Anxiety and Couples Escaping Intimacy Instead of Vulnerability

Anxiety and Couples: Escaping Intimacy Instead of Vulnerability David J. Van Dyke, Ph. D, LMFT CCPC Workshop January 29, 2016

Learning Objectives • Integration informs Couple Therapy • What is a systemic view of anxiety in couples relationships. • Self-of-therapist relationships used as a resource for dealing with escapes. • Practical clinical and personal skills.

Integration

Integration Questions • How do we think about pathology and healing? • How do we respond couples?

Three Key Domains • Biblical & Theological (1) and Systemic (2) understanding of: • • Personhood God Brokenness Healing • My personal faith and relationship with God ((3)

Double Bind and Sin Re-Integration How does systems theory fit onto my faith perspective? • Brokenness: Bateson’s Double Bind theory • Healing: View of Atonement • Reconciliation • Therapist use of self: Jesus as a Secondary Change agent • Bonhoeffer’s story of relationship as sacrament

How do we see and treat others? We are broken people. We do harm. We struggle. We hurt those closest to us. What do we deserve? Dietrich Bonhoeffer refused to judge his jailors. He knew that they were broken people in the midst of their own suffering. This freed him to respond differently (intentionally), instead of returning pain (reactivity) with pain (reactivity). Think about your spouse this way: I must learn to regard [insert spouses name] less in light of what they do or omit to do, and more in the light of what they suffer. – Dietrich Bonhoeffer

Couple Relationship • Imago Dei • Genesis 1: 26 – 27 • Trinitarian, relational view • Equality in Oneness & Uniqueness (St. Augustine) • Metaphor • Body • Big picture drives immediate concerns

Systemic Perspective

Bowen • Individuals struggle with biology that accentuates lower brain functioning and stimulates fight-or-flight anxiety. • Anxiety leads to the inability (reactivity) to separate the emotional (limbic) and rational domains (m. PFC) of the mind. • Anxiety and reactivity are developed/nurtured in and through all our past relationships. • We bind our anxiety by • • emotional fusion without autonomy, emotional cutoff, Pathologizing our spouse, and conflict through 3 rd parties rather than directly (triangulation). ”

Intimacy & Anxiety

A Definition of Intimacy is: • the recursive process of open self-confrontation and disclosure of core aspects of self in the presence of a partner. • A multisystemic process – intrapersonal and interpersonal – involving both the discloser’s relationship with the partner and his/her relationship with himself/herself. • Experienced as loving and validating (when partner response is acceptance and mutual). If trust is lacking in other (experience other as threat), then intimacy with self (self-soothing & differentiation is needed) • Self-validated intimacy is the foundation of long-term couple intimacy. • Sexual intimacy is the self-confrontation and expression of one’s eroticism • Use of sexuality as vehicle for disclosure to the other Schnarch, D. (1991)

ANXIETY: Couple’s Brains

John Cleese explains the brain to Mental Health Providers…

Quick Neurobiology • Interconnection between Neurons interconnection between people • Tripartite Brain • Brain Stem • Limbic System • Cortex/pre-frontal Cortex • We are wired for habit & change

Interconnections • Hebb’s Theorem: • Neurons that fire together…wire together • Couple Therapy can change the wiring • Our habits create and are created by neurons firing • Habits are ingrained in our relational, “neural grooves” • Therapist’s intentional relationship is key.

Tripartite Brain: Limbic System Amygdala * Biased toward fear/anxiety * Fast processing & imprecise * Emotional memories stored -no time stamp * Activates sympathetic nervous system & releases stress hormones.

Tripartite Brain: Medial Prefrontal Cortex (m. PFC) • Response flexibility • Self-regulation, self-control, judgment, thoughtfulness, selfawareness • Self-soothing • Social cognition, moral center • Calms amygdala

Wired for Repetition • You are what you do; learned from previous relationships. • Think about the tread on the Spanish Steps. • Ruts form in certain places due to repeat usage. • Brain is an “organ of adaptation” • Plasticity: ability to change • Our previous reactive becomes the balance • However, the brain is adaptive to new repetitions. • Unlearning is preventing the old patterns and pathways.

Hand Model of the Brain (Siegel & Hartell) Amygdala m. PFC connection

High and Low Arousal • Some stimuli are highly charged and lead to high arousal. These include emotions like anxiety and fear (and joy). • Other emotions are associated with low arousal (sadness and contentment)

Pursue/Avoidance

Outbursts

Flee

Blame

Pathologizing our Spouse

Clinical Message: UNLEARNING is as important as learning

Bowen: Relational Processing • When do you see reactivity? • How has it been helpful to the couple? • What may need to be unlearned? • Can unlearning happen in the family? • Anxiety and its effects on learning/unlearning • Reactivity based on the FOO and experienced responses • Unlearning involves physical & emotional relaxation, prevention of previous learned patterns, and new patterns. • Differentiation…slowing down the process…takes in new information.

SKILLS

Intimacy Skills Identify the hurts, threats, attachment injuries Slow process down … mindfulness Identify their relational dance Look for continued couple’s reactivity Provide a new meaning or story (displacement stories) Participate with partners, demonstrating tools to manage reactivity and make intentional responses (enactments) • Facilitate empathy, playfulness, and trust • Repetition, repetition… • • •

Systemic Skills • Help couple have a “meta”-view of cycle (insight into the dance) • View both partners as vulnerable and (inadvertently) cocreators of cycle (see vulnerability cycle) • Notice cycle and break pattern • Use of therapist relationship in modeling secure relational space • Also use of story • Individual mindfulness when feeling vulnerable & when reactive (also spiritual formation disciplines) • Clinician speaks from own vulnerability (with appropriate boundaries)

Vulnerability Cycle (Scheinkman & Fishbane, 2004)

Remember: Unlearning involves • • • Reinforce, strenghten, support, encourage, & repetition highlighting successes (until it almost becomes annoying)

SELF of the THERAPIST

INTIMACY (therapeutic alliance? ) IS… the ABILITY to INTENTIONALLY display one’s INNER LIFE in relationship with the OTHER. KEYS: * Sense of your self * Ability to soothe * Ability to be intentional * Vulnerability

Anxiety in the Clinician • What does it look like? • • • Distant Lecturing Othering Emotionally reactive Lacking hope • Ways of unlearning for us? • Own therapy…work through our issues • Supervision, peer consultation • Physiological response

Discussion: Self of Therapist Get in groups of 3 to 5 people. 1. When are you MOST hopeful in therapy? 2. What personal issues get in your way of BELIEVING in change for your couples? 3. What does your reactivity look like in session? When is it most present? 4. How does your anxiety/reactivity view you as a clinician? 5. What struggles do you have with couples?