5. Facilitating Self-Expression - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
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5. Facilitating Self-Expression

Therapist Resources > Therapy Books > DownRelRabbitHole- Assessment

Down the Relationship Rabbit Hole, Assessment and Strategy for Therapy

An individual, either partner, or family members may have problems expressing him or herself clearly.  Facilitating clear expression of feelings and thoughts can be very difficult.  A major root of dysfunctional relationships is the poor communication between any two or more people, the couple, or in the family.  There are four requirements for self-expression; an individual must be:

1) Introspective

2) Insightful

3) Connected to Own Feelings/Process

4) Articulate

To express oneself, an individual must be able to be introspective.  The ability to look into oneself and contemplate and savor ones experiences, feelings, thoughts, and perceptions may be unfamiliar and uncomfortable for some individuals.  Intense life experiences, especially trauma that demand high sensitivity and vigilance to moment-to-moment dangers may not have allowed for much introspection.  Note and react can become the survival habit of such an individual.  Introspection also may not have been fostered and even may have been discouraged.  One strain of American male adolescent culture glorifies and avoids introspection with the slogan, "Just do it."  When working with an impulsive client, the therapist may note to him or her that the assertions, "Whatever" or "Screw it!" or "F—k it!" are almost inevitably followed by a poor choice.  Each of these expressions asserts an avoidance of self-examination or further examination of the context and the consequences of potential actions.  Other family-of-origin or cultural models may further minimize introspection.  

If an individual is able to be introspective and contemplate his or her processes, he or she may begin to gain insight about his or her thinking, feelings, habits, aversions, needs, and so forth.  Insight also depends on developmental maturity and wisdom acquired from others.  Stressful or traumatic experiences however tend to blunt or stall intellectual, emotional, and psychological development.  In addition, family or cultural expectations or religious dogma may foster or hinder development of insight.  In some situations, fostering understanding and insight is considered essential to healthy development.  Explaining the rationale, logic, or process of decisions and behavior helps the individual learn principles to apply to new experiences and challenges.  This proves to be a functional and adaptive process for changing and evolving relationships and community demands.  However, in certain families, communities, and societies, the individual is directed to and focused instead on conforming to established behaviors.  The "right" or correct choice is the decision or behavior pre-determined by cultural edict, or whether it draws punishment or not from family or community members.  This orientation may be insightful only to the extent whether the choice or action does or does not comply with established standards or gets one into trouble.  This is intended to maintain and perpetuate consistency within the family, community, or society that is assumed to be in of itself to be consistent.  However, even minimal insight can become problematic if there are changes and new demands.  Joining together as a couple, in a job, or any group is an inherent change with new demands where the previous "right" or correct choices of the family-of-origin or culture may prove ineffective.  

Introspection hopefully leads to insight about and furthermore, to connection to ones feelings.  Since the relationship depends on sharing feelings and vulnerability, inability to understand and own ones feelings precludes a deeper intimacy.  An individual can also be extremely emotional to the extent that he or she gets flooded or overwhelmed.  The lack of insight may cause such an individual to be "over connected" to his or her feelings, and become highly reactive without the ability to judiciously channel emotional energy productively.  Insight about temperamental, trauma, and/or cultural contributions to emotional intensity can lead to adaptations for more productive expression of feelings.  Introspection, insight, and emotional self-connection may be expressed when and if the individual has acquired the means and skills for articulation.  The experience and practice of articulating feelings is supported or discouraged by the family, community, and/or society.  The effectiveness of communication training in therapy may not be from teaching skills, but be from the therapist providing articulation examples and models for the individual, partners, or family members.  An individual may be introspective, have insight, and be emotionally self-connected but have trouble articulating it verbally and/or non-verbally.  Communication nonverbally with facial expression and body language and behavior may not have been received or interpreted accurately by another person.  Verbal expression, which may not have been familiar or well practiced by some individuals, often becomes essential to convey intention and meaning of nonverbal communication.  Therapy becomes most beneficial by helping the individual, partners, or family members learn the verbal "language" of intimacy and relationships.  Or conversely for another individual, partners, or family members, by teaching the nonverbal "language" of intimacy and relationships.

Ineffective expressive communication may come from a variety of causes.  Family of origin work may be necessary to identify the origin of communication styles that are problematic in the individual, couple, or family.  Shifting to direct communication is often essential to help individuals become more introspective and insightful.  This usually requires understanding the origins of poor communication, defensive and offensive styles.  An individual, one or both partners, or several family members may have issues with direct and indirect communication styles or overt and covert communication.  Much of communications oriented couple therapy emphasizes direct communication.  For example, using "I" statements, expressing specifically what one feels or what one wants.  While the "what" to do may make a lot of sense, doing so may fundamentally challenge a person's communication habits.  Indirect communication is often the style of necessity and survival for oppressed or disempowered individuals or peoples.  It may be labeled as being respectful or being deferential, but in actuality reflect inherent power inequities.  Power inequities from the family of origin and/or cultural patterns may be replicated in the relationship making therapist direction to use direct communication extremely challenging in the couple or at work, for example.  This and any other underlying dynamic that affects communication or the ability to adjust communication will often need to be processed in the therapy.  The therapist may need to interpret, translate, or "speak for" an individual because he/she is otherwise unable to speak articulately from his/her feelings.  Some individuals may be able to intellectually or cognitively process (that is, argue!) communication or behavior, but have major difficulty with affective communication.  They often respond to an inquiry of what they feel by describing what they think.  The therapist may accentuate feelings by using provocative language- including perhaps profanity.  This is a therapist stylistic issue, but also a therapeutic strategy.  Amplifying the emotional message may also facilitate expression of the key vulnerabilities between the couple.  This may be particularly important if direct communication is unfamiliar for one or both partners.  As a result, communication especially with emotional content may be very tentative and easy to overlook.  Provocatively charged language as opposed to dry emotionally barren cognitive interpretation may strike to the core of the individual.  In fact, mild or even highly profane language may be more effective.  

"So, when he/she says that, it hurts.  Shutting down is a way to defend yourself and also to say, 'screw you, back!'  It must be scary to feel you're going to be abandoned."  Drawing words from George Carlin's monologue on the "Seven Words You Can Never Say on Television" (1972) may help articulate a more accurate portrayal of the intensity and depth of pain and injury suffered!  Instead of "screw you, back!" it may suffice to prompt a client with something more intellectual and analytical such as "I'm upset with how you treat me.  And I want to criticize you for being so hurtful… and for being an uncaring negative person.  I want you to feel the distress that I feel too because you deserve my negative evaluation."  Such verbalization may work very well for some individuals, while being too benign and insufficiently emotionally intense to convey the essence of their emotional experience.  In general, the individual who has difficulty being emotionally expressive may benefit from being prompted to use emotional language.  He or she may have retreated to intellectual or "rational" communication to avoid emotions.  This may be from personal or family experiences or from cultural training.  On the other hand, the individual who becomes emotionally flooded may benefit more from cognitive structuring of communication.  Each therapist has his or her own principles and practice around the use of profanity or other emotionally intense language and must find what works for him or her.  More importantly however, each therapist must find what works for the individual, couple, or family in therapy.  For some individuals, emotionally communicative language may be very familiar to highly unfamiliar.  Some will find such language comfortable and promoting of expression, while others may be off-put or sensationalized negatively.

As the therapist is continually assessing the communication of each individual, sometimes "speaking for" or a clinical interpretation becomes a cultural translation, "So, when you change the subject, it is your way... from your father's model, to save your wife from the emotional pain that she is experiencing?"  Or, the therapist may prompt for a cross-cultural explanation.  Depending on cultural or systemic diagnosis and knowledge, the therapist can specifically name or speculate about the emotions underlying the anger, other communication, or behavior.  The therapist does not have to know what the family dynamic or cultural dynamic may be, but know that a dynamic may affect their communication or behavior.  The therapist may inquire if a dynamic or if a cultural stereotype is relevant, that is has been internalized.  "Is it ok to express your anger from your family training?  Or, from your cultural training?  From your family or culture, how does a woman (or man) express her (his) anger?  Does your partner know that?"  In some couples, one or both partners may not be functioning from a family or cultural model, but in direct opposition to it.  The following couples case illustrates this.  

Leigh was adamant that she would and had to express her frustration and anger openly between the couple and in the family.  Her husband, Carter found her intensity unreasonable and uncomfortable.  It didn't make sense to him that she would be so confrontational and emotional for what he experienced as minor issues.  He would say, "Calm down.  Don't make such a big deal about it.  I don't see why you're so upset."  She readily admitted that sometimes she would get riled up about inconsequential matters.  However, Leigh said she needed to process such matters out loud.  Carter retorted she wasn't just doing it out loud, "She gets all worked up!"  Therapy took her to a deeper level when the therapist asked her if she had been silenced before.  She recounted cultural and family patterns that she experienced in childhood where her mother and all females in the family were silenced.  Their feelings and thoughts were considered irrelevant to her dominating father.  He would rage at them if they dared to speak up or have an opinion, especially an opinion that disagreed with his.  Asserting her voice and protecting the voices of her daughters was her defiance against her prior oppression.  Leigh then realized that her resistance to Carter's desire for her to "calm down" was from anxiety that he was attempting to silence her.  As is often the case in a couple, Carter had a negative complimentary background to match her anxiety.  In Carter's family, his mother's, father's, and older brother's emotionality would often morph into hostility and conflict.  Once someone passed some threshold of emotional intensity, all hell would break loose.  As the youngest child, he would watch helplessly, terrified as verbal and sometimes, physical abuse would ensue.  Instead of experiencing Leigh's venting as her personal emotional processing, he took it as the beginning of an eruption to be avoided.  Carter anticipated Leigh would go toxic and eventually, assault him as he had seen his family members do in his childhood.  This time he would do something about it.  Carter would not be silent and let Leigh get out of hand.  Unfortunately, his criticisms and attempted interventions inadvertently frustrated Leigh need to express and process.  When Leigh and Carter identified how each of their respective counter-cultural or counter-familial processes contributed to miscommunication between them, they were able to negotiate a clearer and more functional process.  Leigh would vent and voice her frustrations while letting Carter know that she was not going to get out of control.  Carter would remind himself that Leigh could vent without going ballistic or becoming abusive and activate self-soothing practices to manage his anxiety.  Leigh gave Carter permission to assert boundaries he needed for him to be reassured of her restraint and his safety.  The therapist should always remember that although therapy may start with simple instructions how to communicate more clearly, the couple will often be unable to follow through because of communication styles and habits that may have deeper therapeutic roots.  The therapist needs to be prepared to handle these obstructions to communication.

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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