My stuff, your stuff, our stuff

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Murray Bowen, one of the fathers of family therapy, believed that we all marry someone of the same “level of differentiation” as ourselves.

What this means in layman’s terms is that while our stuff may manifest differently from the stuff of our significant other, we have exactly the same amount. And the interaction of our respective-same-amount-of-stuff will keep playing out in the same old predictable cycle until someone decides to get help.

 

Cycles of interacting stuff

By far the most common arrangement of interacting stuff that I see (in both my individual and couple clients) is the anxious/avoidant relationship. The terms anxious and avoidant come from John Bowlby and Margaret Ainsworth’s attachment theory, which broadly identifies three relational templates – formed through our relationships with primary caregivers – that are pretty much in place by 2 years of age.

 

The strange situation

To assess these templates, researchers in the late sixties created an experiment called “the strange situation”, whereby they would watch mothers interacting with their 18 month old children. Mom, with a bug in her ear, would be asked to leave the room and a stranger would enter to watch over the child until mom came back in again. The researchers were particularly interested in the demeanor of the child when mom left, the child’s interaction with the stranger, and then the reunion when mom returned.

 

Secure attachment

The first set of kids interacted well with mom and were a little perturbed when she left, but were able to carry on playing with the stranger (in an albeit distant and polite kind of way) until mom returned for a happy reunion. These were the “securely attached” kids, who had received consistent caregiving and attunement since before birth. They had learned very early on that mommies never leave them with anyone frightening or dangerous, and more importantly, that mommies always come back.

When securely attached kids go to pre-school and see another kid crying, they offer comfort. Not only is this the pattern that’s been modeled to them, but they’ve also learned that the world is generally a safe and predictable place, and there’s no need to be upset for long.

 

Anxious attachment

The second set of kids interacted with mom as did the first set, but when mom left they became absolutely inconsolable and sometimes enraged. When mom returned they would do the cling/kick maneuver; clinging to mom because they were so terrified she’d leave again, but kicking at the same time because they were so mad that she’d left.

These were the “anxiously attached” kids, who had received inconsistent caregiving and a lack of emotional attunement. These kids never knew for sure if mom would come back or if the stranger was trustworthy. Furthermore, they were acutely aware of their inability to protect themselves, and thus lived in constant fear of abandonment. Every time mom left, they had to believe she was never coming back, because maybe this time, she wasn’t.

When anxiously attached kids go to pre-school and see another kid crying, they get upset too. Heartbreakingly, this is often what they’ve seen their caregivers do. And, when the world is scary and unpredictable, whatever trouble is befalling the other child is likely on the way to them too, even if they don’t yet know what it is.

 

Avoidant attachment

The third set of kids didn’t really interact with mom as the first two had, and didn’t show much of a response to mom’s coming and going at all; nor did they interact with the stranger. These were the “avoidantly attached” kids, who had learned at a young age that mom comes when mom comes, and that there’s very little they can do about it. Rather than using up valuable energy to summon help like their anxious counterparts, they close off and take care of themselves.

When avoidant kids go to pre-school and see another kid crying, they look over and wonder “why on earth would you do that?” and go on with what they are doing. Once again, this is what’s been modeled to them by their caregivers, and they’ve learned that regardless of the state of the world, there’s really no benefit in getting upset.

 

Pairings of attachment styles

The crunch comes when kids grow up and start engaging in romantic relationships. On the basis that we get together with someone who has the same amount of stuff, young adults with a secure attachment style manage to find each other, and their relationships play out pretty well.

While there are those who strongly believe themselves to be securely attached while care-taking a partner who is not, the proof is typically in the state and length of the relationship. Generally, the only time I see clients in therapy who have a secure attachment style is when something non-normative happens, like a botched surgery or the death of a child, that has nothing to do with how they grew up, or how they relate to their significant other.

With the secures all wrapped up with each other, this leaves the anxious and the avoidant styles available to pair up in one of three combinations; anxious/anxious, avoidant/avoidant, and anxious/avoidant.

 

Anxious/Anxious couples

Put an anxious with an anxious, and the result is a mess. These are the “can’t live with ‘em, can’t live without ‘em” always-in-crisis, high-drama couples where there’s so much clinging and kicking and fear of abandonment going on that it’s really hard to maintain any lasting relationship. These are also the couples who send therapists into early retirement.

 

Avoidant/Avoidant couples

Alternatively, you can put an avoidant with an avoidant. On the surface, this looks like a stable relationship where each party meets their own needs and drives for their own goals. Many power couples fall into this category, and can maintain their relationship for long periods of time. The problem comes when one of them unilaterally decides to have a baby, or to take a job in Hong Kong, and is astounded when the other objects. Because avoidants have always focused on their own well-being, they have no idea how to negotiate a solution that takes into account the needs of both, and typically end up calling it quits.

 

Anxious/Avoidant couples

That leaves the anxious/avoidant combination, which actually works pretty well for a time, as the anxious person provides the “glue” keeping things together, while the avoidant regulates the distance, keeping things from getting too messy. But after a while, the anxious person – who is acutely aware of their unmet needs – gets tired of their partner’s distance and lack of awareness. Meanwhile, the avoidant person – who is largely unaware that they have any needs, let alone that their anxious partner has been meeting them – is baffled by the “sudden” demand to step up.

These are the couples who come to therapy – usually because the anxious partner (the one with abandonment issues) desperately wants the relationship to work. The avoidant still doesn’t understand the problem, but comes anyway – largely because they just want things to return to how they were.

Whether therapy results in an improved relationship depends partly on how much “stuff” each side has to deal with. Mostly, however, success is predicated on each partner’s willingness to acknowledge that their stuff is impacting the relationship, and to do their own work.

 

The work ahead of the anxious partner

The anxious partner is usually fully aware of both their stuff and their partner’s stuff, but is of the mistaken belief that each person should be fixing the other. Not only are they mad that their needs have not been met by the avoidant, but they also get up in the avoidant’s business, unintentionally triggering their greatest frustration – the avoidant’s disappearance down into an avoidant hole. The work of the anxious partner is to learn how to meet their needs for themselves, and realize they can be in this relationship (or in any other relationship) out of empowered choice, rather out of powerless desperation and fear of abandonment.

 

The work ahead of the avoidant partner

The avoidant partner, on the other hand, is generally less aware of their stuff, and although they’ve heard ad nauseum about their partner’s stuff, they don’t see it as having anything to do with them. They are of the mistaken belief that everyone should – and does – take care of themselves, and have no idea how their avoidance, self-focus and unilateral decision-making unintentionally triggers their partner’s fear of abandonment. Their work is to learn how to carry their own weight in relationship, and realize that their partner needs to be nurtured, cared for and considered if the relationship is going to survive.

 

Earned secure attachment

The goal of the work is to achieve what’s called “earned secure attachment”, where both partners transform the templates of their early attachment experiences enough to be able to show up in secure, respectful, adult relationship.

Sometimes, it happens.

More often, however, the avoidant – who was perfectly happy before the anxious partner blew everything up – decides it’s just too much work, and enters into a new relationship – often with a new anxious person who is happy to do all the relational running (at least for a while). With their unknown needs being met again, the avoidant convinces themselves that all of the problems in the previous relationship were with their partner, and so the cycle begins again.

The true potential (at least in this therapist’s mind) is when the anxious person realizes that they are a fully competent adult who no longer needs to fear abandonment. At this point, they can go out and find another formerly anxious person, and the two make a beautiful, securely-attached life together, where each are attuned to the needs of themselves and the other.

The Difference Between Therapy and Coaching

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As a licensed therapist who recently became a certified coach, I am frequently asked to explain the difference between therapy and coaching. Sometimes I can’t tell if the enquirer is genuinely interested or merely being polite, so I have a few nutshell responses to offer before seeing where the conversation takes us.

“Therapy is about healing; coaching is about growth.”

“Therapy is how the past impacts the present; coaching is how the present impacts the future.”

“People come to therapy because they want something fixed. They come to coaching because they want something changed.”

and then the zinger, which is a blog topic in itself,

“People are willing to pay a lot more for coaching than they are for therapy.”

Of course the reality is much more nuanced than a nutshell response can provide, and the more I try to define it, the more slippery it becomes. But what I’ve mostly found is that where you’re from, what you grew up with and what you trained in has a lot to do with how you see it. 

If you’re from England or Canada where therapy was historically the preserve of the rich, the American and those with debilitating mental illnesses (I dare you to draw a Venn diagram), there’s not so much of a distinction. Coaches and counselors stepped into the vacuum to offer therapeutic-type interventions to the general public, while therapists got wind of motivational interviewing and reframe that had typically been the purview of the coaches. Diagnosing was – and still is – only offered only by psychiatrists (the ones with medical degrees) or psychologists trained in standardized assessments. And with the exception of a few sessions of Cognitive Behavioral Therapy offered at the doctors’ office, everyone else offers some combination of private-pay interventions to get you moving in a better direction, no matter what they call themselves.

In the US, however, it’s a different story. Here, therapy is considered part of the already-convoluted healthcare system, which means that national and state boards step in to protect the public from anyone who might seek to offer services without the right credentials. The result is a tangled bureaucratic web of licensure and state-line turf-wars. Insurance companies then join the fray and argue about who, what and how many sessions they won’t cover, providing a catch-22 for therapists who are bound by state guidelines not to allow third parties to influence their treatment. The result is a mess of unnecessary diagnoses, paperwork and way too much fear-based practice, which is then seized on by lawyers who need therapy records for their divorce cases and personal injury claims. At which point you can bet your bikini that those clients who minimized their symptoms to avoid a big diagnosis are disappointed that they didn’t get the big-ass diagnosis after-all, because they’re suing someone for something bad.

If it sounds exhausting, I can assure you, it is. For several months I’ve had a recurring dream where I’m at a conference and someone invites me to participate in a great opportunity, and I go to grab my bag so I can join them. But I have so many purses and backpacks and plastic bags and – in one dream, even a hat and a cat carrier – that no matter how hard I try, I can’t consolidate them all fast enough. By the time I find a temporary solution – like throwing everything in a shopping cart – everybody’s left without me, and I can’t get the shopping cart down the stairs anyway. 

It doesn’t take a psychoanalyst to interpret what’s going on in my head, and you may be wondering why I still hang on to therapy licensure when it represents so much baggage for me. In truth, I do think about letting it go from time to time, but the reason I haven’t is the same reason that I stay in fancy hotels when I travel. If I’m going to go to a strange, challenging and possibly scary place, I want to know that I’m going to be safe and well taken-care of. And that’s how most of my clients feel too, especially when I’m digging into their past issues of trauma and deep-seated shame.

For all of my griping, the truth is that therapy licensure brings with it some meaningful assurances. Although some coach training programs are pretty rigorous (and CTI, the program that certified me, is one of them), a person doesn’t have to complete – or even start – a training program to call themselves a coach. A therapist licensed in any state however, has been through an accredited graduate school program, post-degree supervision, national and state exams and must complete continuing education hours to ensure they stay up-to-date. While therapists may choose not to treat certain diagnoses in their practice, they’re still very adept at spotting them, which can help a prospective client find the help they need. And, despite the shortcomings of health insurance, it does (occasionally) enable access to therapy for more people than would be able to afford it privately.

Of course state licensure isn’t entirely foolproof – there are some terrible therapists out there just as there are some truly incredible coaches. But as a general rule, it’s a bonus and a privilege to work with someone whose state is willing to vouch for their level of education and standard of care, as Minnesota is for mine.

Therapist or coach?

I’m neither, and I’m both.

Whatever you call me, it’s the relationship between us that brings the healing, the magic and the growth. 

You Can be Right or You Can be Married

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“You can be right or you can be married” is a saying of the famous couples therapist, Terry Real*. He even goes so far as to list “being right” as the first of five losing strategies. Yet it’s also one of the most difficult concepts for distressed couples to grasp, especially if being right is all they’ve got, as the only alternative is being wrong.

The problem with debating right or wrong is that it involves a cognitive process using the front part of the brain that completely negates the lived experience stored in the relational part of the brain. Relational living means connecting with how our significant other is experiencing a situation, and recognizing that while our own experience may be different, that’s okay. In fact, it simply means we’re human. Learning how to hear and empathize with our partner’s experience – and then letting them know that we had a different experience – is not only crucial for conflict resolution, it’s crucial for intimacy.

The story I tell my couples to illustrate this concept starts with a rite of passage from my teen years, where it was typical to go to a pub and buy a round of drinks before your 18th birthday (the legal age for buying alcohol in England). Being asked to show ID (or “getting carded” as they say in the US) was rare, but if it happened, it was the ultimate humiliation. Here you were, thinking you were so cool and sophisticated and grown up, and some bar-tender got to tell the world (or at least the punters down the pub) that actually, you were just an acned teenager acting way out of your league.

Ouch.

Fast forward to the grand old age of 32. It was my first full day in the States, my house had been trashed by the renters, and I was being denied a much-needed gin & tonic at TGI Friday’s (of all places) because I didn’t yet have a US driving license and it hadn’t occurred to me to take my passport to the bar.

“Oh it’s a compliment!” cooed my 50-year-old female co-workers, somehow missing the fact that, a) I was only thirty-two, and b) it’s hardly flattering to be denied a cocktail.

“Well, the server could lose their job if they served alcohol to under-age minors”, the male co-workers mansplained, somehow also missing the fact that I was thirty-two, and, frankly, the point.

While both of these responses may have been “right”, neither of them were especially helpful, and neither allowed me to feel seen, felt or understood. Both were aimed at correcting my interpretation of the situation – perhaps with the intention of helping me feel less upset about it – but it didn’t work, because the relational piece was missing. A more relational response (aside from being served a measly gin & tonic in the first place) would have been someone saying, “Oh honey, what a bad day! I’m so sorry,” or even, “Ooof, those carding rules can seem so arbitrary sometimes.” Yet nobody did – and still doesn’t – perhaps because my experience is literally foreign in a land where nobody bats an eye about being asked to show ID.

The point of this story is that although our significant others might not literally be from a foreign country, they are from a foreign land. Their land – of family rules, norms, expectations and experiences, past hurts and humiliations – is different from ours. And those foreign lands inform how we experience interactions in the present day. Debating whether each other’s lived experience is right or wrong is not only unnecessary but actually quite ridiculous; our lived experience just is what it is. Instead of working to correct our significant other’s perception, we need to first empathize, and then get curious. “Oh I’m so sorry you felt so sad/hurt/misunderstood.” “Tell me about that.” “What did it mean to you?” “What did it remind you of?” “Oh, that’s really interesting, because it landed very differently for me.”

As for me, I’ll be honest that it still ticks me off a bit when I get carded, but these days I’m a lot more relational about it. I no longer cry (as I did that day in TGI Friday’s), roll my eyes in contempt or make a big production of pulling my driving license out of my purse and slamming it down on the counter. I now understand that the servers don’t make the carding policy, it’s not worth losing their job over, and if they can’t tell I’m nearing 50, it’s probably a good thing.

I do, however, still glance at my husband, who – because he knows a bit about my lived experience – gives me a sympathetic look, rubs his hand on my back and says, “Sorry, hon. I know that bugs you.”

Which is all it takes to be relational.

 

Jane McCampbell-Stuart is a licensed therapist, a certified EMDR therapist and a relational coach. She works with individuals and couples, helping all of us become the very best version of ourselves.

*Terry Real is the founder of The Relational Life institute. His website is www.terryreal.com.

 

 

The Don’t Ask Conundrum

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“Those who ask don’t get, and those who don’t ask, don’t want!”

This was one of my grandfather’s favorite sayings; albeit delivered with a twinkle in his eye, but delivered nonetheless – mostly when he caught my siblings and I looking hopefully at the sweetie-tin on the mantlepiece, the ice-cream van in the park, or the last chocolate biscuit on the tea-trolley.

It would be many years before I learned about double-binds as a therapeutic concept, but even at six years old, the conundrum was not lost on me. 

Ask and you’d appear ungrateful for what you’d already been given. Even worse, you’d put a kindly elder in the heartbreaking position of giving up something they were saving for themselves because they didn’t want to say no to a child. 

Don’t ask, and nobody would realize you were even interested. “Well, since no-one else wants it,” my father would say, helping himself to the last of my grandmother’s perfectly crispy roast potatoes, right in front of our forlorn, puppy-dog eyes.

Because when you can’t ask, puppy-dog eyes are your only recourse. You gaze longingly at what you desire, and then beseechingly at the person with the power to grant it, in the hope that they might notice, take pity on you, and offer it up. The trick is to be obvious enough to get your grandfather’s attention but subtle enough not to arouse your dad’s, because he’s been playing the game for longer, and is better at it than you are. He’s also acutely attuned to how your behavior around his parents might reflect badly on him.

“Say please!” “Say thank you!” “Don’t be greedy!” “I think you’ve had enough!”

With upbringings like that, it’s no wonder we all have such a hard time asking for what we want; why we drop hints and send indirect signals that can be quietly ignored by the receiver or briskly denied by the sender should they inadvertently make anyone upset. But it only takes a few years of marriage for the puppy-dog eyes to slowly degenerate into glares towards the overflowing trash-can interspersed with some stomping about, banging of cupboard doors and a sarcastic “nothing!” when asked what’s wrong.

Our biggest difficulty – and women, I’m mostly talking to you – is that despite what fairy tales and Disney would have us believe, significant others don’t typically swoop in to heal all the wounds of childhood and indulge us benevolently like our grandparents did (or should have). They don’t yet have the wisdom, the life-perspective – or frankly, the time – to anticipate and meet our needs as much as we might want, expect, or feel entitled to. And – if they’re anything like most of the men who come to me for couples therapy – they’re probably just expecting us to meet our own needs, which is what they’ve learned to do for themselves.

Incidentally, meeting our own needs is a reasonable – if not entirely relational – solution to the don’t ask conundrum. A more relational solution, honestly, is to just use our words. Which means that next time we want our significant other to unload the dishwasher, take the kids to a dental appointment or share the last profiterole, we should try just asking – preferably in the same tone of voice we would use to ask a co-worker to help us move a table. Our significant other gets to respond with a yes, a no or a counteroffer. They don’t get to ignore the request, judge the request as ridiculous or say yes and not follow through – because all those would be anti-relational. And why would anyone be anti-relational when we’ve asked them so nicely? 

Unless we forgot to say please.

Jane McCampbell-Stuart is a licensed marriage & family therapist and relational coach. She works with individuals and couples, encouraging relationality and helping all of us become the very best version of ourselves. Find her at therapyjane.com.

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Symptoms of trauma and PTSD

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Nightmares, flashbacks, hyper vigilance and insomnia are all typical symptoms of trauma and post traumatic stress disorder (PTSD). But while most sufferers believe that there must be something “wrong” with them, the symptoms are actually part of the human survival system.

Allow Jane to explain.

If a truck ran over our foot, we would expect it to hurt. We would spend time in hospital having the bones reset, sit for weeks in plaster or a hard boot waiting for it to heal, and then undergo a painful exercise regime to rebuild strength. It may be months or years before we would be able to walk on it again – if ever. We hope such accidents won’t happen to us, but sometimes they do, and when they do we deal with the consequences.

Symptoms of our humanity

What we often dismiss, however, is that the brain can get hurt too. If we witness or experience something devastating, ugly or horrific, it will – and should – affect us. In fact, if it didn’t affect us then there’d probably be something wrong with us. We’d be considered hardened, inhumane, a psychopath, or – at the very least – out of touch with our feelings. The symptoms of PTSD happen not because we are weak, but because we are human, seeking to survive like all human beings. Unlike other human beings, however, we have undergone ordeals no-one should ever have to face.

The purpose of nightmares and flashbacks

When nightmares and flashbacks occur, the brain is trying to learn everything it possibly can from a bad experience so that it can spot the signals and keep us from ever having to undergo something like that again. But sometimes this survival system goes into overdrive and prevents us from identifying the true level of threat in front of us. In many of these cases, the brain’s natural information processing system – REM sleep – is unable to place the information into long term memory, either because we’re not sleeping, or because we wake before processing is finished.

How EMDR can help

EMDR therapy facilitates a process that is similar to REM sleep, which takes all of the information about a traumatic incident (including images, sounds, smells and body sensations), combines them into one cohesive experience and files them away into long term memory. At the end of treatment, the memories remain, but they feel firmly in the past. And, if something happens that looks, sounds, smells or feels like the original trauma, we can notice the similarity without feeling as though it is happening all over again.

As a result of this reset, EMDR therapy gives us back our uninterrupted sleep, clears out the flashbacks, and enables us – amazingly – to feel normal again.

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Understanding Panic Disorder

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“Everything that happens once can never happen again. But everything that happens twice will surely happen a third time”.

Paulo Coelho, The Alchemist

Panic disorder is an extremely debilitating condition. Many sufferers report symptoms of heart palpitations and hyperventilation, the fear of being out of control and an impending sense of doom.

For many sufferers, panic attacks may be triggered by elevators or airplanes, traffic jams or movie theaters. Others are triggered by shortness of breath – whether through exercise, humidity or being in a stuffy, confined space with lots of other people.

Most sufferers are extremely embarrassed about their panic attacks and wish they could “just get control of themselves”. Many have undergone excruciating treatment using a systematic desensitization approach which involves gradually exposing the sufferer to what they most fear – with limited results.

Rather than a set of random, unexplained symptoms, Jane believes that panic attacks are triggered by subtle cues that look like, smell like, sound like or feel like a life-threatening situation to which the sufferer has been exposed before – not once, but twice.

The brain is usually very good at dealing with a one-time traumatic event – particularly if it occurs when we are young – and is usually able to tuck it away as an isolated experience that is unlikely to happen again.

Should a similar experience occur later in life, however, the brain suddenly kicks into overdrive, recognizing that the same experience could occur again and again and being ultra-sensitive to any cues that may resemble either of the previous events. Often the sufferer has no idea what the original event may have been; in many cases it may have been something that occurred pre-natally or pre-verbally and is stored as “lived experience” in the limbic system but there is no explicit memory of the event. Other times there may be knowledge or explicit memory of the underlying event, but the sufferer has never connected it with the panic attacks.

A common example is in the case of an infant who stops breathing. Panic usually ensues – not only for the caregivers but for the infant herself as she fights to stay alive. While the caregivers may remember the event and become especially vigilant and anxious, the infant may grow up to be largely unaffected – that is, until being smothered by an elder sibling in a game of rough and tumble at age 7, or running out of breath on the sports field at age 11. Both events could trigger a panic attack – where the body recognizes the cues as being similar to those it felt when it stopped breathing as a baby – but the child usually has no idea what the root cause might be. To make matters worse, nobody else connects the two events either, and the child is labelled as anxious, sensitive or otherwise unpredictable. Not surprisingly, the child grows up perpetually fearing another attack – not only because stopping breathing is so terrifying, but because it’s embarrassing and everyone else is often puzzled and unsympathetic.

By the time the child grows up to get on an airplane as an adult,  they’re the one having the meltdown as soon as the door is closed, delaying the plane and inciting impatient glares and tuts from all the other passengers. Most simply stop flying, avoid driving on freeways, or always take the stairs – and may often be labelled as controlling or neurotic by others around them. But when flying, driving and elevators are impossible to avoid, sufferers have no choice but to seek help.

Treating panic disorder

Jane uses a combination of Thought Field Therapy and EMDR Therapy to treat panic disorder. The beauty of EMDR is that the sufferer doesn’t have to know which events might be triggering the panic attack – rather, EMDR will find them.

She starts by taking a thorough developmental history, paying careful attention to issues of prenatal, birth or preverbal trauma, which sometimes highlights possible areas where the original trauma may have occurred. She will also ask the sufferer about the most recent panic attack, and using that as an entry point, will ask the client to float back to any times when the body may have felt the same way before.

By building a chronological list of contributing events, Jane will use EMDR to target the first, worst and most recent events of panic, before using a Future Template technique to target future events where panic could potentially occur.

The crucial ingredient, however, is teaching clients to have compassion for themselves, and engendering a sense of wonder at the body’s amazing ability to keep us safe.