5. Fixing - Interventionist - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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When old psychological patterns and emotional challenges are identified and examined, the therapist may find clients still unable to successfully activate knowledge and awareness to break negative behavior patterns.  Or, some clients may be unwilling to consider psychodynamic or family-of-origin influences and ask the therapist to take more active roles beyond judging, mirroring, or increasing awareness or providing knowledge.  Clients sometimes ask the therapist to fix what is "broken" in oneself or another person in the relationship.  Couple or family therapy may be seen as the relationship repair or "fix-it" shop for unhappy couples and families.  Sometimes, an individual deems him or herself broken.  More frequently in couples or family therapy, an individual will assert that a partner or other family member is broken.  Often, everyone shares consensus that the relationship- couple or family is broken.  Very often, it is relevant in therapy to uncover the expectations, covenants, and contracts that have been broken.   There are often three sets of issues covered in the individuals' expectations, covenants, and contracts: conscious issues, semi-conscious issues, and unconscious issues.  Conscious issues tend to be discussed in couples during courtship and are more likely to have been negotiated and compromises developed with relatively clear boundaries.  Examples of conscious issues would be where to live, what the household roles will be when babies are born, how many children to have, and the like.  Discussed in open negotiation, contracts and disagreements that cannot be fixed become potential deal-killers that break up the relationship.  Occasionally couples come to therapy over such issues.  Uncovering any potential deal-killers between Carson and Vee would be vital to the therapy and their relationship.  Or, an individual may be implicitly or explicitly complaining about these issues in his or her problematic intimate relationship.  For the couple, the therapist may act as mediators or facilitators to negotiate some compromise acceptable to both.  One partner wants to have children and the other does not.  One partner wants to raise the as yet unborn children in one religious faith versus another.  One partner doesn't want the other partner to travel so much or find his or her work was inherently problematic (for example, dangerous or morally unacceptable), while the other partner is dedicated to his or her career choice.  For the individual, the therapist may need to help him or her clarify personal expectation for the relationship, and subsequently how to express and negotiate for them.  The viability of the relationship would depend on how well differences may be worked out.  Family therapy often is a mixture of individual expectations- particularly, of the parent(s) and developmental influences adapting those expectations, as well as relative functionality.  In the family, there are not deal-killers ordinarily as children and parents do not get to opt out.  And children often do not have power or sufficient voice in early childhood leading to repressed upset and anger.  This unfortunately embeds distress dysfunctionally in the family system leading to a variety of problems, including adolescent outbursts.

Unfortunately, some individuals defer to their partners or family members' requirements or demands while holding secret hope to eventually convert them to accept their wishes later.  Or, they hold secret resentments for giving up their dreams or desires.  Sometimes, clients come for therapy because of conscious expectations that had supposedly already contracted for perpetuity, are being violated or re-negotiated.  The therapist often finds this type of negotiation difficult as underlying issues become evident in therapy.  Semi-conscious issues lurk below awareness until the individual, couple, or family stumble across them or they cause functioning to stumble.  Semi-conscious issues arise unexpectedly but become identifiable when the implicit expectation or contract held by the individual or one partner or family member is unknowingly violated by another.  A classic couples' example would be whether one partner calls when he or she is away on a trip.  There may be a semi-conscious rule or expectation of getting a call from the traveling partner that has been violated.  "Carson, you didn't call," or another indirect communication of "I missed you (you didn't call)," or an even more circumspect communication of Vee thinking "You must have been really busy (Is that your excuse for not calling me!?)."  Semi-conscious issues often are worked through in the early parts of the new relationship through straightforward negotiation and compromise.  Vee can be prompted to verbalize, "I need you to call me when you're gone," or "I like hearing from you when you're gone."  "I miss you when I hear from you."  The relationship expectations are confirmed when such comments prompt Carson's response, "OK, I'll call you from the airport when I'm about to board the plane."  And the implicit or explicit assertion of "Yes, you important to me."  The response effectively negotiates the issue and turns a semi-conscious expectation to a conscious contract.  

The therapist may find some individuals resisting or having difficulty agreeing to or following through on a contract.  Problems in negotiating semi-conscious requests or desires so that they become conscious expectations often come from even deeper hidden meanings within someone such as Carson or Vee.  Unconscious issues are un-discussed and un-resolved in conscious and semi-conscious communications and negotiations.  Deeper psychodynamic, family-of-origin, and cultural expectations are often symbolically expressed in conscious and semi-conscious conflicts.  Exclusively addressing the facts or the functional resolution may miss the symbolic unconscious concerns.  "I was tied up and couldn't call" or "I'll call if I have time" may be realistic reasons or conditions for actions and may be acceptable to some individuals.  However, the same communications may trigger symbolic angst for others.  The statements may imply to some individuals, "I'm not important enough compared to your other needs to call."  The violation is based on an unconscious need- "I need to be reassured or else I'll fall into despair."  And, based on a fundamental but unconscious rule- "If you love me, I'm supposed to be so important that you will always prioritize me at the top of your priority list!"  When a complaint or grievance involves some unconscious violated contract, no remedies to "fix" the problem will suffice.  Therapy often requires investigations of and for mystery meanings hidden in the psyche of individuals.  The therapist often must first operate as psychodynamic detectives to discover the underlying meaning of behavior, expectations, needs, or attachment trauma before beginning to address any contractual violations.  

Being an interventionist is an active therapist process that avoids negative aspects of the fixer or judge roles while taking advantage of other aspects of those roles.  When the therapist takes primarily a facilitating role, it may not be sufficient and may allow the individual, a couple, or a family to lead the therapy astray.  This can be problematic if the clients' dynamics are continually toxic and continually are replicated in therapy.  Emotional and relational damage for the individual, couple, or family may increase as a result of therapy rather than be reduced.  Fixing the individual, couple, or family places inappropriate responsibility on therapists.  However, the therapist must hold clients accountable for their negative choices.  The therapist often need to make judgments about personal and relationship dynamics as effective or ineffective and as appropriate or toxic in achieving individual, couple, or family goals.  Labeling certain behavior as problematic avoids judging individuals since it does not choose one person over another as being right or wrong (whether in or outside the session).  The behavior is inappropriate since the results of the behavior are unsuccessful to positive functioning.  Beyond assessing and labeling behavior, the therapist often needs to actively intervene against negative dynamics of the individual, between the couple, or among family members.

Bill and May, who are from Zimbabwe are enmeshed in a destructive dysfunctional cycle of injury, anger, rage, self-righteous vindictive attacks and counter-attacks.  The therapist wonders if there is a familiar cultural pattern to this for the Bill and May.  The therapist does not know whether it is a cultural pattern or possibly a family pattern for either of them.  Even if it turns out to be a familiar cultural pattern, it does not mean it is a healthy cultural pattern.  There are many American cultural patterns that are arguably highly dysfunctional.  The therapist should determine with Bill and May whether or not this pattern is a familiar and/or healthy pattern in their culture, and/or if it has come from their families-of-origin.  Regardless of its origins, the therapist must interrupt the cycle of anger and hurting.  The therapist should try to break the pattern any way he or she can!  Combining knowledge and experience of positive and negative dynamics with observations of the couple's interactions, the therapist can overtly block or interrupt dynamics that are likely to increase hurt and disengagement.  A direct challenge to functionality may be appropriate.  The relationship is not working for Bill and Mary regardless of how much one or both of them claim cultural determinism or cultural relativism.  "…all behavior has a purpose and is used to meet a goal.  As a result, the themes or dynamics of an individual's lifestyle are not considered to be 'good' or 'bad' but 'useful' or 'not useful.'  Thus, a client's use of behaviors that arise out of his or her particular lifestyle can make things in the relationship go smoothly or poorly" (Peluso and Macintosh, 2007, page 260-61).

Utility or functionality is the counter to determinism and relativism.  The therapist may not completely understand the dynamics, but can nevertheless recognize when they are not useful.  Intervention is needed.  If clients' attitudes, values, beliefs, and behavior work sufficiently for them, they would not be in therapy.  When individuals recognize life is not working and that certain patterns are not useful, then they can understand "Stop.  This isn't working."  By interrupting and challenging behaviors that clearly are ineffective, clients are compelled or can be challenged as to how and where the behaviors originated.  In this way, underlying cultural values and behaviors and/or family-of-origin models and experiences may be revealed.  Attempts to teach healthier communication dynamics will not be effective if they run up against unarticulated cultural or psychodynamic barriers.  Frustration from failed interactions will continually create greater misunderstanding and resentment.  Accusations against another may come from anger that originates from older deeper issues from before current circumstances or the now problematic relationship.  Misunderstanding may elicit retaliatory behavior against random people, intimate partners, or family members.  Unless, the therapist interrupts such processes they cycle repeatedly to greater harm.  The therapist can intervene by introducing alternative behaviors or communications, prompt alternative interpretations, and make connections to experiences and trauma from outside of current situations.  Scheinkman (2008) describes the couple's dynamic as a couple's dance.  "…the couple's presenting problem is usually embedded in a circular pattern that is maintained by the reciprocal actions and reactions of the two partners. Although reciprocity is a necessary ingredient for coexistence… reciprocal patterns become problematic when they escalate through recursive loops of negativity and misunderstandings.  These patterns eventually render the partners unable to listen, empathize, communicate, negotiate, and solve their problems; they are referred to here as the couple's 'dance.'"

Individuals, couples, and families attempt to use therapy to interrupt their negative dynamics or dance.  Ironically, despite this intention, they often compulsively replicate their dynamics in the therapy room.  The individual client may engage the therapist as the authoritarian parental figure, anticipate rejection, become emotionally enmeshed, and so forth.  The couple or family act out in the session as they do so at home.  When couple or family's relationship and process is highly dysfunctional, interfering with their process is almost automatically good therapy.  Interacting differently with the individual client other than he or she expects may also be good therapy.  Since what they have been doing is clearly unproductive, anything else that happens between clients (or with the therapist) may be productive.  Individuals, couples, and families come to therapy to have something different happen, so the therapist have implicit permission to interrupt and intervene.  Scheinkman sets four major goals on her first level of therapy that may be applicable to various types of therapy. The first three goals all serve to intervene in the couples' dysfunctional cyclical dynamics.

To track the couple's problematic interactions in order to ascertain their pattern.

To identify and challenge each partner's mode of participating in the dance.

To block their misguided attempted solutions and escalation and to encourage behaviors and meanings that lead them in a preferred direction.

To further establish the therapist as a bipartisan mediator. (page 201)

The fourth goal of establishing the therapist as a bipartisan mediator also serves intervention by placing the therapist into the couple's system (or the individual's intrapsychic system or the family system).  Prior to entering couples therapy for example, the couple bickered and battled without resolution over and over.  When the therapist is inserted into the system, then bicker, battle, process with therapist becomes the new couple's dynamic.  Bicker, battle, bicker, battle, bicker, battle, on and on is replaced with bicker, battle, process, bicker, battle, process, bicker, battle, process.  This creates the possibility that the therapeutic process may decrease the bickering and battling or eventually, curtail it.  "On level one, the pattern itself is deemed the villain to be defeated. It is named and externalized… so as to allow the couple to explore it with curiosity and enough distance"(page 201).  Stopping or minimizing the negative behaviors is the goal of some therapies, while being an early goal in other therapies.  The therapist adds to or changes the thought process or inserts awareness or insight in the individual or one or more partners or family member.  Worry, worry, doubt, snap, worry, worry, doubt, drink may be adapted to worry, worry, doubt, reframe, worry, process, change behavior.  Therapist input may intervene with compulsive or negative behaviors or choices for the individual, couple, or family.

ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
(510) 614-5641 or (510) 582-5788
fax: (510) 889-6553
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