Opening the Can of Worms, Complications in Couples and Couple Therapy The therapist must anticipate complications- anticipate uncovering a "can of worms," that confuse and overwhelm the partners and therapy. Issues arise or intrude that ignite intense emotional reactivity from beneath the psychic surface to make easy living difficult if not impossible. Often minor issues become major issues over time and/or with other contributing factors. The therapist is tasked to uncover how issues interact in complex, nuanced, and fluid ways to influence emotions, thinking, psychology, spirituality, and behavior. Therapy must adjust to discovering that the direction of lower emotional reactivity to reduce problematic behavior although appropriate is complex to activate. Therapy can direct clients how their emotional reactivity including as expressed in bipolar disorder, post-traumatic stress disorder, developmental trauma disorder, sexual trauma, self-medication, and personality disorders function as third partners in the couple that cause seemingly illogical behavioral changes.
PTSD not just in warzones but also in family experiences, developmental trauma disorder, and the Predator-Prey-Witness triangle (aka Combat PTSD Trinity) are examined in particular for how they complicate later relationships. Gottman's Four Horsemen of the Apocalypse along with other theories of psychodynamic, attachment, family systems, and family-of-origin help direct important psychoeducation, therapy, and the partners' change. The therapist is guided how to anticipate and use inevitable therapeutic failures as well as issues of chronicity, grief, loss, and self-medication due to high emotional reactivity to hone and adjust the conceptualization, strategy, and direction of therapy.
Opening the Can of Worms
Complications in Couples and Couple Therapy
by Ronald Mah
Table of Contents (links to chapters and sections)