Intro: Communication Oriented Therapy - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Mirror Mirror… Reflections of Self-Esteem in Relationships and Therapy
INTRODUCTION: COMMUNICATIONS ORIENTED THERAPY
by Ronald Mah





**Author's Note: Other than public figures or people identified in the media, all other persons in this book are either composites of individuals the author has worked with and/or have been given different names and had their personal identifying information altered to protect and respect their confidentiality.  

"We have trouble communicating," says Terry looking over at Bert who nods in begrudging confirmation.  Thus, begins the conversation of individual, couple, or family therapy.  It could be something deeply personal within the family, but could also be a consultation about a relationship at school, work, or in the community such as in church or youth sports league.  The relationship problem could be between the individual and a schoolmate, a work colleague, supervisor or supervisee, fellow parishioner, teammate, or other volunteer.  The individual, one or both partners, or one or more family members present this self-assessment to the therapist and set the goal, "I (or We) need help communicating better."  Somehow how they see themselves and how they see one another does not reflect the images they desire.  They implicitly request the accompanying strategy to heal or create intimate and/or more productive relationships.  Therapist activity to help the individual, couple, or family communicate better is expected to create a healthy partnership or relationship.  A relationship suffers if what is put out to another is not reflected back in kind or in affirmative esteem and relationship building manners.  One's partner, prospective partner, or family member fails to be the desired mirror and give back the validation desired.  Terry says that Bert seems intent on interpreting what she does and say in a negative way.  For his part, Bert can cite chapter and verse of Terry's previous words and actions that have been dismissive or demeaning.  There are distortions in the mirror mirror.  Yet both readily affirm that the other is a good person and tries very hard to be a good parent.  They both claim that they got together with the best intentions and it just did not work out.  It was a mutual decision to divorce because it became clear to them that staying together was in no one's best interests- especially the children who would end up witnessing unhappy and resentful parents.  They are both in committed new long-term relationships.  There is no regret about their failed marital relationship.  However, it is the co-parenting relationship that gets messed up they believe with their communication.  It has to improve so they can co-parent effectively with the children they both cherish.

The client's assessment and recommended strategy appear to be confirmed by research.  "…the influence of communication on the quality of marriage and marital satisfaction has been extensively investigated.   Research findings (Glick & Gross, 1975; Satir, 1964) emphasize the positive relationship between communication and good marital relationship.  Evidence (Haynes, Chavez, & Samuel, 1984) also suggests an association between communication deficits and marital distress" (Pollack, et al., 1989, page 620).  Happily married spouses communicate enjoyable discourse more often and in various manners.  They make higher quality caring gestures specific to spouses.  "These findings suggest that therapists who help distressed couples restore intimacy, attend to marital positivity, engage in higher quality caring gestures, and establish relationship-enhancing and positive partner-focused cognitions are likely to be the most efficacious" (Langhinrichsen-Rohling, 1998, page 208).  Distressed husbands who have aggressive behaviors towards wives do not use playful communication such as silly voices, baby talk, and special communication as often as distressed but non-aggressive spouses.  "One result of marital aggression could be less silly, childlike and trusting behavior between spouses.  This type of communication may be a marker of intimacy.  Alternatively, it may be that the lack of this type of relationship communication is one of the risk factors for the occurrence of H-to-W (Husband to Wife) violence" (Langhinrichsen-Rohling, 1998, page 209).  Playful communication is either an indicator or an outcome or poor relationship quality.  The invitation to play is not mirrored and the enriching reciprocal cycle of reflected affection and interest is broken or never well established.  

Poor communication skills in general may be reciprocally instrumental in emotional disorders and relationship problems.  "Depressed individuals tend to express less functional conflict communication (e.g., Christensen & Shenk, 1991; Heavy, Christensen, & Malamuth, 1995) and show less problem-solving behavior and more negative and disruptive communication (e.g., Christian, O'Leary, & Vivian, 1994; Jacobson, Dobson, Fruzetti, Schmaling, & Salusky, 1991).  Numerous studies with a large variety of perspectives on communication have further demonstrated that maritally distressed couples can be differentiated from nondistressed couples by their communication style (e.g., Heavy, Larson, Zumtobel, & Christensen, 1996).  This is particularly true for communication during conflict, with abundant evidence that interactions such as demand/withdrawal (a pattern in which one spouse avoids discussion while the other nags or complains) and mutual avoidance are associated with concurrent marital dissatisfaction (e.g., Caughlin & Huston, 2002; Heavy et al., 1996)" (Heene et al., 2005, page 414).  

Individual therapy often includes helping the individual express him or herself in therapy, but critically to the important people in his or her life.  Couple or family therapy normally includes working with the partners or family members on communication and problem solving.  This presumes that relationship problems are significantly due to difficulty resolving differences.  Over the course of a relationship, there is potential for issues to arise and intensify.  Terry and Bert's early idyllic relationship did not stand up well to the challenges of a mature relationship over time and children.  Cramer (2003, page 86) reported a "cross-sectional study in which the duration of romantic relationships was positively related to the frequency of differences of opinion over minor issues and the frequency of negative experiences in trying to resolve these differences."  Observations of couples and as reported by couples both identify conflict resolution skills as indicative of positive relationships.  The ability to negotiate differences is a fundamental relationship skill between one person and another- a person, his or her community or environment. "Development of the ability to negotiate is essential both to survival and to the enhancement of the quality of life" (Pizer and Pizer, 2006, page 76).

Virginia Satir's early work while at Mental Research Institute was considered to be a communication model. She emphasized "people interacting with each other in a 'straight' manner" (Banmen, 2002, page 17).  Satir felt that people survive depending on communication of any form: verbal or non-verbal, conscious or unconscious.  Clear, free-flowing communication is critical for conveying essential information among people.  "Many obstacles may prevent this: words and expressions have multiple denotations and connotations, individuals have different rules of generalization, abstraction, and deduction, one or both parties may lack the skills needed for asking for or giving the clarifications necessary for the avoidance of misunderstandings" (Moore and Kramer, 1999, page 429-30).  Communication is complicated because of differences between verbal and non-verbal communication.  Contradictory messages cause challenges for the recipient of communication.  An appropriate response to one part of a communication may be inappropriate for different co-existing but contradictory message also embedded in the communication.  "This especially harms children who have no skills (or habits, or motivation) to ask for clarification when they encounter double messages" (Moore and Kramer, 1999, page 429-30).  The harm often continues into adulthood especially in relationships when one or another person become confused about the intent of the one expressing him or herself.

"Virginia Satir's process of change is a way to assist people in making choices that raise self-esteem, provide self-accountability or responsibility, and move a person toward being more congruent with self and others… Transformation within the change process, using the Satir model, is based on connecting people at the level of their yearnings, expectations, perceptions, and feelings (Satir, Banmen, Gerber, & Gamori, 1991).  The result of that connection is seen in a person's ability to share, value, and accept themselves in making conscious, congruent choices.  As we become more consciously congruent, we grow more whole, we are open to new discoveries, and we want to understand more.  We seek out new opportunities to test what we do know, versus the judgment or misdirected advice of others.  The search for the resources that people possess within themselves, as opposed to focusing on what 'should or could have been' brings us to the place of 'transformation.'  The goal is not to eliminate what no longer works, but to add to what already exists to 'transform' the meaning and understanding of the entire event (Satir et al., 1991).  The transformational change process is about having more, not because someone gave it to you, but because you uncovered the resource within you that is already sufficient.  The goal is to change and transform the behavior, not to eliminate it.  When we attempt to eradicate something in our lives, the physical and emotional cost is often very high, frequently resulting in people returning to a prior level of coping.  Looking at change through this transformational lens, we can help people in the process of discovery, awareness building, and understanding, transforming their survival stances into more congruent ways of speaking their truth at that moment in time (Satir et al., 1991" (Sayles, 2002, page 94).

Transformation requires that it be experienced, felt, integrated, and practiced within the individual, couple, or family.  As the individual is able to integrate new parts, it mitigates potential conflict in experiencing and developing his or her relationship with the new self that has self-esteem.  The therapist takes a critical role in integration to consolidate important changes in perceptions, feelings, beliefs, and behaviors.  New ways of feeling and experiencing oneself that were once odd and uncomfortable become progressively more comfortable and familiar.  The therapist tries to get the individual, couple, or family to make choices in life without making choices for them.  By supporting the individual and his or her choice, the therapist helps him or her stay in control.  This therapeutic approach "keeps them in charge of their lives and acknowledges the trust and willingness of the person to take risks, bringing us back once again to anchor the transformation that happened" (Sayles, 2002, page 107).  The individual, couple, or family take experiences in the change process and practice them as homework.  It is important to integrate behavior and is critical to change.  When the individual or the partners or family members collectively examine what they have experienced in therapy about change, they consider new possibilities.  "This practice increases self-esteem and value as they take away and use this new way of relating to themselves and to each other (Sayles, 2002, page 108).  The therapist continually facilitates transformation by which the individual, couple, or family experiences at deep levels the possibility that they can control what is felt, believed, and experienced.  Within the individual are older held memories that bring him or her to experience pain that can be felt again, and then adapted and currently re-integrated.  The resultant individual, couple, or family have belief in self, raising self-esteem, and gain the knowledge that change is viable, as it has occurred.  "Transformational change happens as people embrace the pain of the past in the present and feel the difference in the core of their being.  The process of transformation begins with a person, full of possibility, taking the risk 'to be more fully human'" (Sayles, 2002, page 109).

Satir's model has some fundamental beliefs that may be shared by various theories and by the therapist:

1. There is a strong belief that change is always possible, even if change can only take place inside of the person. These changes might include feelings, perceptions, and expectations.

2. Therapy sessions need to be experiential in order to bring about second level change. This involves a change in being, not only in doing or feeling.

3. The problem is not the problem; coping is the problem. Therefore, therapy focuses on improving one's coping instead of just solving one's problems.

4. Feelings belong to us and, therefore, we can learn to change them, manage them, and enjoy them.

5. Therapy sets positively directional goals and resolves the impact of negative experiences.

6. Therapy is systemic, both intrapsychically and interactively.

7. People have the resources they need to cope and grow. Therapy is one vehicle to harness these resources to help people change.

8. Most people choose familiarity over the discomfort or fear of change, especially during times of stress (Banmen, 2002, page 8).

When the therapist holds and conducts therapy from these beliefs, implicit and explicit affirmative messages come forth naturally to individuals in relationships. Confidence that change is possible comes through the therapist in numerous ways verbally and non-verbally- intentionally and unintentionally. Therapist confidence that the individual, couple, or family are capable, resourceful, and powerful is also communicated.  The mindset of the therapist focuses on change in being rather than doing, clear goals, and on coping with problems, rather than the problems themselves.  This gives further messages that therapy is purposeful.  As with confidence in almost any theoretical orientation, the self-assured yet sensitive therapist communicates to the client a purposeful therapeutic container and process of therapy.  

The Satir model focuses on three major areas for therapeutic intervention: the intrapsychic, the interactive, and the family-of-origin.  Therapy may begin with a simple question to gain some description of important events, "Well, tell me, what brings you here today?"  An individual may present his or her story of unhappiness and his or her hopes for therapy.  The Satir model may differ from other orientations and initial session process, since it wants the story only to provide basic context for therapy.  The therapist would then ask exploratory questions to reveal the internal- intrapsychic experience of the individual, his or her feelings, perceptions, expectations, and yearnings:

"How do you feel right now?"

"How did you feel when your spouse left?"

"How did you express or handle your feelings?"

"How do you see yourself now that your wife left?"

"How do you see your partner now that he or she left you?"

"What other feelings are you aware of?"

"What hopes and expectations did you have of your marriage?"

"What did you possibly contribute to make the break up take place?"

"What deeper longings are you aware of?"

An individual's answers begin to reveal his or her internal or intrapsychic experience.  The therapist should then set goals related to the individual's internal experiences.  The individual may want to feel better and more positive about him or herself and the relationship.  There may be unfulfilled expectations and yearnings that have caused reactive negative feelings lately.  There may be hope for self-forgiveness, self-love, and self-acceptance, including becoming able to appreciate accomplishments and a positive identity.  The individual, couple, and/or family need to commit to goals.  "Now, the therapist helps the client to change whatever is in the way of experiencing some harmony, some self-worth, and some sense of accepting and empowering himself.  He needs to resolve his disappointment, his possible guilt, his anger, hurt, and sadness.  The focus, initially, is to work on the intrapsychic area before focusing on the interactive area of his life.  Goals are positively directionally framed to provide the client with a focus for change" (Banmen, 2002, page 9-11).  

The second focus of the Satir model is the interactive domain.  Some theoretical models, particularly behaviorally oriented models may emphasize this area.  The focus may be on skills development without much attention to any historical or psychodynamic origins of behavior.  Therapy may be relatively atheoretical as it focuses on what to do without addressing why embedded behavior exists and why it may be resistant to change.  Communication classes may attempt to teach skills and behaviors deemed to be productive.  For example, based on the work of Miller (1971) and Nunnally (1972) the Couple Communication (CC) program was developed to facilitate couple enrichment through communication skills training.  "The CC is a standardized communication skills training program that uses brief didactic presentations, directed practice or role playing, and homework exercises. Concepts and skills presented include self-awareness, speaking skills, listening skills, conflict resolution skills, and understanding of styles of communication… The program is typically presented in weekly, 2- to 3-hr sessions over a 4-week period. Groups generally consist of 5-10 couples.  The structured format of the CC, with specific training manuals and certification of instructors, facilitates experimental control, manipulation, and replicability" (Butler and Wampler, 1999, page 224).  Relationship or couple therapy from various theoretical orientations often productively duplicates many aspects of couple communication programs.  

The therapist however may find that interactive work alone or without more nuanced conceptual foundations may prove ineffective with individuals with challenging characteristics and with difficult couples or families.  Teaching communication skills remains relevant but an additional focus on family-of-origin work may be highly beneficial.  While much research and examples derives from and targets couples and couple therapy, conceptualization, interventions, and strategies are often applicable to individual and family therapy as well.  The Satir approach emphasizes family-of-origin work as a major focus.  The family map or genogram can be used to explore issues, relationships and re-occurring themes in families, including as they apply to individual behavior.  From generation to generation, it helps reveal the rules of parents and grandparents to discover family patterns (e.g. occupations, illnesses, coping stances…) family values and beliefs, as well as family myths, secrets, and family themes.  Originally, used to help an individual client reconnect with his or her adult parents, it is often used to help resolve "the negative impact of one's internal experience in the family-of-origin and reclaiming the resources one has received from one's family-of-origin.  Family maps are very important in family reconstructions, one of Satir's most well known therapeutic vehicles for change.  Now, they are often used in individual and family therapy sessions, as well" (Banmen, 2002, page 13-14).  The family map can include the factual present and the perceptual past.  From considering the factual present, the therapist seeks to help the individual trace family rules and other values back into the perceptual past.  Family maps and other family-of-origin exploration are often very informative when emotional and behavioral reactivity fail to make sense in the current dynamics or relationship.  They can identify childhood issues that have yet to be processed successfully.  "If there is no specific event or context that is generating the negative impacts which the client is experiencing, we use a wide net to explore the impact of many areas.  For example, we might explore the impact on the client of the family member relationships, the adjectives of each family member, the survival stances of each family member under stress, any illnesses that family members had, any losses that the family had, any other significant events family members had, and so forth" (Banmen, 2002, page 17).

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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