11. Communication & ProbSolving - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
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11. Communication & ProbSolving

Therapist Resources > Therapy Books > I Don't You Don't, DepAnxiety-Cple

I Don't… You Don't… It Don't Matter, Depression and Anxiety in Couples and Couple Therapy

Houts (2008) found that "Destructive couples exhibited considerably more tension, hostility, and negative affect than communication skills, supportive validation, and positive affect.  In contrast, Constructive couples maintained eye contact, asked their partner for more information, and conveyed that their partner's statements had been registered, acknowledged, and encouraged… Destructive couples reporting more depressive symptomatology and less positive and more negative views of their marriages than couples who used Constructive problem-solving styles" (page 119).  Depressed individuals often have greater difficulty communicating appropriately in problem solving or conflict situations.  They display poorer problem solving behavior and tend to communicate more negatively and disruptively.  Depressed people display higher levels of reassurance seeking and negative feedback seeking, are more self-punitive in their interpersonal behavior, are restricted, passive, and under-responsive in their interpersonal behaviors, and tend to be helpless, sad, pessimistic, vulnerable, and generally negative in the content of their statements compared to non-depressed individuals (Baucom et al., 2007,page 691).  Depressed individuals clearly bring a lot problematic characteristics and behaviors into the couple's relationship that potentially negatively affect its functioning.  Couples with relationship issues tend to be distinguished in communication style from those who are more functional.  Differences are more pronounced when there is conflict with greater likelihood of "demand/withdrawal (a pattern in which one spouse avoids discussion while the other nags or complains) and mutual avoidance" (Heene et al., 2005, page 414-15).  This is more characteristic of problematic relationships.

Jocelyn complained to the therapist that she was overwhelmed with household chores, children, her family, and working full-time.  She said Hassan was too involved with his buddies in the soccer club to spend much time and energy with her.  If there wasn't soccer practice, there were games on the weekends.  If there wasn't practice and games, there was organizing the trips to tournaments.  If it wasn't tournaments, it was updating the club website.  The therapist asked, "Have you told Hassan, you'd like more together time?"  "Of course, I have but it is always something.  This practice… new jerseys… carpooling… always something," Jocelyn complained bitterly.  "I love the kids, but sometimes I feel I'm doing it all alone."  She slumped into her chair, teary eyed, and arms crossed.  Hassan had glared at Jocelyn as she began speaking, interjecting with a mutter, "Guess she's going ream me ANOTHER new asshole!"  Despite his anger, the therapist was able to focus Hassan on Jocelyn's hurt and how much she wanted his attention.  "Jocelyn wants more of you, not less of you.  She LIKES you… LOVES you… and feels that she doesn't matter… Jocelyn thinks that how she feels doesn't matter to you."  The therapist evoked Hassan's ideal self-definition with a challenge, "I can't believe you don't you care about Jocelyn… how she feels."  Hassan said, "I do care.  I didn't know it was that bad for her," as he gazed sadly at Jocelyn.  Hassan had softened and appeared ready to reach out to Jocelyn.  However, Jocelyn chose this moment to retort, "I don't know how you can fucking not know!!  I tell you all the time!"  She glared at him for a moment, and then turned her whole body away from Hassan, gathering her legs into her arms in to a semi-fetal position.  Hassan turned his hands up and looked helplessly to the therapist.  "See?  I try to talk to her… work something out, and I get nuked for my effort.  Damn!  What the fuck am I supposed to do?  Keep coming back for more abuse?  Let her rip me over and over?!"

Jocelyn was doing her version of demand-withdrawal.  When Hassan responded or tried tentatively to respond however slowly or imperfectly, Jocelyn would shut down and pull away.  She'd fall into her self-righteous cave of resentment.  All alone, abandoned or withdrawing (functionally, these are all the same) Jocelyn became more depressed and unhappy in the relationship.  Jocelyn could describe her demand-withdrawal process.  She admitted how she would avoid anticipated disappointment and rejection from Hassan when the therapist asked about how she dealt with her feelings.  Self-reported demand-withdrawal and avoidance mediated women's levels of depression and relationship contentment.  On the other hand, self-reported constructive communication mediated levels of depression and relationship contentment.  In general, depressed individuals have poorer conflict communication skills and behavior in most situations.  Variation in the quality of interpersonal communication may determine the relationship between depressive symptoms and marital distress.  It is possible that self-reported conflict communication associated with depressive symptoms is more predictive of relationship health than the depression itself.  Demand-withdrawal and avoidant communication patterns in women appear related to lessened relationship satisfaction.  It is not clear what the causal direction of these various factors or conditions.  Jocelyn was depressed because she was avoidant or withdrew and was avoidant or withdrew because of relationship problems.  Or, she was avoidant or withdrew because she was depressed and was depressed because of relationship problems.  Or, she had relationship problems because she was depressed and she was depressed because she avoided or withdrew from intimacy.  Or…  Or, all she did or was all these things because Hassan was an insensitive emotionally disconnected jerk!  Or, perhaps everything had to do with everything else.

Self-reported constructive communication mediated men's levels of depressive symptoms and relationship adjustment- that is, depressed men report less constructive communication.  Less constructive communication may cause poorer relationship quality and also be associated with depressive symptoms.  Hassan admitted sadly that he did not know how to talk to Jocelyn when she was upset.  In addition, self-reported avoidance moderates the direction and strength of depressive symptoms and marital adjustment interactions in women.  How women communicate affects the relationship between depressive symptoms and marital.  Since everyone who gets more depressed does not suffer greater relationship distress, communication style may be key moderator.  "Because the association between marital distress and depression was highest when low avoidance was reported, however, one might speculate that when one is depressed, engaging in avoidance is a strategy that protects against marital distress.  Otherwise, when there is a high level of marital distress, avoidance seems to protect against depression, as a coping strategy that reduces the possibility that depression and marital distress will co-occur" (Heene et al., 2005, page 429-31).

All in all, while there may be significant interplay and influence among communication styles, depression, and relationship quality, the therapist must ascertain the specific ramifications for an individual or a particular couple.  The therapist may find asking the couple for a self-assessment useful to determine therapeutic strategy.   Instead of working on the process between Hassan and Jocelyn, the therapist may find it beneficial to ask each in turn to identify and explain his or her interaction and relationship style and behaviors  "Couples who appraise themselves as negative on communication patterns may find that marital problems are difficult to approach, and therefore become depressed (or vice versa).  Clinicians treating couples who report high dysfunctional conflict communication may want to include techniques designed to disrupt such communication patterns (see also Cordova & Gee, 2001; Davila, 2001), and efforts to educate spouses about the association between communication, depressive symptoms, and marital distress.  In addition to an insight of the issues underlying their destructive interaction patterns (see also Baucom, Shoham, Mueser, Daiuto, & Stickle, 1998), the implementation of communication training can be an important component for long-term maintenance of progress, improving their repertoire of effective interpersonal behavior" (Heene et al., 2005, page 434).

Hassan and Jocelyn had stresses on the family that demanded better communication.  As a relatively young (thirties) couple, they were sensitive to being negatively influenced (infected) by each other, but did not have or had not developed the skills to handle it.  Harper and Sandberg (2009, page 554) say that when older married individuals get a chronic illness diagnosis, both diagnosed person and the partner are vulnerable to developing depression.  Older couples may have to deal with issues that younger couples have yet to face: physical illnesses or deterioration along with economic changes and developmental stresses of aging.  Fear, anger, and loss are mixed with needs to make health care decisions and changes in lifestyle and environments.  When older couples are creative and effective with problem solving communication, they are better able to deal with these issues.  However, they have difficulty expressing and resolving feelings and problem solving through effective communicating, they may suffer greater vulnerability to depression.  "As a result, gerontologically focused health care professionals across disciplines would need to be willing to assess the functioning of both the patient's partner and their marriage when working with an older patient at risk for or experiencing depression" (page 553).  They may benefit from education, emotional and problem solving communications skills in marital support groups.  "Even in cases where the depression is related to dementia or organic causes, the course of depression and marriage might be helped by specific marital intervention, namely helping married partners develop improved affective and problem solving communication skills."  This recommendation extends beyond this age group and perhaps, beyond any specific stressor.  Improving problem solving communication also tends to alleviate depression in younger marriages, and lessening depression also improves problem solving communication (page 548).  The same has been found in middle-aged couples (page 552). "Symptoms of depression, such as hostility and irritability, as well as dysphoria and withdrawn-avoidant behavior, may interfere with an individual's ability to use adaptive behaviors to resolve conflict" (Marchand-Reilly and Reese-Weber, 2005, page 85-86).   Specifically, relationships that include a depressed partner at any degree of distress, "self-disclose less frequently and exhibit higher levels of aggressive behavior than non-depressed couples.  In addition, the depressed/distressed couples displayed less facilitative behavior than all other couples" (Harper and Sandberg, 2009, page 548).  There appears to be a positive and possible progressive relationship between getting older and more effective affective communication in relationships.  Couples of any age that have unhappy relationships tend to have difficulties with increased negativity.  "…older couples seem to have developed an ability to control the emergence of the negative affect, a skill that has eluded their younger counterparts" (page 548).  Experience and maturity may be important to relationship health.  Couple therapy may be conceptualized as an overt intensive form for partners to accrue experience and facilitate maturity from a therapist/educator.

Couple therapy that improves problem solving ability can lead to lower couple's distress and greater satisfaction.  Interventions in therapy (or otherwise) to improve marital problem solving can help prevent and resolve marital distress.  Conflict, in of itself may not be harmful to the relationship.  How the normal differences and challenges in the relationship are addressed is the key to relationship quality.   Hassan and Jocelyn had fairly common household challenges to balance: work, children, and the couple's relationship.  The dysfunctional dynamics dealing with the challenges, especially Jocelyn's demand-withdrawal style can be seen as constituting their core problem- and thus, can become the primary focus of therapy.  Once they can anticipate that intimacy is stable and secure through a workable process of communication and conflict resolution, everything else is simply problem solving.  If partners can stay "engaged, issue focused, and concentrate on negotiation and mutual problem solving," the conflict "would likely be constructive to marital functioning, whereas conflict characterized by negative escalation and the use of threats and coercion would be destructive to marital functioning (Cox, Paley, Payne, & Burchinal, 1999; Deutsch, 1969; Gottman, 1994)" (Houts et al., 2008, page 104).  Couple therapy, therefore may be to teach couples how to fight- how to be in conflict.  The therapist may purposely initiate confrontation that serves to achieve resolution, justice, boundaries, and greater intimacy.  This may be a major paradigm shift for the couple that it is necessary to embrace rather than avoid conflict.  Both Hassan's soccer focus and Jocelyn's withdrawal served to avoid conflict, intensified rather than reduced their mutual distress.  Avoiding conflict may be a major underlying contributor to individual and couple's depression and anxiety.  The problem to solve may not be any of a number of relationship challenges, depression, anxiety, attributions, attachment styles, or communication per se, but how to accept engagement in conflict resolution as an integral part of the relationship.  Feeling that one does not matter to an intimate partner and previously to the intimate caregiver, but being unable to confront to seek validation would lead to depression.  Feeling that confrontation and thus, also conflict is not allowed promotes a helplessness and vulnerability to the unpredictable machinations of others.  The therapist thus is tasked to create a therapeutic environment where it is safe enough for each individual to risk and assert what matters to oneself to the partner who can give or withhold validation.  The communication challenge for the therapist becomes how to convey and convert individuals and the couple to accept a paradigm that may inherently trigger current and past attachment anxieties, fears, and traumas.

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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