|Narcissistic Clients Challenging Cases Attachment Great Attachment Debate The Future of Psychotherapy Mary Jo Barrett Future of Psychotherapy Couples Brain Science Wendy Behary Couples Therapy Mindfulness Clinical Mastery William Doherty Community of Excellence CE Comments Trauma Gender Issues Diets Mind/Body Clinical Excellence Attachment Theory Ethics Anxiety David Schnarch Linda Bacon Etienne Wenger Symposium 2012 Men in Therapy Alan Sroufe|
|Practice Makes Perfect - Page 5|
Principles in Practice
A few years after my sessions with Bill ceased, Don was referred to me by a colleague who'd been treating him and his wife, Cara, in marital counseling. They were in their mid-fifties and had been married for 25 years. Cara was a nonpracticing teacher; Don was a minister. While good at counseling and supporting other people, Don was helpless to control his own fury at perceived criticism from his wife. Her body language or tonal inflections alone could elicit a strong reaction. At least several times a week, he'd become flooded with a venomous rage at his wife, attack her verbally with great hostility and contempt, and even follow her from room to room trying to extract what he felt was a satisfactory response from her. Cara would completely shut down and stonewall, often withdrawing from Don for days. This pattern—of perceived criticism from her, fury and contempt from him, followed by her cold withdrawal—exacerbated his feelings of rejection and anger.
By the time Don was referred to me, the couple was feeling hopeless and discouraged by the emotional climate of their marriage. At the end of her rope as Don's angry outbursts continued in spite of their hard work in therapy and the insights about their marriage, Cara was threatening divorce. At this point, Don agreed that marital therapy wouldn't be effective unless he mastered his knee-jerk defensive reaction to her perceived disparagement. He decided to see me in conjunction with the joint therapy work he and Cara were doing.
The referring therapist reported that the couple had mastered many essential components of their marriage therapy while in session. In addition, Don had considerable insight into the dynamics of his relationship with Cara, and how earlier childhood wounds were being replayed in his marriage. He "understood" his marital impasse well, and both he and his wife were quite expert at applying new strategies while they were in the therapist's office. But at home, it was another story. There, time and time again, Don couldn't overcome the considerable hostility he felt in the heat of the moment. He didn't need to learn communication skills—he had those down pat. Rather, he needed to learn how to diffuse his reactivity, so that he could apply the new communication skills at home with his wife.
Don was worried and upset when he came into the office—afraid his marriage wouldn't make it and distressed about his out-of-control rage at Cara. But his entire frame relaxed when I told him he could learn a handful of techniques for diffusing his reactivity. As always, I emphasized that his mastery of these techniques depended entirely upon his commitment to practicing them every day.
We first worked on developing his ability to practice his daily 20-minute relaxation session. Although Don was eager for his outbursts to lessen and gave me a verbal agreement to practice, he appeared hesitant about incorporating the extended practice sessions into his daily life. So we closed our first session by "practicing how to practice" with the visualization of his setting his alarm that night to ring twice the next morning—the first time to wake him and the second time, 10 minutes later, to remind him to practice. Due to his seeming reluctance, I made a note to call Don in two days to see how his practice sessions were going.