1. Assessment - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
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1. Assessment

Therapist Resources > Therapy Books > Mirror Mirror- Self-Esteem Relationships

Terry and Bert separated for several years, get into hostile fights about partner custody and support payments despite their best intentions.  They seem to always hurt each other and their respective new partners with their fights.  They came to therapy to see if they can work out some issues so that their support and custody discussions and interactions can be more positive.  Terry is very depressed about the continuing fighting.  Bert is skeptical, but is willing to try so that the "damn lawyers don't get it all!"  From Satir's model, or relative to communication issues and self-esteem, initial assessment with this couple finds: individual pain, family pain, low self-esteem, poor communication skills, blaming stances, placating stances, and the couple not leveling with each other.  Within each of the previous assessment categories, various cues may draw the therapist's attention.  For example, the therapist may note one type of several potential indicators of poor communication standing out.  "Findings in social psychology have linked pronoun counts to social processes.  First-person plural pronouns (e.g., we, us, our) appear to be markers of shared identity and affiliative motivation.  Studies have found that people increase their use of first-person plural pronouns after a large-scale trauma (Stone & Pennebaker, 2002) or after a victory of their home football team (Cialdini et al., 1999).  Highly committed partners also use we pronouns more frequently than less committed partners when writing about their romantic relationships (Agnew, Rusbult, Van Lange, & Langston, 1998).  In contrast, first-person singular pronouns (e.g., I, me, my) and second-person pronouns (e.g., you, your) have been interpreted as indicants of individuated identity and of self-focus and other-focus of attention.  Studies have found that high self-monitoring (other-focused) individuals use you more frequently than low self-monitoring individuals during unstructured peer interactions (Ickes, Reidhead, & Patterson, 1986) and that individuals high in trait anger use you more frequently than individuals low in anger during monologues (Weintraub, 1981).  Similarly, numerous studies have linked first-person pronouns to self-focus (for a review, see Pennebaker et al., 2003).  Marital theorists have argued that, with respect to marital interaction, I statements facilitate adaptive communication processes, such as verbal immediacy and self-disclosure, whereas excessive you statements signal blaming or distancing attitudes (e.g., Hahlweg et al., 1984).  However, in the only study of language use during marital interaction, Sillars, Shellen, McIntosh, and Pomegranate (1997) found that happier couples used both fewer second-person pronouns and fewer first-person pronouns, compared with less happy couples" (Simmons et al., 2005, page 933).

Communication skills training teaching the use of "I" statements may be emphasizing the benefits of open and honest communication and ownership of ones feelings and thoughts.  However, as the research mentioned seems to indicate, a predominance of the use of "I" may be indicative of personal and relationship issues.  It is not clear whether frequent "I" usage causes communication issues that cause personal and relationship problems, or personal and relationship problems cause frequent "I" usage.  Communication skills training may presume change in pronoun use among other communication changes would facilitate positive personal and relationship growth.  If however deeper personal and relationship problems precipitate the communication style, then the therapist would need to adjust the focus of therapy.  Individuals who used first-person plural pronouns more often than others during conversations involving conflict did not report better relationship contentment.  However, individuals who used "we" more often were better at resolving an issue in ways that were mutually satisfying.  Possibly, using "we" was indicative of higher shared responsibility or greater investment in the problem, leading such individuals to be more willing to co-operate.  Better problem-solving skills may be "why couples who score high on we-ness (Buehlman et al., in press) have lower rates of long-term marital distress and dissolution than other couples.  Pronouns other than we were related to marital satisfaction and interaction negativity.  As predicted by marital theory, use of you was positively correlated with negativity during problem discussions" (Simmons et al., 2005, page 935).  In individual therapy, comparable pronoun use or emphasis would be on the other person referenced as "he," "she," "him," or "her" in some accusatory communication.  Heitler said, "...many people don't know how to ask good questions.  In other words, the alternative to you-messages is not just I-messages it's good questions.  Good questions almost always begin with "What?" or "How?" and many people don't know how to ask those questions.  Lastly, many couples lock into a tug-of-war over 'I want X,' – 'No, I want Y.'  Many people don't know how to switch levels to the underlying concerns that fuel such tensions" (Wyatt, 2009).  Pronoun use is a way to make the partners more aware of intentions and desires, but may not suffice for changing the overall dynamic.  The therapist deepens the communication with the "What?" and "How?" questions to bring underlying feelings and thoughts into consciousness for overt examination and negotiation.

It is often useful to identify at which stage of a negative relationship progression individuals are in.  This theory sees seven stages of decay.  Depending on which stage each partner is in, challenges to therapy and to rebuilding the relationship are different.  Needless to say, the more negatively advanced- the more devolved the relationship, the more difficult is the rebuilding process.  While this model (adapted from John Gottman's work) focuses on couples, it can be expanded and applied to any relationship- in the family, with peers, and at work.  It can be used for therapeutic assessment and treatment planning.  An individual will comment about a behavior that he or she finds uncomfortable or negative in the hopes that the other person will figure out the implicit message.  For example, Bert may comment, "I don't get to see the kids on my birthday."  The commenting individual expects the receiving person (in this case, Terry) will process thus- "Since he or she mentioned that, it must be something that bothers him or her.  And, since I care for him or her, I will automatically change my behavior."  Commenting may be one-sided or mutual.  If the other does not reflect back as desired- specifically does not respond appropriately, the commenter begins to make negative assumptions about why not.  Bert may interpret Terry's non-response as her not caring about him being sad that he missing the children sharing his special day.  When either individual makes a comment, the therapist should ask him or her to explicitly reveal any hidden meaning.  For example, "Bert, what did not seeing them on your birthday mean to you?"  This is a situation where encouraging an "I" statement would be appropriate.  The therapist should guide the individual to take ownership and responsibility for what he or she wants.  Bert might respond, "I will really miss them… I feel bad that I can't have them share my birthday."

After commenting about the behavior, but getting no response (change), the individual will complain specifically about the undesirable or absent behavior.  For example, Bert may go further and say, "It was messed up having my birthday without the kids."  The complaining individual expects that the receiving individual (Terry) will process thus- "Since my partner (or Bert) has complained specifically about this behavior, and since I care for him or her, I will automatically change my behavior."  Bert hopes that Terry may respond, "Oh, let's see if we can switch the schedule so they can be with you on your birthday."  The implicit accompanying message would be "…because your feelings Terry are important to me."  Complaining may be one-sided or mutual.  If the other does not respond appropriately, the complainer begins to make negative assumptions about why not.  Bert may think Terry is insensitive or dismissive of his feelings.  When a client complains, the therapist should ask him or her to explicitly reveal any hidden meaning.  Specifically, what he or she wants or desires in the affirmative.  Complaining or "not" statements (for example, "not drive so fast" or "not spend so much money") may be indicative of a negative life perspective.  Prompting "I" statements would also be appropriate here, with the major caveat that to not use an accusatory "you" in the statements.  Using "we" would express a joint desire rather than an individual egocentric grievance.  Ideally Bert may explain, "If we can be sensitive and responsive to each other, we'd get along so much better."

After complaining about the behavior, but getting no change, the individual will move from complaining about behavior and begin complaining specifically about the other person.  In other words, the partner begins criticizing the other person's personality or character.  Bert may say, "I don't get what's so hard for Terry to give a little accommodation with the kids' schedule for my birthday."  The criticizing partner's logic is "Since my partner who I complained to has not changed his or her behavior, there must be something wrong or corrupt about his or her personality or character."  Criticizing usually becomes reciprocal.  Terry may retort, "He always wants some change to benefit him… as if I don't have any needs."  Again, if the other does not respond appropriately, either or both criticizers' negative assumptions about why not become more intense.  When the individual criticizes the other person, the therapist should ask him or her to explicitly reveal any hidden meaning.  Specifically what does he or she want or desire the other person to do instead?  Criticizing the other person may be indicative of needing to be the "good guy" by making the other person the "bad guy."  Prompting "I" statements would also be appropriate here, with the major caveat that using "you" in is allowable if the statement is a request for positive behavior (as opposed to stopping negative behavior).  "You don't give me a break" becomes for example, "I would like a break." Allowing for using "we" encourages the desire for mutually beneficial actions.  "Maybe we can figure out something that works for both of us."  A line can be drawn here to indicate the transition of treatment planning from primarily communications skills training.  Much of the issues raised in #1, 2, and 3 can be handled with good communications skills training.  When commenting or complaining shifts to criticizing the other person, treatment now requires a more difficult level of therapy.  When the relationship has devolved past this line, at issue is no longer just poor communication but also of emotional injury.  Bert's criticism of Terry (and her criticism of him) indicate having been hurt.  This requires a healing process as well, which probably will require an adjusted therapeutic approach.

After criticizing the other person's behavior, lack of behavior, or choices, and still being frustrated in getting the desired response, the criticizing individual adds intentional insult based on personality or character.  The individual thus conveys a sense of disgust, that is, contempt (resentment, disrespect, questioning integrity) for the other person.  At this point, any positive qualities or previous good experiences are often forgotten.  Bert turns to the therapist and asks rhetorically, "What kind of mother denies the father of her children their relationship?"  The answer is obvious- a despicable one!  Because of having suffered the first insult in his or her mind, the individual begins to self-righteously, harshly, and even abusively treat the other person.  The logic of the individual holding contempt is that, "My partner has failed to behave properly because he or she is disgusting, stupid, and incompetent."  If not already a part of the relationship, contempt creates emotional injury.  Bert now feels entitled to purposely hurl contempt at Terry.  Now both individuals have wounds that require healing: Bert the one that did not get the response implicitly asked for and the other person- that is Terry now punished with contempt for not responding as desired.  Contempt tends to be highly reciprocal.  The therapist needs to interrupt and stop contemptuous communications since it injures and re-injures emotional wounds.  The therapist can identify, reveal, and challenge the individual's decision to intentionally hurt the other person.  The individual may deny that he or she is intentionally harming the other person.  One of the challenges of individual therapy would be getting the individual to own his or her contemptuous or vengeful hurtful behavior towards another outside of therapy but in relationship with him or her.  In couple or family therapy, the therapist should elicit from the targeted person his or her experiences of insult and disrespect.  The revelation of harm may suffice to interrupt the injuring.  The therapist must hold each individual accountable for the attacks.  He or she is responsible for the choice to hurt no matter the excuse.

After contempt enters the relationship, often both or all individuals are mutually abusing each other.  Each person feel victimized by another, and respond by being defensive about his or her behavior.  Bert may think, "If Terry weren't so unreasonable, I wouldn't get so hostile with her."  And, Terry may conclude, "I can't give Bert any slack, because he'll just take advantage of me."  The logic of each is, "It (including my behaviors) are all his or her fault.  His or her behavior and/or flaws force me to behave so negatively in response.  I know what his or her evil motivations are (mind reading)."  Being involved in negative behavior towards the other person challenges ones self-image of being a good and fair person.  Neither Bert nor Terry want to see themselves in the mirror as being unreasonable, insensitive, or mean.  Defensiveness develops in order to self-justify abusing the other.  Instead of answering complaints or criticisms, each responds with his or her own set of complaints or criticisms. A second line can be drawn here to indicate another transition in treatment planning.  At this point, communications skills training and a therapeutic process facilitating healing of emotional injuries becomes further complicated.  The individuals have history of evolving disconnection and denial of responsibility for their respective behaviors.  The fear of further injury from intimacy and proximity avoidance prevents further risk taking.  Vulnerability is avoided despite being essential to improving communication and healing.  Each individual becomes self-righteous and will focus on what other person should change, rather than take responsibility for or attempt to change his or her own behavior. Therapy has moved to a significantly more difficult level and needs to be adjusted once again.  The therapist may need to aggressively hold each individual responsible for his or her role in the relationship.  "Yes, other person did that- something despicable and then, you chose to hurt back."  This often involves the individual who asserts having the greater grievance being challenged for staying or giving permission for hurt to occur and persist.  The therapist should require the individual to state what and why for behavior or choices.  For example, after acknowledging the triggering action by the offending partner, the other partner can be prompted to use the verbal template of

He or she did ______, so I felt _______.

Since, I felt ______ so I choose to _________.

The therapist might prompt Bert to acknowledge, "When Terry didn't offer to change the schedule, I felt hurt.  Since I felt hurt, I choose to spite her by bringing the kids back late."  Terry may be prompted to own that, "When Terry got grumpy, I felt anxious that he'd blow up on me again.  So, I when felt threatened, I decided make it more difficult for him to reach me.  I turned off my cell phone."  As the underlying entitlement for grievance is identified, the therapist can connect it to the individual's self-righteous justification to be hurtful.  And then the therapist can challenge its moral appropriateness versus its communicative functionality for relationship intimacy.

After engaging in the fruitless negative and painful cycles of arguing, eventually one or both persons disconnect from the other person despite the invested relationship.  They purposely deny mirroring the other's feelings or experiences.  Bert purposely avoids acknowledging Terry's struggles with the kids' upset when he is late or has to cancel time together.  Terry blocks having any empathy for his loneliness from missing important events in the kids' lives.  Emotional disconnection is experienced as necessary in order to avoid the pain of caring for someone who appears to not care reciprocally, to avoid rejection and abandonment, and to attempt to stop mutually abusive battles.  As a result, communication may be strained or severely circumcised, dealing only with the business/functional aspects of the relationship.  The communication style and process will be largely perfunctorily between disconnected individuals despite the ongoing relationship.  It becomes the business and logistics for example, of picking up and dropping off children, financial affairs, meals, and other functional interactions.  It may be polite but devoid of emotion.  Positive emotion becomes collateral damage to the individuals avoiding anger and hurt.  People may co-exist in a disconnected relationship for years...or for life.  The therapist needs to assess whether the individuals can risk emotional connection once more.  This risk would be based on the hope of renewed intimacy.  However, the therapist should acknowledge that both individuals will inevitably be hurt again as they attempt to reconnect.  Neither Terry or Bert for example, nor the therapist will be immediately so skilled that mistakes will not occur and injuries ignited or created once again.  The therapist should present the requirement to risk and suffer emotional disappointment and injury again in other for the couple to have a chance of healing or growing.  If individuals accept the challenge to risk emotionally again, the therapist must manage their emotional vulnerability carefully.  Small gestures and minor revelations of positive feelings should be tested first.

This is the physical and/or legal divorce between partners.  The relationship gets broken.  It happens between partners, peers, friends, employee and business, and individuals (including children) and families.  A family may "divorce" its difficult teenager.  It may occur or not depending on other factors (economics, age/youth, and so on).  The therapist should help either or both individuals' clarity what can and cannot work for self and the relationship.  Terry and Bert were already divorced, but remain in a critical co-parenting relationship that neither wants to retreat from.  In addition, neither one of them wanted to "divorce" the other from the co-parenting of their children, as they are both committed to raising the children in some collaborative manner.  In their situation, separation altogether was not an option but other boundaries needed to be established for them to become more functional.  This is clear to them.  For others, divorce, final separation, or terminating the relationship is the necessary course of action.  In that case, the therapist may be able to help individuals separate more cleanly.  If a couple comes to the decision to divorce, the therapist should offer feedback about areas that will continue to cause conflict between partners beyond separation.  The therapist's input may be useful to prevent continuing injuries and long-term damage to the partners and to any children during the process of separation.  Realistically, one or neither partner may have little or no interest in this feedback or desire to separate cleanly.  The therapist can still warn them of the potential destruction of such a course of action.  Specifically, poor communication between individuals in a failed relationship that persists and intensifies during and after separation bode badly for subsequent relationships.  Continued work may be necessary with custody and financial arrangements.  Terry and Bert had suffered such poor communication and subsequent problems in the years after separation.  Fortunately for them and hopefully for their children, rather than allowing everyone to continue enduring problems, unlike many other ex-partners they sought therapy for assistance.

3056 Castro Valley Blvd., #82
Castro Valley, CA 94546
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
office: (510) 582-5788
fax: (510) 889-6553
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