand to see themselves and their reactions monolithically.

Not long ago, I consulted at a hospital with a woman who was depressed, suicidal, self-mutilating, and defiant.

"How long have you been so depressed?" I asked.

"Since I was 8 years old," she said.

"That's a long time. I'm surprised you've lasted this long."

"Well, two times over the years I almost succeeded in killing myself."

I was curious about how she'd kept herself alive. She told me she'd struggled against the depression so long because in some ways she wanted to live and find a way out of depression. Nobody really understood that, she added, because she was always talking about killing herself.

A few weeks earlier, I'd seen Mike Wallace on 60 Minutes interviewing a woman with a degenerative illness, who was fighting through the courts for the right to die. Wallace asked her why she was suicidal. She replied, "I'm not suicidal. I just don't want to live like this, and I want the right to choose to die." Wallace insisted that, since she was fighting for the right to die, she must be suicidal. "No," she replied, "I love life. I just don't want to live like this. I love life."

I told the woman at the hospital the story and said, "You've lived all this time because you want to live. You've made it this far, by luck, or because the angels were watching over you, or because someone cared for you at times, but mostly because you just kept yourself going. You want to die and you want to live, but you definitely don't want to live like this."

"That's it exactly," she said. "No one has understood that. I'm suicidal and I'm not!"

Now you might say that these women really didn't want to die. But I think that's the cheap version of their reality. They did want to die in a certain way, and (there's that word again) they were still alive, which spoke powerfully for their desire to go on living. Only by recognizing the complex truth of the matter, taking it seriously, giving words to and accepting these dual realities can this permissive, inclusive method work. So clients really do want to live. And the reality that you must come to terms with is that they may really die.

Practicing What We Preach

If the approach I've been laying out here was purely a matter of logic, theory, and better clinical outcomes, its principles would be more widely demonstrated in therapists' consulting rooms. But embracing clients' multiple realities inevitably leads therapists to face emotional issues in their own lives, issues that make an inclusive approach much more than a merely intellectual exercise. At least that's what my own experience has taught me. It's been one thing to give clients permission to accept their ambivalence, but quite another to do that in my own life.

Some years ago, my wife Steffanie was stricken with a painful and life-threatening illness. By 1997, she was bedridden, gaunt, and in extreme physical pain. While the doctors could offer many diagnoses, they had no viable treatments. Many told her there was nothing more they could do. Others referred her for assessments or treatments she'd already tried. She was despondent and convinced she was going to die.

I would hear none of it and found it impossible to support her hopelessness. So I unswervingly emphasized the possibilities for treatments yet to be developed, and the need to keep a positive attitude to support her immune system. I thought, of course, that this would be helpful to her, but it often had the effect of sparking terrible arguments between us.

She would tell me, "You want me to feel better, and I don't feel better. What you're saying just makes me feel worse and more alone." But at some level, I felt that if I didn't expend all my energy in fighting her pain and hopelessness, I would be giving in to it, even making it worse. I was terrified that if I accepted her reality, she was doomed and I would lose her.

Finally, help came from an unusual quarter. We'd recently moved to Santa Fe, New Mexico, and rented a house out in the country. It turned out there were some problems with the well because of leaks and some toxic materials stored in the house. I called the landlady, explained the situation, and told her that we intended to move out. The landlady didn't want us to move and, in addition to making the needed repairs, had a suggestion that could only happen in Santa Fe (or perhaps Sedona): she proposed hiring a "house psychic" to do a reading on the house and deal with the problem at a more cosmic level. Skeptical and a bit bemused, Steffanie and I decided we had nothing to lose and agreed to let the house psychic do her thing.

After a few Feng Shui-type suggestions, the house psychic did a reading for us that revealed, she said, that in a previous life Steffanie and I had been a couple living on a large estate in ancient Italy. Steffanie was the heir and I, as the new husband, had taken over managing the estate. But because I had little experience in such things, I was running the estate into bankruptcy and stubbornly refusing to listen to Steffanie, who unsuccessfully kept trying to tell me what to do. In our past life, the psychic told us, our stalemate ultimately had led to tragedy for Steffanie and I'd spent the rest of my life regretting I hadn't listened to her.

I know, I know--only in Santa Fe! But whatever its value as a past-life story, the psychic's tale was so parallel to our situation that it had an electric effect on me. I realized that I hadn't been listening to Steffanie. However inclusive I'd tried to become as a therapist, at home, I'd been determined to screen out her "negativity." As I might have predicted had I had any distance from our situation, the more "positive" I got, the more desperate Steffanie became.

Something about the psychic's making me see how stubbornness can led to tragedy made me think about my own family story. I suddenly made the connection to growing up in a household in which the unwritten injunction was "don't get sick." We kids had to be essentially on our deathbeds to be allowed to stay home from school or work. If we did stay home, we were never coddled. There was no television or other distractions. My mother, a tough farm girl, would leave some 7-Up and soda crackers by the bedside and check back every few hours to make sure we were still alive. No doctors, no medications. It was as if sympathy would somehow reinforce the illness.

From fear that Steffanie might die, I'd been reenacting an old family drama. I saw that I had to quit trying so hard to make everything okay again. I needed to let myself just be with Steffanie in her hell. I remember going into our bedroom and just lying down and holding her for a long time, without saying much of anything. Then, we quietly spoke about the pain she was in. Later, she told me that it was the first time she hadn't felt left alone in her despair. From then on, something shifted between us. I realized that accepting her hopelessness didn't mean I had to give up my own hopes for our future. I could hold them both. Soon, Steffanie began to talk about future plans and other small dreams that indicated she hadn't given up. I could, in turn, speak to her about my fear of losing her and being left alone. She's still far from well, but the tension between us has been replaced by a sense of connection and an awareness of my tendency to "go positive."

It's relatively easy for most of us to think inclusively with our most functional clients, but much harder to do so with those who are difficult and demoralized, or when our own psychological hot buttons are being pushed. But being a therapist means taking the time to get all the pieces of people's reality, spoken and unspoken. At the most basic level, we must discover how to perform the balancing act of simultaneously giving up the need to see clients change while holding open the possibility of change. This attitude requires us to face our own fears (of lawsuits, suicide, failure) and be still with the client's pain, immobility, glaring absence of change, and , at the same time, we must be able to see the "and"--that something more, unrecognized and unspoken, happening beneath the dead calm of an apparently inert sea.

Bill O'Hanlon is a therapist, author, and workshop presenter. His latest books include Do One Thing Different; Try and Make Me; Collaborative, Competency-Based Counseling and Therapy; and Even From a Broken Web. His book A Guide to Inclusive Therapy is due in early 2003. Address: 551 West Cordova Road, Suite 715, Santa Fe, NM 87505. Website: www.brieftherapy.com.

 

A Matter of Life and Death

When the Therapist Becomes the Survivor

by Frank Pittman

I've been in full-time private practice for almost 30 years. I've seen maybe 10,000 families (it certainly feels that way.) In that time, three patients in my practice killed themselves. Strangely enough, the three suicides were eerily similar. Each suicide has left me shell-shocked and questioning my therapeutic attitudes and methods.

I did not expect Adam to be one of my casualties. He reminded me of the guys I grew up with in rural Alabama. He was large, loud and rough, masking his intelligence behind a display of anti-intellectualism and cultural ignorance. I know these guys and I've had success at retraining them, since I'm not afraid of them or contemptuous of their fragile, hypermasculine pride and their awkwardness with emotion. Like so many of the scared, bullying men I see, Adam had been trained to fail at relationships.

Adam had grown up poor and fatherless. His mother divorced his violent father when he was 12. Adam never saw him again. He didn't drink, he went to church a lot and he was an active, hands-on father to his own children. He hovered protectively, though controllingly, over Angela, his quiet, compliant wife of almost 20 years, who was a nurse. He had made a great deal of money building houses, and was now building a gigantic dream house for their large family.

Six months before I saw them, Adam had slugged his hulking oldest son for quitting his high school football team. After being advised by a counselor at work, Angela threatened divorce. Adam, baffled that she would consider leaving him after such a (to him) minor incident, suspected her of having an affair and got first paranoid and then violent, breaking furniture and punching holes in the wall with his fist. Angela went for help to a therapist, who advised separate therapy for her and Adam, as the conventional wisdom in those years was to see violent couples separately and try to get them to divorce. Angela's therapist (who never met Adam) communicated both neutrality and pessimism about the marriage, and pushed for divorce.

Adam saw a psychiatrist, who put him on Prozac, which mixed badly with his two-pot-a-day coffee habit. He became toxically irritable and, as Angela pulled further and further away, increasingly violent. For the first time in all their years together, he actually hit her. Angela's therapist advised her to call the police (I would have given the same advice). They had Adam hospitalized for a few weeks in a special program for batterers. He went willingly and was a model patient. On discharge, he went home and found Angela and his kids had moved out. He stalked her, begged her to come back and, when she resisted, beat her up. At that point, Angela called me in. She had heard I was an expert with over-the-top men.

I saw Adam, Angela, the couple and the whole family in alternating combinations. She had a court order, which, while a good idea, offered no protection. I got Adam to promise us all there would be no more violence. And there wasn't, for the remaining few months of his life. Off caffeine and Prozac, he went into a clinging, dependent depression, but was stabilized on Stelazine for paranoia, Tegretol for explosiveness and Zoloft for depression.

Angela set up a separate home for herself and the children, and put Adam on notice that she was serious about getting a divorce. I did not question her intention or try to slow her down (a failure that continues to haunt me). Instead, I used the pressure of impending divorce to spur Adam on, as I tried to teach him some manners, some sensitivity to someone else's feelings besides his own. I hoped the changes in him would bring about a reversal of Angela's resolve to get away from him permanently. I saw him often by himself, developing what I thought was a great level of intimacy, full of personal revelations, shared experiences of the rural South and humor about the changing world around us. We talked about fishing and revivals. We talked about rattlesnakes, baseball, Hank Williams and the search for an exit from the swamps we grew up in. We talked most about the loss of his grandfather to bad homemade whiskey and his father to divorce. Then we talked about the difference between the father figures he had, the ones he imagined and the one he wanted to be. Once he was calmed and connected, I also put him in a group of non-batterers. I tried to be the gentle daddy he never had.

Adam felt in better control of himself, and redoubled his efforts to get his family back. He completed the dream house, begged Angela to move into it with him, was rebuffed and moved in alone. They had talked a lot, in my office and outside, about the terms of the separation. He was generous, sweet and apologetic with her, without control or bombast. Angela, aware of the drastic change in him, feared her longstanding tendency to pity and protect him. She held firm about divorce, but he (and I) saw her softening. I couldn't imagine him doing better than he was doing; I couldn't imagine that she would want anything better than the reprogrammed Adam. I thought I was doing a great job with Adam and that it was just a matter of time before Angela gave him another chance.

Throughout his adult life, Adam hadn't been connected to anyone else except Angela and the kids. So I thought it was imperative that he heal the longstanding rift between him and his mother. I sent him over to South Carolina for a weekend with her. While there, he also dropped by to apologize and make peace with Angela's family. On his return, I called him to postpone our next appointment for a day, as I had to go the funeral of an old childhood buddy. Adam and I talked for a long time on the phone. He told me how good he felt on his visit with his mother, especially learning the story behind the breakup of his family. He was proud of his new skill of apologizing. He had called Angela and was optimistic he could get her back. He sounded eager to see me a couple of days later.

Adam didn't show up for his next appointment and didn't answer his telephone. I called his secretary and he had not made it in to work, either. She and I both somehow knew what had happened, though suicide had never been mentioned before. She went out to the new house, where she found Adam in a chair with a shotgun in his mouth and his brains all over the living room wall. The divorce papers, which Angela unexpectedly had served on him, were on his lap.

I was stunned. It was not just a personal loss (I wanted to save this guy); it was not just a blow to my grandiosity (I kept telling myself in my newfound humility, this sort of thing doesn't happen to therapists who work as hard and care as much as I). I was sad over the loss of what Adam could, with time and effort, have become. His suicide was a dumb and preventable waste. His children were devastated. Angela felt many things, among them relief: when the abuse started the year before, a well-intentioned counselor had warned her that violent men never change. She had been fearful that she could not get herself and the kids out of the marriage alive.

I had been trying so hard to respect Angela's need to empower herself and feel in control of her life and the marriage, I had been non-directive and neutral with her, so much so that she didn't fathom that I had hopes not only for Adam, but for the marriage. I certainly foresaw a different outcome than this.

I met often with Angela and the kids during the next year or so, and occasionally still do, as they and I try to recover and understand. Adam didn't leave a note. We know he spent the day before his death shopping with a friend for kitchen appliances--not the actions of a man planning suicide. No matter how much he and I had talked about the possibility of divorce, Angela and I think the divorce papers came as a bewildering shock, snapping him out of his, and my, optimistic fantasy that a change in his behavior would get him his life back. To him, the divorce papers meant that there was no hope, no future. He wasn't ready yet for divorce; he didn't yet have a life apart and he was not a patient man.

As I played the case over and over in my mind, I saw clearly that I could have asked Angela to slow it down. And she would have. She was in no hurry and would have proceeded at whatever pace seemed safest for herself, her children and for Adam, whom she still loved. She had no way of knowing what I knew: that, in time, as long as his behavior was different, she would very likely feel safe with Adam. Those who have been abused cannot trust the ups and downs of their own feelings. Even as they track the abuser's behavior and react to the changes they see in the way they are being treated, they can't trust their sense of their own power in the relationship. And even though I had experience, expertise and wisdom about such matters, I didn't use it.

I don't know why I didn't know that those papers would be served that day. Clearly, I knew they were coming soon, but I was actively trying not to direct Angela's divorce process, or anything else she found empowering. I was optimistic in my ability to turn Adam around and, more important, in his ability to turn himself around if he had a different model of manhood. Beyond that, I was optimistic, after so many hundreds of cases in which it has happened, that Angela would take him back and the violence would not recur. So I acted neutral. I realize from this tragedy that it is as idiotic for me to be neutral about matters of marriage and divorce as about matters of life and death.

At the time I saw Adam, I had been so influenced by the feminist critique of family therapy that I'd gotten into the pattern of treating men as amateur human beings and coaching them on just what to do--of supervising them in relationships. It worked great. But at the same time, I'd become increasingly careful to validate women's feelings and avoid telling them what to do. The result, of course, was that many men changed their behavior quickly and many women were left nursing their hurts, feeling like victims and not noticing or responding to the changes in the men or the increases in their own levels of empowerment.

My pragmatically mechanistic approach toward relationships (i.e., ignore your feelings, do what will get the desired response from your partner and let the new interaction change the emotions) has a certain limitation. There are some offenses against marriage that feel unforgivable--at the moment and for a little while after. And no change in behavior can provide the necessary reassurance--at the moment and for a little while after. We all have grounds for divorce (or suicide), but we know that tomorrow is another day. I get so carried away with my belief that any change can be made and any offense can be overcome that I may leave behind some traumatized casualties of life's cruelties. Adam and I got ahead of Angela. After the offenses stopped, we needed to slow down long enough for the healing to take place.

I often think about my three suicides. All three of them were men who had done the unforgivable and couldn't get their families back quickly enough. I beat myself up about them and sift through them to find what I can do to keep it from happening again. People can make such a mess of their lives that they see no hope, but suicide is too hard on the survivors--including me. It threatens to make me cautious, pessimistic and risk-averse. To be truly helpful, I need my jaunty optimism about what can be survived in life and in marriage. Without it, I can't keep people afloat long enough for them to get their lives back. Did I give Adam too much hope? Did I give Angela too little? Did I fail to coordinate the trajectories of the changes the therapy was bringing about by being two different kinds of therapists--feminist for her, behaviorist for him? Did I go to the wrong funeral on that last day? If I'd known the papers were being served that day, I would have been with him, even if only by telephone. If he had just called me when the papers came--

Clearly, it will never be over for any of us.

Frank Pittman, M.D., is a contributing editor to The Family Therapy Networker and is in private practice. Address: 960 Johnson Ferry Road, N.E., Suite 543, Atlanta, GA 30342.

 

My Most Spectacular Failure

Voluntary Simplicity Meets Shop Til You Drop

by Mary Pipher

I will never forget the Correys, who were referred to me by their family doctor in western Nebraska. As is not unusual in our vast, rural state, they flew to our sessions by private plane. Frank was a wealthy businessman and realtor. Donna was a housewife. They had a 16-year-old daughter. Every other week for a year, I saw them, during which time I tried pretty much every trick in my therapeutic arsenal. I spent hours discussing their case with trusted colleagues and read up on their particular problems. I don't know how many nights' sleep I lost worrying about how to get these folks on the right track. And in spite of all my efforts, the Correys were one of my most spectacular failures.

From the moment I met the Correys in my waiting room, I was baffled about why they were together. Frank was tall, good looking and suave; Donna dowdy and sullen. They were both in their mid-forties, although Frank looked younger than that and Donna older. She barely bothered to greet me, and stared resentfully at Frank. As soon as we were seated, Frank jumped in to complain about Donna's spending. He was clearly used to being in charge, confident and eager to explain their situation. And Donna was used to being passive and angry.

Frank explained that even though they lived in a town with only a grocery store and gas station, a town one hundred miles from the nearest mall, Donna used catalogs and the shopping channel to spend nearly $8,000 a month. I couldn't believe I heard him right, and actually asked him to repeat the figure. I tried to keep my expression mild and non-judgmental, but inside I was appalled. I can go months without buying anything but groceries, and have not spent $8,000 on consumer goods for myself in my entire life.

According to Frank, Donna tried to keep her spending secret. He only discovered the extent of her extravagance when he found credit card bills or his secretary noticed that his business accounts had been cleaned out. Ironically, even though Donna "owed" Frank more than $50,000 for unauthorized spending, she had little to show for it--no boats, fur coats or new cars, just boxes of shoes, clothes and household gadgets. Of all the questions and reactions I had to this case, my big question was--how could anyone stay married to such a loser wife?

I generally divide an intake into thirds: one-third for the presenting problem, one-third for some contextual information and one-third for a discussion of therapy. And I give each person a chance to explain the situation. Frank blamed Donna's spending on her depression and low self-esteem. He said he would be happy if only Donna would cook, clean and limit her spending to $1,000 a month. I thought to myself, "Climb a low mountain, Frank."

When her turn finally came, Donna pointed out that Frank was a millionaire and the sums she spent were insignificant. She complained that Frank was almost never home, and when he was home, he stayed in the basement managing his stock portfolio on his computer. She said, "Frank's moody and he takes no interest in us unless there is a crisis." She agreed she was depressed. She had once been active in her community, but in the last few years she had withdrawn from everyone but her daughter.

Ah-ha, I thought, now I get it. Her spending was functional. It kept Frank's attention. Frank worked all the time to keep Donna in dough, which she then spent rapidly to punish him for working. He worked to avoid a dull, depressed wife, while she spent to deal with her loneliness and sense of inadequacy, brought on partially by Frank's neglect. Still, even though I had a crisp intellectual formulation of the case, I suspected from the first that I wasn't quite on target. I couldn't get over Donna's spending and I was impatient with her stolid, stubborn demeanor. I felt sorry for Frank that he was stuck with such a lump.

At the end of that first session, I made a few recommendations to the Correys --that they tear up their credit cards, that Frank come home for dinner a couple nights a week and that they have a date as a couple. I suspected Donna was clinically depressed, so I encouraged her to exercise and to buy a copy of David Burns's Feeling Good. Neither one of them was happy with my suggestions. Frank insisted time demands made it impossible to spend more time with Donna. Meanwhile, Donna refused to cut up her credit cards. But they let me bully them into agreeing to try these assignments and we rescheduled for two weeks later. I sighed as they left.

Right after our first session, the cast of characters expanded. Donna scheduled an appointment with a psychiatrist, who prescribed antidepressants and wrote me a letter saying that she thought the real problem was Frank, who was invested in his wife's being labeled sick and was a mean son of a bitch, although she said this in medical jargon. The psychiatrist didn't see Donna's spending as any big deal, and what's more, she actually liked Donna, whom she described as having a keen sense of humor and good insight.

I was baffled by the psychiatrist's take on this case. I didn't see any meanness in Frank. How could the psychiatrist have missed his charm? And where was Donna's sense of humor when she was with me and Frank? I explained the discrepancies in views by recalling that the psychiatrist was recently divorced and perhaps angry at men. I knew she was a major consumer herself.

The Correys did have a few dates, mostly dinner at the nearest restaurant, a Pizza Hut 30 miles from their home. But the dates didn't generate any romance. Donna didn't exercise and hated Feeling Good . I found myself resenting the failure of bibliotherapy. After all, books always helped me. Donna eventually agreed to cut up her credit cards and to attend Debtor's Anonymous, which meant Frank flew her in for a group meeting once a week. They actually liked these meetings, although Donna didn't really reduce her spending. Somehow, no matter how carefully Frank and I tried to control her, Donna found ways to charge stuff or order junk over the Internet, Although she said the medication helped, Donna was still mildly depressed and still not cooking or going out in her community. Frank stayed mad about Donna's spending, although not that mad. Meanwhile, no matter how therapeutically neutral I tried to be, I remained appalled by her extravagance.

By now our sessions had lost any therapeutic momentum. Increasingly, I felt as if I were dragging a barge across the desert. The couple would fly in, report little change in Donna's symptoms, Frank's work habits or their relationship, and fly out. Both said they were dissatisfied with the relationship, but after 22 years of marriage, neither was considering divorce.

The less progress I saw in our sessions, the harder I tried. I utilized every technique I could think of. I tried paradoxical techniques and prescribing the symptom. Thud. I saw them alone and encouraged Frank to draw a line in the sand. Thud. I saw Donna alone and encouraged her to find women friends, go back to school, get a job, take walks or find a volunteer commitment she could enjoy. Thud. I recommended a vacation, which they half-heartedly tried and both hated. Thud. I encouraged them to  communicate their needs, set up a budget and work on their emotional relationship. Thud. Thud. Thud.

My exasperation and confusion peaked during one session in which, as Frank itemized her wasteful spending, Donna actually fell asleep. After I woke her, I asked Frank how he felt about Donna's sleeping. He insisted that he didn't mind that much. After all, Donna was tired. At that point, I almost jumped out my own office window.

How could I work with someone who was about as different from me as a woman could be? Donna was passive, preoccupied with consumer goods and she actively disliked exercise. She was bored by trees and prairies and had no interest in education. That boggled my mind. How could anyone not be interested in education? I knew I was being judgmental, but I was convinced that I knew how to be happy and she didn't. There was no question in my mind that my way of being in the universe was better than hers.

I felt more sympathy with Frank, who was at least a hard worker. Also he was a high-powered salesman and could sell me on his excuses, his interest in making things better. But I didn't really understand Frank either. He wasn't much more cooperative in therapy than Donna, especially with my insistence that he tell his wife what he would and wouldn't put up with and then hold that line. In fact, as I worked harder and harder to fix this couple, they seemed to become more locked into their original problem behaviors.

Finally, I had it with the Correys. When Frank found that Donna had opened a new line of credit and charged another $10,000 of purchases, I fired them. I can still see the three of us in our last session, me earnest and serious, trying to hide my anger and wishing them well with a different therapist, "who would offer them a fresh approach." There was Frank, not as unhappy at being fired as I would have hoped. In fact, he was a little rude to me, as if I were an employee who no longer mattered. And Donna, smiling for the first time since we had met. As they left my office, she said almost kindly, "Don't be too hard on yourself, we are nutty and we're hard nuts to crack." There, for the first time, was the sense of humor the psychiatrist saw.

I thought a lot about the Correys in the months after our termination. I'd ignored the wisdom that people only change when they feel deeply accepted for who they are. Instead, I'd let my own values about spending prejudice me against Donna. And I had other values conflicts as well--over reading, education, gardening and the importance of taking action.

A wise therapist once told me that our first task in any therapeutic encounter is to find something to respect in our clients. Without respect it's impossible to really help anyone. I realize I flunked Therapy 101. I didn't respect Donna and I let that important fact slide. I suspect Donna sensed my lack of respect and that's why she fell asleep in our sessions. She had no connection to lose with me. The big lesson from the Correys was that I need to find something I can truly and authentically respect or I need to get out. I can't pretend respect. And without it, there is nothing on which to build a therapeutic alliance.

Being a therapist is intellectually taxing, emotionally draining work, and respect is what fuels the process; it's what gives us a reason to care. Without it, the work is mechanical, for us and our clients. With no respect, there can be no connection, and without connection, therapy loses its meaning.

Mary Pipher, Ph.D., is author of the bestselling books Reviving Ophelia and Another Country: Navigating the Emotional Terrain of Our Elders. She is a clinical psychologist in private practice in Lincoln, Nebraska. Address: c/o Family Therapy Networker, 7705 13th Street, N.W., Washington, DC 20012.

 

Altered States

Why Insight by Itself Isn't Enough For Lasting Change

by Brent Atkinson

In the 15 years that I've been following developments in neuroscience, the most compelling clinical lesson I've learned is likely to rub you the wrong way. An overwhelming body of research now suggests that we clinicians rely too much on insight and understanding--and too little on repetitive practice--in promoting lasting change.

This wasn't welcome news to me. I'm a couples therapist, and I got into this business because I loved transformative moments when intimate partners' defenses crumbled and their deep emotions emerged. That was what juiced me--not, getting couples to do the same things over and over again.

Yet, year after year, I watched couples let go of judgment and blame for an instant, only to show up for the next session as miserable, critical, or withdrawn as ever. They didn't even remember the profound insights they'd had that I felt sure were going to rock their worlds.

Then I encountered a series of studies published by neuroscientist Jaak Panksepp, from Bowling Green State University, and came to understand that when they were upset, my clients were in the grip of one of seven major body-brain mood states, which he calls "executive operating systems."

Our Brains' Executive Systems

Panksepp uses the terms rage, fear, seeking, lust, care, panic , and play to describe the signature emotion of each system. But they're more than passing moods. They're complex neurochemical cascades, in which hormones race through the body and brain and electrical impulses fly over familiar neural synapses, shaping what we feel, do, and think. When one of these systems becomes active, emotions, motivation, and thoughts take over in the service of the goals it's programmed to achieve. It's as though we've gotten on a plane to Paris, and no amount of fiddling with the seatbelt is going to change the plane's direction before the wheels touch down at Orly.

Four of the systems are wired for love: they draw us together. One of these is old-fashioned lust. Another promotes spontaneity and play. A third, the instinct to nurture others, which Panksepp calls care , is activated by the release of the hormone oxytocin into the bloodstream and brain. Another mood system Panksepp calls "panic" is experienced as yearning or even abandonment, when an intimate partner leaves on an unexpected business trip or storms out of the house during a fight.

Most of these mood states can help promote emotional bonding during couples therapy. But the states that therapists find the most frustrating in the consulting room--and often the most common--are two other body-brain mood states that used to be called fight or flight. Activated by the amygdala, they produce self-protective thinking and action. Fight, which Panksepp calls rage, quickens the breathing, sends blood to the muscles in preparation for striking out, and releases adrenaline and noradrenaline into the bloodstream and brain. It sharpens some mental functions and leads a person to think in decisive, impulsive, blaming, oversimplified ways. It's accompanied by the attitude "You're wrong, and I'm right."

This hormonal cascade can be lifesaving in the appropriate situation--in the face of a dangerous driver, say, or a possible mugger or rapist. But in intimate relationships, it's often toxic. In its grip, men (and some women) can become physically abusive; others yell, nag, blame, and complain. And as almost everyone knows, it's much easier to get on this particular tiger than to get off.

The second self-protective cascade, which Panksepp calls fear, produces feelings ranging from anxiety to intense fright, along with worried thoughts and the impulse to freeze, flee, withdraw, or hide. It, too, is accompanied by critical thoughts about the intimate partner. A man in the grip of this neurochemical cascade may exhibit sullen, disgusted, or spacey withdrawal in the face of a barrage of angry complaints from his wife.

Hence my frustration. I couldn't understand why couples continued in these patterns when they'd learned--in those magical moments of insight--that blaming or withdrawing didn't help them get what they wanted. It seemed so irrational. But when people are in the grip of these emotional takeovers, certain parts of the prefrontal cortex (the folded outer layer of the brain behind the forehead) are less active than when they're calm. The prefrontal cortex is the seat of free will and self-awareness. It allows us to plan, strategize, imagine the results of our actions, and choose to do one thing rather than another. When portions of it are inactive, as they appear to be when we're in the grip of one of our executive operating systems, our inner switchmaster is asleep: we simply can't shift from one state or course of action to another. So the wife keeps blaming, like a hamster on its treadmill, and the husband, in an equally mechanical state, keeps staring out the window.

Learning to Shift Mood States

When I first encountered this information in the early '90s, I worked at getting clients to shift out of these powerful mood states. When I got frustrated, I reminded myself that they were caught in neurochemical reactions beyond their control. I'd usually have one partner wait in the waiting room for a few minutes while I worked with the other, finding that a few minutes of concentrated empathy, validation, and acceptance would often calm someone down. Under these conditions, they could hear me say--in a soothing tone--that blaming would only stimulate the other's defensiveness and not get them what they wanted. We could then brainstorm more pragmatic, emotionally open, skillful ways of communicating. I was training them to reactivate the neocortex--the inner switchmaster--in the face of strong emotion.

I assumed the lessons would stick, but I was disappointed. I'd underestimated the hardwired nature of my clients' automatically activated, neural- response programs, ingrained through years of relating to each other. They needed far more practice than a weekly therapy session could provide.

It wasn't enough for my clients to rehearse new thoughts in calm moments. They needed to practice new ways of thinking under "game conditions"--when they were actually upset and least able to think clearly. And they'd have to do this over and over: most neuroscience researchers agree that the brain acquires new habits through repetition. One of the most enduring concepts in neuroscience is Hebb's Law, named after the pioneering McGill University neuroscientist Donald Hebb, who stated that brain processes that occur together over and over again become grafted together, and are more likely to occur in conjunction in the future. According to Hebb's Law, if my clients engaged in new thinking processes while they were upset, and did this enough times, the new thinking processes would begin happening spontaneously each time they became upset.

Audio-Facilitated Change

Then one of my clients, a registered nurse named Judy, who kept struggling to tame her tendency to get enraged with her husband, said to me, "If only I could take you home with me!" When she was furious, she was in the grip of the delusion that her anger was her empowering friend, only to find that her outbursts actually disempowered her. She asked me to make an audiotape for her to listen to precisely at the moments when she became upset with her husband. In this audiotape, I offered encouraging words and reminded her repeatedly that she was far more influential and powerful when she stood up for herself in ways that didn't put her husband down.

She loved the tape and listened to it not only when she was upset, but also when she was driving in her car and on a Walkman, while she was doing the laundry and cleaning house. Within three weeks, she experienced a dramatic shift in a lifelong destructive pattern.

I made more elaborate tapes for Maria and Tony, who trudged into my office one crisp October evening for their fourth session. Maria was so upset that she refused to speak to Tony. She'd had elective surgery the previous week, and had gone into rage mode when Tony left her alone in the hospital one night to go home and get some sleep. I asked Tony to stay in the waiting room while Maria told me how incredibly selfish he was for thinking of himself when she was in so much distress. In the grip of her amygdala-driven cascade, she couldn't see that her attack was sending Tony into disgusted withdrawal as usual. I sympathized with her feelings, and then simply suggested that although her attitude was perfectly understandable, she'd need to drop the idea that he'd done something wrong, and simply tell him how she felt. She struggled inside for a moment and then relaxed. Her eyes moistened and she said softly, "Okay, I think I can do it." When Tony joined us, Maria spoke from a different place inside, and Tony responded instantly with an apology.

I then made an audiotape that essentially repeated the words that had helped Maria shift during this session, and asked her to listen to it each time she became upset with Tony during the following week. The next day, she got off work early, pulled into the driveway, and saw her children playing at the neighbor's house, even though Tony had agreed that he wouldn't let the kids go out to play after school until they'd finished their homework. She felt a surge of anger, but as she reached for the car door, she remembered the audiotape in her purse. She paused for a split second, torn between the urge to vent and the desire to avoid going down the same old path.

Reluctantly, she plugged in the tape and listened in the car. After 10 minutes, she realized that she was in no frame of mind to talk to Tony, and decided to take a walk around the block. After 20 minutes, she felt calmer, and by the time she saw Tony, she was able to keep an open mind and simply ask him why the kids were playing, rather than accuse him of breaking their agreement.

What happened during Maria's walk around the block? Frankly, I don't know. In Maria's audiotape, I didn't tell her what to do or how to shift her attitude, I simply reminded her of a few reasons why she might want to try. The decision was hers. Clients often have difficulty describing how they get shifts to happen. Most report a willingness to let go of control and a momentary surrender to the fact that you can't make life go exactly according to your plans. The shift is usually accompanied by physical relaxation and a release from obsessive thinking. The client returns to the present moment, and is able to respond to what's actually happening, rather than what they fear is going to happen. The most important ingredient in getting an attitude shift to happen is desire. When clients decide they truly want to shift, they do.

Ancient Wisdom

What clients report helps them shift brain states has something in common with many repetitive religious practices--from praying "Thy will be done" to practicing mindfulness, kissing a St. Christopher medal before going up to bat, or making a list each night of things one is grateful for. All of these approaches help people create enough of a pause to free them from the grip of intense rage or fear and to generate states of generosity, acceptance, and trust. Like them, my audiotapes allow the body and brain to calm down, and they serve as timely reminders that it's in the client's best interest to try to shift.

Maria, for instance, used her tape as regularly as some people light candles at mass. She told me that she often could feel an attitude change beginning as soon as she heard my calm, confident tone. It reminded me of what attachment researchers speak of when securely attached children evoke images of their caregivers to soothe themselves. In her third week of using the tapes, Maria told me that she began to spontaneously hear my voice inside her head every time she got upset.

Some clients need little more than a verbal reminder. Others require vivid images or metaphors. Tony, for instance, once told me that when he reflexively defended himself, he felt like he was swatting Maria's complaints back at her with a baseball bat. In a minisession without Maria, I helped him imagine turning the bat into a pillow. The image worked, and when Maria returned, he was better able to absorb and digest what she had to say.

I put the pillow image on a tape for Tony. Then we got Maria to record a tape full of her complaints--a litany about how Tony didn't keep his word, didn't fix things around the house, and hadn't kept the kids quiet on Saturday morning after promising he'd let her sleep in. In a solo session, I had Tony listen. As soon as he began feeling defensive, we'd stop the tape and he'd focus on how his body felt; he'd tremble and go into a sort of disgusted shutdown. Then he'd practice trying to shift, seeing the pillows, relaxing physically, reminding himself that there might be some validity to her point of view. Then we'd start the tape up again and repeat the process. Tony used the tape regularly in his truck and became so adept at generating a state of acceptance and compassion that one of his employees remarked that he'd undergone what seemed like a spiritual shift.

I still love the drama of transformative experiences, and my favorite moments are still the tearful ones, when partners drop their defenses and exchange heartfelt expressions of love. But nowadays, I see these moments as just the beginning. They give clients the motivation for the real work of change, which is much less dramatic. I rarely get to see it because it doesn't happen in my office. It happens a little bit at a time, day in, day out, as clients practice letting go of the critical judgments that arise with the brain's self-protective mood states.

My happiest clients make shifting a daily practice, not unlike prayer. The tape recorder, and all my modern knowledge about neuroscience, have ended up supporting the practice of routine and ritual, largely ignored by modern psychotherapists, but intuitively known and practiced by sages since the beginning of time.

Brent Atkinson is the director of the family therapy program at Northern Illinois University, and is in private practice in Geneva, Illinois. Address: School of FCNS, Northern Illinois University, DeKalb, IL 60115. E-mails to the author may be sent to: Brent@thecouplesclinic.com.