It has been said almost too many times that treating couples is very hard work. But, so what. Most couple therapists aren’t afraid of hard work. What they don’t like is working too hard and feeling like they are getting nowhere. It is very difficult to stay motivated that way.
Throughout my career, I have been drawn to opportunities that blend leadership with service. As a Public Health Service Officer and Licensed Clinical Social Worker, my commitment has always been to serve where the need is greatest. Whether during deployments addressing humanitarian crises or through research focused on homeless veterans, I’ve seen firsthand the difference compassionate leadership makes.
Fleeing treatment is an understandable wish. Effective Neurodynamic Couples Therapy is often frightening and painful–sometimes horribly painful. Metabolizing historical feelings requires that they be relived precisely as intensely as they were originally experienced when first stored, along with the perceived sense of danger that was present in the original experience. It makes sense to be scared of this process, so addressing the wish to flee should be seen as a normal part of the treatment.
Most of the time most of us therapists work as hard as we can to keep a treatment going, knowing that attempts to derail therapy have many meanings that can be explored and understood. I know that I have always been extremely reluctant to “give up.”
There is no doubt that treating couples is often quite difficult. This is a primary reason that many therapists decide to not treat couples at all. In fact, statistics say that the rate of failure for couple therapy is higher than for individual therapy.
What do prospective clients look for when seeking a new therapist? Credentials, education level, years of experience, and specialization are all important. But what about languages spoken, ethnicity, gender, clinician’s age, or their preferred pronouns?
Frequently in my consultation groups, I hear from therapists, “They just aren’t getting it.” They are referring to the couples they are treating who feel particularly frustrating to the therapist. “We’ve talked about the same things over and over again, and nothing is changing,” exclaims the exasperated therapist.
Men's health month is recognized in June of each year. This health awareness observance brings attention to a range of well-being concerns affecting men and encourages self-care along with preventive health visits. Well-being is an experience of health, happiness and prosperity. It is holistic and consists of many domains including physical, mental, spiritual, and social. These can impact the total health of men and illnesses unique to them such as prostate cancer.
Some forms of couple therapy have emphasized the importance of helping couples differentiate–helping them see each other as two separate individuals, instead of succumbing to a type of “twinning” where only alikeness is tolerated. There are certainly benefits to helping couples resist the draw to substitute being alike for being close. However, ignoring the nonconscious “sameness” of intimate partners is also missing an opportunity to make use of the right-brain natural attraction of similars in service of healing.
I recently came across an article titled, "Reframing Clinician Distress: Moral Injury Not Burnout." Moral injury is a concept that refers to the psychological, social, and spiritual impact of challenging events on individuals who uphold strong values, such as providing quality care for patients, especially in high-pressure situations where they may have to compromise these values. Common symptoms of moral injury include feelings of guilt, shame, anger, and contempt towards a system that may prevent individuals from delivering proper care.
The concept of moral injury sheds light on many of the difficulties we currently face in our profession. As clinical social workers, an understanding of moral injury can help us to identify the root cause of our distress and burnout within a flawed system, rather than attributing it solely to individual shortcomings. This perspective allows us to recognize and address larger systemic issues at play. By acknowledging our role within the system, we can work towards implementing meaningful changes.
Whether we work in private practice, academia, or healthcare settings, it is important for all of us to understand the factors that contribute to moral injury and how the existing system perpetuates it. This understanding can guide us in advocating for systemic improvements that promote well-being for both clinicians and the individuals they serve.
Many types of mental health treatment include some form of exploring feelings. In Neurodynamic Couples Therapy, exploring feelings is the pathway to metabolizing and integrating them into a cohesive sense of self and relationships and creating a bond of empathy and understanding between partners.
Burnout among Clinical Social Workers has emerged as a critical issue, reflecting their work's intense emotional and psychological demands. A comprehensive systematic review spanning twenty years of research highlights several key aspects of burnout within health social work[i]. The review underscores the prevalence of burnout as exceeding that of other health professions, influenced by work setting, job turnover, physical and mental well-being, and the importance of coping skills training[ii]. Notably, workload and work setting were the primary job demands contributing to burnout, with personal characteristics such as age and gender also playing significant roles.
The term “woke” means to be aware. It is the opposite of slumber and suggests a person is consciously aware of their role, its influence on others, and the associated societal climate. It is an act of submission which recognizes the importance of the patient’s agency. The term “woke” was first introduced in the 1940’s to emphasize the importance of being aware of social injustices (Ng, 2021). At the height of the racial tensions within the last ten years, the term was used in a pejorative nature to undermine another person’s stance on issues that he or she identified as worthy cause(s) to elevate. To be deliberate in addressing systemic issues that impact the underrepresented members of our communities as well as granting them the authority to narrate their stories clinicians must practice “staying woke.” Wokeness suggests an active pursuit of knowledge and consciousness. Wokeness is a deliberate practice of taking action to better inform a clinician’s practice. It requires introspective engagement, minimizing judgment to promote social change.
Couples have a nonconscious, intersubjective system between the two partners that has been existent and developing in complexity since they first met each other. It has been well-established in recent years that this type of system gestates during childhood and becomes the template that dictates who we will be attracted to and commit to as a life partner.
I have written many times about the radical intersubjective stance that Neurodynamic Couples Therapy takes regarding the treatment of couple relationships. In essence, we are treating what happens between the partners–not individual psychologies. The theory holds that it takes two brains in each other’s presence to access the affective material that has been generating the couple’s conflicts in order to heal historical wounds. The individual psychologies heal and change through the couple work.
“You can’t go back and change the beginning, but you can start where you are and change the ending.”
It is said to be ‘the most wonderful time of the year,’ however, we must recognize that the winter holiday season is not a season of festivities and joy for everyone, especially those grappling to live with the loss of a loved one. As social workers, this truth offers us opportunities to reflect on the pain, loneliness and sorrow some may feel and offer to hold space for those in need of hope and comfort in knowing that they are not alone. Pausing and remembering the past weeks, months, and for some years of difficult times, we can remember the poignancy of memories, the grief, the sadness, the hurts, the pain of reflecting on our own mortality.
One of my patients recently informed me that November is the National Month of Gratitude. This makes sense given the date of our Thanksgiving Holiday. It reminded me of some basic mannerisms and courtesies associated with general civility but also within the context of professional social work. Patients often express gratitude for the care they receive at my clinic. Their topics of discussion are typically too delicate to share with family and friends. Many feel socially isolated or disenfranchised to openly discuss such sensitive and personal matters. Similarly, I try to remain grateful to my patients for inviting me to discuss their private thoughts and feelings.
I have been thinking a lot about self-care in my work with patients experiencing high-stress circumstances. In my practice, with peers and patients, I tend to ask, “what are you doing to take better care of yourself?” The frequent response is so common it could be considered universal …blank stare, awkward silence, and a sheepish, “I don’t know,” usually accompanied with a shrug.
Most therapists have had the experience of feeling that a treatment is being derailed and perhaps headed for failure. Even when we are able to see it coming and try to redirect the treatment, it can be like attempting to turn a battleship around (as the saying goes).
