13. Quantitative Change - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Ouch! Where'd that come from?! The Borderline in Couples and Couple Therapy
Chapter 13: QUANTITATIVE CHANGE


Small increases in quantity accrue to lead eventually to significant qualitative differences or movement into another stage.  For the individual, a bit more communication skills, a bit more psychological strength, a bit more life balance, and other quantitative changes can coalesce eventually into a qualitative change of being a healthier individual.  Frequency, intensity, duration, resonance, and damage/benefit are measures of quantitative change that can lead to qualitative change.  Generally speaking, the client presents for therapy looking for qualitative change whether or not he or she speaks in terms of quantitative or qualitative change.  For example, the individual with borderline personality disorder seeks change that improves quality of life, not just the quantity of intimate experiences: more closeness, more fulfillment, more communication, more sharing, more stimulation, more security, more understanding, and so forth.  The couple seeks the end of relationship hostility, not just lower quantity of negative interactions: fewer fights, less anger, less secrets, less resentment, less instability, less insecurity, less unpredictability, and so forth.

The quantitative change process reminds the therapist, that the couple's current problematic stage did not suddenly erupt out of nowhere. The therapist should challenge the couple about their longitudinal process of how negative quantitative changes accrued while positive quantitative changes diminished.  Therapy should explore how and why had both partners been complicit in allowing the accumulation of negative experiences and reduction of positive experiences.  While the partner may complain about the individual with borderline personality disorder's erratic behavior and in turn be accused of insensitivity and crass reactions, both partners allowed negative quantitative changes to accumulate and positive quantitative changes to diminish.  These quantitative changes accumulated to wreck corrosive qualitative change in couple's intimacy.  They had consciously chosen to stay in the relationship despite obvious negative interactions.  Despite the couple's expressed desire for positive qualitative change, the only thing that can be focused on and worked on is quantitative change.  If the therapist offers qualitative change without working on quantitative change, it is tantamount to offering "magic" as opposed to therapy.  Qualitative change cannot be disconnected from quantitative change.  The therapist should be aware that a couple comes to therapy seeking qualitative change.  They want to turn their poor relationship into a good relationship.  The therapist can help them gain this ultimate goal.  However, functionally therapy helps them improve the unfulfilling relationship by focusing on quantitative changes.  Specifically, the work in therapy and at home for the individual with borderline personality disorder and partner must be in the quantitative categories of:

Frequency looks at how often borderline reactive events occur.  Positive frequency is to be increased (for example, increasing interactions where hurtful feelings were addressed calmly from infrequent to daily, to a couple of times daily, and eventually to almost all the time).  Negative frequency is to be decreased (for example, from snide remarks every day to every other day to twice a week to once a week, to every other week, to monthly, to every third month…).

Intensity looks at the degree of feelings.  Positive intensity is to be increased (for example, from benign acknowledgment, to gracious appreciation, to interactions with warm emotional verbalization or hugs).  Negative intensity is to be decreased (for example, furious interchanges become incrementally less intense by becoming heated exchanges, to intense disagreement, to minor aggravation).

Duration looks at how long something persists. Positive duration is to be increased (for example, interactions that facilitate benign or positive feelings for each other last longer and longer from a few minutes to hours to days to weeks). Negative duration is to be decreased (for example, from a two-week seething resentment, to ten days, to one week, to 3 days, to one day, to 4 hours, to 2 hours, to a half hour, to a 15 minutes fight).

Resonance looks at how much couple's interactions affect the rest of one's life.  Positive resonance is to be increased (for example, good feelings, a sense of satisfaction, attachment, and security from interactions positively and increasingly resonate throughout ones life, and through the couples relationship.  Negative resonance is to be decreased (for example, increased ability to compartmentalize negative interactions so as not to affect other life functioning, and decreased doubts about the quality or viability of the couples relationship).

Benefit/Damage looks at how the foundation of the relationship is affected.  Positive effects- benefit is to be increased (for example, as reflected in greater hope, security, and confidence in each other and the relationship).  Negative effects- damage is to be decreased (for example, reducing anxiety, insecurity, and despair about the future of the couple and self gradually shift).   

REAL THERAPY
Therapy therefore seeks to enable the couple to accumulate sufficient quantitative behavior changes such that a critical emotional mass develops that allows for qualitative change.  Therapy works constantly on the members of the couple accruing quantitative changes in the relationship.  Such quantitative change lead to qualitative change.  Accumulation of enough positive quantitative changes and reduction of negative quantitative changes between Frieda and Cliff for example, can eventually lead to a qualitatively happier, more fulfilling, intimate, and cohesive relationship for the couple.  Various theoretical approaches to therapy target changes in attitude, values, thinking, awareness, motivations, and so forth.  All such changes however eventually must result in quantifiable behavior change.  Internal emotional, psychological, cognitive, or spiritual changes are insufficient until they express in quantifiably increased positive behavior and quantifiably decreased negative behavior.  The therapist or the couple may consider quantitative change interventions to be simplistic or not "real" therapy.  However, it is the realistic work of therapy.  When the individual or a couple makes fundamental qualitative change, more often than not it is the consequence of quantitative changes accumulating to reach a therapeutic or emotional or psychological tipping point.  It may appear that a specific intervention triggered substantive change.  The therapist often recognizes that the same intervention had been done or feedback had been given several times previously.  Not so much as time or good timing alone, but accrued quantitative changes finally reached a critical mass igniting qualitative change.  The therapist often needs to convince clients that only quantitative change will lead to the qualitative change they desire.  Unsophisticated expectations of the couple for improving the quality of their relationship without dealing with the accumulation of formative experiences may be an original contributor to intimacy problems.  The goals of therapy for the individual are quantitative changes in borderline personality behaviors.  These include specific attention to facilitate quantitative change in the nine DSM-IV criteria for borderline personality disorder:

Fewer and less frantic efforts to avoid abandonment,

More stable and less intense interpersonal interactions- lower reactivity,

Less idealization and devaluation- a more stable sense of the partner,

A more stable sense of self,

Less impulsivity and with less harmful behaviors,

Reduction in frequency and intensity of suicidal behavior, gestures, or threats, and self-mutilating behavior,

More stable affective moods- less depression and lower anxiety,

Less chronic and less intense feeling of emptiness, less intense anger,

More appropriate expression of anger, better control of anger, and

Less stress and less resultant paranoid ideation or disassociative symptoms.  

Therapeutic attention should address quantitative changes in the impairments and traits listed in DSM-V.

Less impairment self functioning of identity resulting in less impoverished, more developed, or more stable self image, less excessive self-criticism; fewer
chronic feelings of emptiness or dissociative states under stress.

Less impairment in self-direction with greater stability in goals, aspirations, values, or career plans.

Less impairments in interpersonal functioning involving empathy, including improved ability to recognize the feelings and needs of others associated with improved interpersonal sensitivity (i.e., less prone to feel slighted or insulted); perceptions of others with less selectively biased toward negative attributes or vulnerabilities.

Less impairments in intimacy, including less negatively intense, stable, and cohesive close relationships, marked by trust, mutual fulfillment of need, and realistic self-soothing when dealing with real or imagined abandonment; close relationships often viewed in realistically, valued, with less alternating between over involvement and withdrawal- a more stable sense of intimacy.

Less negative affectivity characterized by emotional liability: stable emotional experiences and less frequent mood changes; lower emotional arousal, more mellow, and/or proportional to events and circumstances.

Less negative affectivity characterized by anxiousness: less intense feelings of nervousness, tenseness, or panic, less reactive to interpersonal stresses; less worry about the negative effects of past unpleasant experiences and future negative possibilities (increase confidence in the future); less fearful feelings, less apprehension, or less threatened by uncertainty; less fears of falling apart or losing control.

Less negative affectivity characterized by separation insecurity: confidence about relationships with less fears of rejection by –and/or separation from significant others, confident and appropriate dependence, independence, inter-dependence, and autonomy.

Less negative affectivity characterized by depressivity: less frequent feelings of being down, miserable, and/or hopeless; ability to recover efficiently from such moods; optimism about the future; ability to avoid shame; feeling of self-worth; fewer or no thoughts of suicide and suicidal behavior.

Increased and appropriate inhibition, characterized by lowered impulsivity: contemplating consequences before responding to immediate stimuli; acting based on a plan or consideration of outcomes; ability establishing or following plans; improved management of a sense of urgency and avoiding self-harming behavior under emotional distress.

Increased and appropriate inhibition, characterized by less frequent and limited risk taking: avoidance of dangerous, risky, and potentially self-damaging activities, consideration of necessity and regard to consequences; concern for one's limitations and the reality of personal danger.

Lowered antagonism, characterized by lowered hostility: occasional or infrequent angry feelings; lowered anger or irritability in response to minor slights and insults.

Each of these interpretations for quantitative change implies some beneficial converse or opposite increase or decrease whether specifically mentioned or not.  With sufficient accumulated quantitative changes, the individual with borderline personality disorder may evolve to become someone with borderline tendencies who further progresses to become an emotionally volatile but relatively functional member of a couple.  This qualitative change along with related accumulated quantitative changes in the partner that lead to the partner's qualitative change enables them to become a couple with a good relationship.  Quantitative change goals for the partner include:

Clearer and more assertive boundaries- less tolerance for poor treatment,

More confrontation of dysfunctional borderline behavior,

More verbalizing care about the individual's distress,

Less deferring or acquiescing to unreasonable demands,

More awareness of the individual with borderline personality disorder's underlying needs,

More consistent boundaries for self,

Recognizing and cutting off unproductive interactions more quickly- less reactivity to the individual's borderline behaviors,

Recognizing more quickly the individual's abandonment fears, affective instability, and other borderline characteristics,

More expectations and demands for appropriate treatment.

The combination of each member making quantitative changes that lead to his or her respective qualitative changes also leads to quantitative changes that lead to couple's qualitative changes.  For the couple, quantitative changes include:

More frequent positive interactions,

Fewer negative interactions- specifically, less borderline triggered conflicts,

More positive intensity and less negative intensity- specifically, lower borderline reactivity,

Shorter and less damaging arguments and fights,

Longer positive periods and shorter negative periods- specifically, quicker re-stabilization after being triggered,

More positive affects on other areas of life and less negative affects on other areas of life- specifically, improved overall self-esteem and security,

Lower frailty and greater relationship stability,

Improved quality of relationship/life,

Less relationship/life stress,

More intimacy, and

Less borderline drama.

Initial changes may not and probably will not be substantial or involve all five categories of quantitative change.  However, if a process of gradual improvement persists long enough there can be sufficient quantitative changes.  Then the first qualitative changes occur: hope and belief.  There may have been tentative hope and faith that the relationship could grow or heal and therapy could work, but there was no or minimal experience to justify them.  Faith does not need facts or experience, while belief is based on facts and experience.  From not believing or having hopeful but unfounded faith that the therapeutic process and/or the relationship can work, the couple changes to believing that the process and the relationship can work.  From no confidence that the relationship can make it to believing that the relationship can survive.  Confidence in surviving is the first goal for the child to achieve in becoming powerful and successful.  With sufficient sensitivity, caregivers can offer sufficient support for the child to develop the skills and strength to withstand stress, frustration, failure, and suffering.  With such skills and strength to endure, the child develops a foundational sense of survivability.  From that base, the child and the individual can take further risks and attempt to flourish.  In the same way, incremental experiences enables the couple to develop confidence that the relationship can survive- become a powerful and success partnership.  Small initial but sustained growth in skills and strength to withstand the stress, frustration, failures, and suffering of the intimate relationship create the foundation of a enduring and fulfilling relationship.  The therapist prompts, guides, and teaches the process to relationship survival that is essential the couple eventually flourishing intimately. The process of therapy stimulates and parallels the relationship growth process as the members endure therapeutic stress, frustration, failures, and suffering.  They can tolerate the challenges because of therapist sensitivity and support models and activates skills and strength.  Confidence in therapy is achieved with sufficient incremental experiential gains.  

With the therapist's guidance and support, the individual with borderline personality disorder experiences first in therapy and then at home that he or she can survive the intensity and anguish of real and imagined betrayal, abandonment, and rejection.  With increased skills and strength, the partner experiences that he or she can survive the drama of accusations and punishments from the individual with borderline personality disorder.  From the despair of ever having a stable fulfilling partnership, confidence in the survival of the relationship to Frieda as an individual with borderline personality disorder and to his or her partner such as Cliff is a monumental achievement.  From that foundation, both members of the couple can risk hope and investment in trying to flourish first in therapy and then at home.  After finding they can survive as a couple, they can seek then fulfillment as intimate partners.  The members' goal from therapy may be to be able to survive as a couple.  Fulfillment as a couple may be an additional worthy goal for them.  However, surviving as a couple may be more than the members expect and they may not be willing to risk more growth to gain fulfillment as a couple.  On the other hand, the members may wish to seek fulfillment or to flourish as a couple as well.   The therapist should propose survival and flourishing as sequential and progressive goals to the couple.  He or she should determine whether each member is seeking one or both goals.  The therapist should not assume that feeling fulfilled and flourishing as a couple is the goal of the members.  If either or both members propose fulfillment as their goal, the therapist should assert that confidence in surviving as a couple is a prerequisite goal.  If the couple- that is, both members are secure that they can survive as a couple, then therapy can proceed towards helping them flourish.  However, if one or both members are not secure that the couple will survive (or as an individual survive in the current relationship), then the therapist has to direct them and therapy to solidifying survival as the first goal.  Attempting to help the couple flourish when the relationship is at risk for not surviving is tantamount to offering "magic."  The therapist can only offer real therapy-sequential and progressive quantitative change to lead to sequential and progressive qualitative change as a couple.

ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
phone: (510) 614-5641
fax: (510) 889-6553
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