13. Validating Logical Craziness - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
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13. Validating Logical Craziness

Therapist Resources > Therapy Books > SunMoon DependentHistrionic-Cple

The Sun, the Moon, and the Stars, Dependency and Histrionics in Couples and Couple Therapy

The therapist can conceptualize couple therapy with a histrionic member and an obsessive member or other partner into five treatment phases, each with specific treatment goals.  “The phases are: (1) engagement (i.e., establishing a working therapeutic alliance); (2) assessment and formulation; (3) rebalancing the couple relationship; (4) modifying individual dynamics; and (5) maintenance and termination.  Sometimes, an additional phase of skill training may be necessary.  If so, skill-training interventions are utilized concurrent with or following the third phase” (Sperry, 2004, page 156).  Conceptualization however does not predict the course of therapy or of the idiosyncratic responses of clients despite accurate diagnoses.  The five phases mentioned may not occur in sequence or progressively as hypothesized.  At any given time in therapy, one or more phases and underlying goals may become the prominent thrust of therapy.  The formulation of the working therapeutic alliance is more than a first phase of therapy for example.  The inability to form healthy relationships is at the core of the histrionic personality disorder (and other personality disorders).  However, the therapeutic prescription for growth and change directs the therapist to essentially do what has been difficult or impossible for the individual.  The methodology is the solution to the problem, yet the problem is the inaccessibility of the methodology.  Rapport and the holding container of therapy nevertheless, can be created gradually with addressing throughout the therapy (rather than just as an initial phase), fundamental assumptions in individual psyche and in the relationship.

“Initially, the couple believe that the histrionic partner is insane, because of this person’s extreme behavior and emotionality in the apparent absence of any adequate reasons.  The therapist’s treatment of the histrionic partner as an individual whose behavior has rational antecedents, who is responsible for her behavior, and who is sane has a multiple impact” (Sperry and Maniacci, 1998, page 195).  The therapist should interact with the couple from the foundation of validating that all behavior (including “craziness”) has logical origins.  In fact, he or she asserts their behavior is complementary as joint collaborative participants.  This strategy challenges the excuse for the non-histrionic to declare “victory” as the sane one and then abandon the histrionic partner.  The histrionic individual although appearing flippant and readily able to find a new partner, is in fear of being abandoned.  At the same time, positing rational and developmental motivations for behavior, take away the histrionic individual’s excuse for being irresponsible.  When the logic of behavior is uncovered, the logic for growth and change is also revealed.  The behavior or personality is exposed as derivative of identifiable forces and therefore, subject to be changed with identifiable other forces or redirection of prior energy.  The partners are accountable for confronting behavior as well with this revelatory stance.

“Similarly, each partner believes that he or she alone is completely at fault for the relationship problems.  This phenomenon, most easily observed in the histrionic partner, accounts for vacillations, in each of the couple, between rage at the partner and severe self-condemnation.  A consistent stance on the part of the therapist, in which he or she repeatedly insists, demonstrates, and acts in accord with the view that each partner is contributing to the marital difficulties, provides each with a more livable, realistic general view and, in the bargain, a better basis for responsible self-scrutiny and action” (Sperry and Maniacci, 1998, page 195-96).  If and when the partners accept this affirming rather than critical frame established by the therapist, there can be significant reduction of emotional reactivity and outrageous behavior.  This enables the partners to see the couple and the relationship more calmly and insightfully.

As the therapeutic rapport and trust with the therapist develops, the couple is less prone to functioning in a continual crisis mode.  Both partners may have more confidence that even when relationship crisis erupts that the therapy will be able to help them calm the disruption.  Moreover therapy will also to help them make sense of it… of themselves.  Therapy can then also work on creating or reestablishing balance in the relationship.  “Rebalancing is typically needed in the areas of boundaries, power, and intimacy (Doherty, Colangelo, Green, & Hoffman, 1985) and represents the main systemic focus of change in couple therapy with histrionic-obsessive partners.  Structural family techniques (Minuchin, 1974) as well as strategic family therapy methods and techniques (Haley, 1976) have been quite effective in accomplishing this rebalancing of boundaries and power.  Issues of rebalancing the relationship of intimacy can be effectively addressed with communication (Satir, 1983) or family-of-origin (Framo, 1992) approaches” (Sperry and Maniacci, 1998, page 196).  As previously noted, straightforward systemic approaches alone may not be effective with individual dynamics that forestall or sabotage such work.  The therapist would need to carefully evaluate the ability of the partners to integrate systemic interventions versus the histrionic, obsessive-compulsive, or other dynamics and mechanisms that may be triggered by such interventions.  Therapy may need to shift back and forth between systemic work and individual work to constantly rebalance boundary, power, and intimacy interactions.

The recommendation by Hanson (2012) for the partner and the relationship is instructive for the therapist and therapy.  “For the partner, the most helpful approach to living well with a histrionic person is to offer maximal emotional support while maintaining strong personal boundaries.  By adopting a loving, but objective stance, while holding the histrionic accountable for his/her behaviors, the partner gives the histrionic person the best chance of learning to trust in a relationship- not out of successful performance, but because of mutual participation and acceptance.  It is also important to sensitively encourage behaviors that are mature, responsible, and based in reality if the histrionic is to emerge from his or her position of childlike powerlessness.  Remaining loving and flexible, while tactfully confronting destructive behaviors in the relationship, can help the histrionic gain a realistic understanding of his or her impact on the relationship” (Hanson, 2012).  The therapist should offer strong emotional support, objectivity, while maintaining strong boundaries, holding the histrionic individual and the partner accountable for choices and actions, and encouraging positive behavior.  This essentially describes healthy parenting that the histrionic individual is hypothesized to have missed.  Realistic feedback is threatening as reality has become threatening.  The fantasy world of histrionic personality disorder is a retreat from the real world as the individual has suffered it.  The challenge of being the histrionic individual’s partner or therapist is that the histrionic individual is highly reactive to reality.  It is threatening and often triggers compulsive and dysfunctional reactions.  The therapist needs to not merely give wise and sensitive feedback, foster insight, offer suggestions, and attempt interventions, but also be prepared to deal with the individual’s histrionic instincts and reactions.  The therapist in couple therapy must model for and prepare the partner to do the same away from therapy.  Gaining the acceptance by the histrionic individual of this need, and giving permission for the partner to give feedback and assert boundaries must also be a major goal of couple therapy.

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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