4. The Fourth C- Communication - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
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4. The Fourth C- Communication

Therapist Resources > Therapy Books > Therapy Interruptus

Therapy Interruptus and Clinical Practice,
Building Client Investment from First Contact through the First Session
by Ronald Mah

• Although communication training can be useful, it is often the deep emotional injuries rather than communication skills at the root of couple's or family's problems.
• Therapist neutrality may need to be challenged or broken to address dysfunctional dynamics or risk giving permission for the dysfunction to continue.
• Communication is made up of expression and reception- effective communication occurs when what is expressed is received as it was intended.
• Therapist "translation" or interpretation may be necessary to clarify communication, including negative communication.
• Therapist recommended communication practice and rules are often cross-culturally challenging.

In various relationships including the couple, the communication may be very effective… effective in causing two or more persons to know and feel exactly how much each is despised and disrespected.  Anger, hurt, and feelings of betrayal and hatred can become embedded in a relationship.  Poor communication per se is not the issue causing relationship dysfunction.  The individual may be very effective in communicating anger or disgust towards others, may have trouble communicating needs, vulnerability, or assertive needs.  On the other hand, the two partners' excellent attacking communication skills allow for accurate expression of thoughts and feelings… sometimes, with extreme detail and articulation.  What is said and what is heard match up perfectly.  Therapy that focuses on improving communication skills would not be effective for improving this type of relationship dynamics.  Deep emotional injuries rather than communication skills are the root of the dysfunction.  Although, communications training may be a part of therapy, the direction of therapy needs to focus on healing.  Communications therapy alone often does not work.  If on the other hand, the therapist finds that the couple or family has only just started to hurt each other, the couple or family therapy can focus on teaching improved communication skills.  Or, if the individual has just encountered challenging situations where alternative communication styles are required, assertiveness training in the form of communication work may be effective.  Therapy working on communication skills for a couple or family without significant injuries will tend to be relatively easy and efficient.  Unfortunately, individuals, couples, and families tend to present for therapy only after there has been significant emotional injuries, often from years of poor communications.

The therapist should inform individuals and the couple or family that communications training or therapy usually does not work, especially by itself.  An individual may hope or believe that there is some magical way of saying something that will work through or transcend emotional, psychological, or cultural barriers against making connection.  The special or magical words however belie the dynamics that interfere with healthy relationships.  The couple or family often mistakenly identifies communication problems as the source of their unhappiness.  As clients usually assert the need to improve communication, or that it doesn't happen often enough, or it doesn't work well between them as a couple or within a family- or at work.  The client further tends to be simplistic about communication.  The client often seeks easy directions not unlike what is presented in self-help books and tapes, by media gurus, and so on.  The couple may have already tried such tools.  Communication guides can easily tell individuals to use "I" statements and not to start sentences with "you," not to give in to impulses, to cool down before bringing up conflicts, to avoid demeaning statements, to take a deep breath, not to go to sleep upset, to not sweat the small stuff… to coolly not go to deep sleep sweaty!  (What!?) Communication has not been or is it currently effective or productive for a healthy and fulfilling relationship between the partners or for functionality with others.  They usually know what they should stop doing and what they should do instead.  However, despite knowing this for years, they have been unable to do what they need.  They know that their communication is dysfunctional, but may not know why it is dysfunction; where it was learned and for what purpose; and most critically why they persist with it despite its destructive negativity.  The therapist who tries to teach and the client who tries to learn the how to's of healthy communication is often continually frustrated at how successfully and persistently others and oneself will sabotage the teachings.  It ain't about what to do; it's about why ya'll don't do it!  

Communication oriented therapy that goes deeper into the couple or family's dysfunction may require the therapist to directly challenge the assumption of therapeutic neutrality being essential to couple or family therapy.  This may also be relevant in working with an individual who references his or her partner, current family members, or family-of-origin members.  It is easier for the therapist to align with an individual client with respect to a partner or another current or past family member who is not a participant in the therapy.  The therapist needs not to worry about angering, offending, or igniting defensiveness a family member not present.  Even in this situation, criticism of a parent for example who was a problematic attachment or caregiver figure may cause the individual to become defensive- not protecting oneself, but ones sense of the family and the "good parent."  Nevertheless, alignment with the individual in session is often a highly beneficial therapeutic strategy.  Moreover, the therapist may find alignment with one or another member important to couple or family therapy as well.  Neutrality should be a strategy option rather than therapeutic dogma.  "Neutrality… as the basic therapeutic stance of being on everyone's and no one's side in the family at the same time … Therapist neutrality toward the family allows the therapist freedom to work without defensiveness, scapegoating, or resistance by family members, because the therapist is not being perceived as taking sides … Neutrality… also has been described as a state of curiosity about many perspectives of the family's problem which allows exploration and invention of alternative views.  When the therapist violates neutrality more than momentarily by an overemphasis on one family member or one solution, the therapist is believed to lose some family member's open communication.  Therapeutically open communication leads to a more systemic understanding and change… the therapist becomes non-neutral for a moment to deliver an intervention.  Non-neutrality exists because the therapist sides with someone when a suggestion occurs, then others may feel sided against.  Intervention in this framework is the process of focusing on one part of the system because multiple foci at one time perhaps cannot occur.  Attempting change via focusing may leave certain members of the system feeling excluded, blamed, or upset" (Scheel & Conoley 1998, page 223)

Violating neutrality is believed to cause one partner to feel sided against or uncomfortable.  A partner or family member may become defensive and frustrate the therapeutic process.  Circular questioning avoids violating neutrality, while more direct interpretations or questioning interventions may make clients feel the therapist is taking sides against them.  "Interventive questions tend to violate neutrality because intervention is inherently non-neutral… Questions seen as more interventive are: (a) future-oriented, (b) hypothetical, and (c) hypothesis- revealing... Questions seen as more neutral by asking for descriptions of present realities are: (a) problem definition questions, (b) questions asking for comparisons between family members or issues, (c) questions asking for family member classifications, and (d) questions asking about agreement…" (page 225).  The assumption is that the therapist who loses neutrality will cause one or another member to feel uncomfortable and become more likely to terminate therapy.  Scheel & Conoley feel clinicians should consider whether they are balancing the introduction of interventions with the gathering of meanings through description from all members of a family. If family members' existing realities are too divergent, there may be resistance or too much anxiety.  They feel too much intervention may make families feel overwhelmed and misunderstood.

On the other hand, therapy may be seen as ineffective if the therapist seeks only information and offers no interventions.  Questions that imply side-taking should be balanced between the couple for neutrality and interventions.  A person who is not seen as part of the problem find interventive questions as blaming unless there were not first descriptive questions (page 233).  An alternative perspective is that the overly careful therapist who is unwilling to risk losing neutrality may be drawn into a couple or family dynamic of holding secrets.  Holding secrets can mean avoiding confronting dysfunctional and harmful behaviors within as system, that is, within oneself, or a couple or a family.  Partner or family member discomfort or displeasure may be the process of control and avoidance that perpetuates the problematic relationships.  Confrontation is an intervention that mirrors the characteristics and dynamics in the partners and the relationship.  As many people, do not like what they see in the mirror, the therapist may withhold the therapeutic mirror.  This can end up with colluding with significant dysfunction.  Silence gives permission in therapy and relationships.  Neutrality may also give permission to the individual, couple, and family.  The therapist should consider if a role of honest mirroring, feedback, interpretation, or confrontation is necessary to the therapeutic process, even if it risks breaking therapist neutrality.  While an individual, one or more family members may have anxiety about being judged or criticized (being accepted or rejected) by the therapist, the therapist needs to take care not to be manipulated because of his or her anxiety about being judged or criticized or rejected by a client.  If the therapist has such anxiety, he or she should do personal work and professional consultation to process it so as not to let the counter-transference interfere with therapy.  The therapist may find that his or her anxiety is indicative of being drawn into the couple's emotional system, and consider introducing it in the therapy.

"I'm finding myself worried about saying something that one of you may experience as taking sides… and getting into trouble for it.  Is that something that happens between you or from your families?"  

The therapist may find that the client can tolerate the therapist giving pointed feedback, or this may be a step towards setting up a therapeutic contract that allows for confrontation.  After setting neutrality aside to make a confrontational comment or interpretation, the therapist can ask,

"Did that feel like I was on your partner's side (or against you? or criticizing your father?)  Do you feel attacked?"

Asking such questions keeps the therapist from continuing the therapy while holding his or her anxiety secret- his or her counter-transference.  If the client or one member answers affirmatively to either or both questions, then therapy can explore how the individual or each person behaviorally respond to his or her feelings.  A therapeutic path has been opened for exploration.  It is not unusual for a couple to come to therapy with one partner already under the gun… facing an implicit or explicit threat not to confront or aggravate the other partner or else couple therapy would be terminated.  The therapist may be sensing this controlling dynamic between the couple through his or her own anxiety or counter-transference.  Bringing the therapist's feelings or concerns may be an effective way to bring the couple's dynamic to the surface for therapy to examine.  Therapist neutrality may be intended to communicate acceptance and non-judgmental regard, but may also create therapist passivity and lost therapeutic opportunities.  Neutrality is an important principle to consider in couple and family therapy, but should not be a requirement.  Perhaps, the art of therapy is how to express disagreement with, confront, challenge, or criticize a client or a member in a couple or family… or the couple or family as a unit, and have the therapeutic communication be received positively.

All communication has two components: expression and reception.  Communication that is well constructed accurately expresses the condition, intent, and meaning of the communicator.  However, the recipient of the communication has the final say in whether it is good or effective communication.  If the target experiences the communication with the original condition, intent, and meaning that the communicator intended, then it is good communication.  If the expresser of communication wishes to convey caring and interest, the quality of the communication depends on whether the recipient experiences the expresser's caring and interest.  If the expression is of anger and impatience and the reception is of anger and impatience, it is effective true communication.  However, if the intent of the communication is of curiosity but the recipient interprets it as demeaning sarcasm, then it is poor communication.  Poor communication is thus not about whether the recipient experiences negativity from the communicator, but whether what he or she experiences has been received as intended.  In this interpretation, an insulting remark that is received as a playful joke is poor communication, since that is not what the expresser wanted the recipient to experience.  The intention of many communications oriented therapies may be to minimize negative hurtful communication and teach positive validating communication.  An alternate strategy would be to aid partners in a couple to express clearly so partners receive communications with essentially the condition, intent, and meaning of the communicator.  For example, that could mean "translating" or exposing a non-verbal behavior such as rolling one's eyes as a message of distain.

The therapist can provoke a more honest communication through observation and a question to the eye roller.  "You just rolled your eyes.  What does that mean?"  Or, intervention can be directed to the recipient of the eye roll.  "She just rolled her eyes.  What does that mean to you?"  Or, the therapist can go directly to a challenge.  "Rolling your eyes is a message of distain or disgust.  What bothers you so much about what she said?"  Or, "He rolled his eyes.  How do you feel when he does that?"  Identifying the non-verbal communication and putting it overtly on the therapeutic table clarifies processes and prompts for more ownership of behaviors, reveals intention and harm, and eventually, can teach healthier ways to communicate.  In addition, verbal communication often has implicit meanings or symbolism that control the relationship despite not being identified and owned.  When someone asks, "What are you doing?" for example, it may not be an inquiry to current activity.  It may be translated to being an invitation for socializing or about attachment needs.  Mismatched indirect communication styles from families-of-origin and/or cultural training can corrupt effective connection.  Therapy may need to focus on why or how it was learned or modeled for each partner that he or she expresses in a characteristic manner.  "Translation" in therapy may simply be about developing and clarifying a shared communication style.  Open and direct communication normally is encouraged in couple therapy.  However, there may be significant emotional charge to a partner's communication style that inhibits open and direct communication.  Indirect communication is the communication style of disempowered, abused, or oppressed individuals in a couple, family, or in a society.  Individuals may resort to passive-aggressive behavior, such as rolling ones eyes to indirectly communicate disagreement or disobedience because overtly aggressive behavior is too dangerously confrontational to risk.  Couple therapy may need to investigate each partner's communication styles for permissions and inhibitions to open and direct communication.

Communication oriented therapies often presume the desirability of open and direct communication that is also emotionally connective.  Effective and positive communication promotes self-esteem, with self-esteem considered the foundation of functional behavior and relationships. This premise may not be true in many families-of-origin or in certain cultures.  Effective communication can be defined instead as to whether or not it creates desired behavior.  Americanized and humanistic orientations for communication couple therapy may run counter to cultural permissions and family-of-origin inhibitions regarding communication of one or both of the couple.  The therapist should assess if the couple can tolerate open and direct communication training.  He or she may need to consider alternative approaches.  The therapist may prompt the husband to tell his wife how her withholding sex causes him to lose his sense of worth.  If the husband follows through on this prompt, he could be betraying a basic rule from his male culture that he should never expose himself emotionally.  That would cause him to be vulnerable.  A psychoeducational approach could be more appropriate.  The therapist can teach about the cultural meaning of sex for men of his background.  Rather than having him admit something that is shameful, educating both of them of the meaning and symbolisms of sex may be effective.  The therapist may define how sex subtly communicates the husband's vulnerability to her, and how sex is his non-verbal expression of love to her.

The therapist may prompt the wife to tell her husband that the responsibilities of managing the household and of taking care of the children are overwhelming to her.  If she follows through, she could be violating her culturally sanctioned role as a mother and a wife.  This had been defined from her family-of-origin and social values that as a woman, she exists primarily to meet others' needs.  To follow through on the prompt, she would have to assert her right to exist as an individual, rather than her existing primarily as a mother or a wife.  This may be completely against her cultural training.  If the therapist ascribes to a more egalitarian cultural division of family responsibilities and roles for a wife, he or she may try to convert both of them to this view.  This may antagonize them both.  On the other hand, the therapist can prompt a role for the husband that is acceptable to both of the- the husband as a "provider."  Being a provider is compatible with how he self-defines as a man and as a husband.  The therapist can then prompt the wife to ask him to "provide" the means by which she can successfully manage her role.  This allows her desired shift in responsibilities and roles to be ego syntonic for him.  Rather then attacking his cultural framework, this acknowledges his cultural foundation as how to be a man and a husband, and "merely" extends or stretches the techniques or strategies to fulfill that role.  This suggestion is not to imply that a woman should not be more overt in her communication.  Such direct communication, however, may be too difficult or too much a stretch for her to execute, or for her partner or the couple to tolerate at this time.  The therapist should be careful not to suggest to her that she must seek to manipulate her husband.  These two examples illustrate how communications training often have an implicit cultural foundation that may not fit an individual, a couple's or either of the partner's perspectives.  Open emotionally connective communication may be productive if participants mutually hold a value of open emotionally connective communication.  However, if one or the other does not hold that value, the therapist's instructions may create more rather than reduce conflict.  It can cause the person who holds the value to feel confirmed while causing the other person to feel ganged up upon… that the therapist has betrayed him or her by joining the other against him or her.  The therapist needs to be aware that although communication work is usually relevant in therapy, why and how it is incorporated will depend on the therapist's accurate assessment of the communication styles and origins of the particular individuals, couples, or families.

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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