Cultural Evolution and Cultural Lag

 

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This is a continuation from my previous post of 2/24/06. I am continuing to discuss unusual ideas incorporated into my model for the psychotherapy treatment of repetitive self-destructive or self-defeating behavior, which I called Unified Therapy in my first book for therapists back in 1988. I mentioned that something called cultural lag is very important.

But first, a little back story.

When I was a resident psychiatrist in the mid-1970’s, psychotherapy by M.D.'s was dominated by psychoanalysts. Behavior therapy was talked about, and cognitive therapy was just beginning to take hold. Many of the ideas of the analysts, such as intrapsychic conflict and defense mechanisms seemed to me quite valid. 

Of course, schools of thought in psychology aren't single theories, but collections of related theories. And even within psychoanalysis, there were a whole bunch of very different models for treatment -  and not just the three famous ones from Freud, Jung, and Adler. All the different theories behind the models were often in some aspects contradictory to the some of the other ideas in the various schools. As I found out later, there were scores of other, different psychotherapy models for treating the very same conditions!

Now of course there can be several different ways to skin the proverbial cat, but this seemed rather unscientific.

My training supervisors were almost all analysts. When I asked questions about the above, my supervisor pressured me to get psychoanalysis myself to find out why I was "resistant" to the ideas (All members of the psychoanalytic institutes received therapy themselves, supposedly so their own hang-ups would not get in the way if them helping their patients). When I asked if I should see a Freudian or a Jungian, I was told, literally, “It doesn’t matter.” What?? If a theory were valid and contradicted another one, it certainly should matter. That was bizarre. 

I was probably naïve, but that sounded very unscientific to my  mind. That turned me off to becoming a therapist myself, and for a while I decided I would just do biological psychiatry and only treat the psychiatric syndromes that were amenable to medication.

Fortunately for me, my curiosity got the better of me and I started getting interested in doing therapy again when a friend of mine lent me a book called The Structure of Scientific Revolutions by Thomas Kuhn. Kuhn said that any young science is replete with conflicting models, but gradually one gained ascendancy as more and more data came in. This was more problematic in psychology than in most other fields, because experimenters can’t read minds, and folks lie a lot.

In my own narcissistic way, I decided that I wanted to try to unify the main theories into a coherent whole, and I started writing soon thereafter. There was a Society for the Exploration of Psychotherapy Integration, which I joined, but they didn’t want to devise an overarching theory because, they assumed, it would just turn out to be one more school. So they contented themselves with modifying techniques from one school and incorporating them into the interventions of another school.

I decided that I would find time to read original works by all the prominent theoreticians.

I found the family systems idea of disturbed family homeostasis (discussed in the previous post) particularly interesting, and wondered if disturbed homeostasis was somehow related to an individual within a family developing an intrapsychic conflict - the central concept of psychoanalysis. I eventually started to see the connection. When family homeostasis was disturbed, it led to an intrapsychic conflict developing that was covertly shared by the entire family. Of course, the next questions were how and why a family’s homeostasis became disturbed, and why couldn’t a family just get together and talk about changing the rules.

In the last post I mentioned the concept of cultural evolution: that the balance between the needs of individuals and their kin group is evolving, so people are becoming freer to follow their own predilections in how they behaved, and in what they thought. The rules of the game for what was acceptable in love, work, philosophy, and play were rapidly changing. But individual families had trouble keeping up with all the changes. The homeostatic rules in many families started to come into question, disturbing the entire system. No one would talk about their ambivalence. This is called cultural lag by sociologists.

I described how and the many reasons why, due to events in family members’ histories over at least three generations, particular rules created ambivalence about themselves. I won’t go into that in this post, but I go into great deal in both my published books for therapists and the self-help book I wrote.

Unifying the Psychotherapy Schools

                                                                  

                                                

                                       Jeff Magnavita                                          

                                                                                            

In my post of December 3, 2024, I discussed the reasons for the fact that there are hundreds of different “schools” of psychotherapy in use today, each with their own theories to account for problematic behavioral, relationships, and thought patterns in individuals. Most of them are variations on the six major schools of thought in the field: psychodynamic, cognitive, behavioral, affect-focused, existential, and family systems. Still, they often have completely different ideas about what is important to focus on in psychotherapy and what techniques to use.

New techniques continue to proliferate at an alarming rate. An increasing number of them are being developed to treat, for example, members of racial and ethnic minority groups. Some have been politicized. This situation is becoming even worse as the quality of psychotherapy is declining, as I described in my post of 4/10/25.

I’ve also discussed the psychotherapy “integration” movement, an attempt to put some of these ideas together, as exemplified by the organization Society for the Exploration of Psychotherapy Integration (SEPI) It has been around since the 1980’s. Unfortunately they seem to  put little emphasis on a completely integrated model for fear it would be just become yet another school. So they content themselves mostly with adding slightly altered versions of techniques from one major school for use in another.

I attempted to form a more unified model which incorporates many of the valuable concepts from the major schools into a single framework way back in the late 1980’s, resulting in publication of my book, Unifying Individual and Family therapies, since re-titled a Family Systems Approach to Individual Psychotherapy. Since then, I've been joined by several people who have also been trying to do that, such as Jeff Magnavita, Andre Marquis, and Gregg Henriques. We each have somewhat different ways of doing so, which may sound like the society’s worries re more schools are well-founded - but these new unified models are very similar and have been a long time in development.

                                                                    Andre Marquis

The more integrative schools look at the fact that there are a huge number of interacting factors which lead to specific behavioral problems – both intrinsic to the brain and external factors such as social ones. And every disorder, and individual with a disorder, is usually subject to different combinations of them. Greg Marquis has divided them up into four groups or quadrants. Example from each are listed here:

Interior-individual: self image, self concept, self efficacy, stability, depression and anxiety

Interior-collective: relationships, cultural norms and meanings, family dynamics

Exterior-individual: medical disorders, brain functioning, medication, diet, sleep patterns

Exterior-collective: Socioeconomic status, neighborhood, environmental stressors, interpersonal and dynamics and history, racism, sexism.

IMO, a clinical evaluation examining factors in each of these areas is an absolute prerequisite for planning strategies for change in any given individual. This requires a somewhat long  session by therapists with a sense of leaving no stone unturned.

Magnavita and others also look at processes occurring at various levels such as in the brain, within the individual's psychology, between individual and family, and families and the larger social context. Unifiers often notice what is referred to as parallel process, where there are similar problems and processes between levels, say, in the family and in the family's ethnic group. I write about shared intrapsychic conflict, in which several members of the same family are all conflicted about personal behavioral standards because of changes in the ambient culture which require different ones than had been required before.

Therapists try to make a determination about at which levels they might have the most leverage for helping clients make changes and have useful therapeutic strategies for possible interventions – such as medications for the brain, or family systems models for problems at the border of the individual and the family. As the reader can tell, therapists familiar with the widest range of models for change and individual strategies to affect various aspects of the patient’s problems will have the most options to choose from.

My unified model is a system of interventions designed for those with personality disorders to change a client’s interactions with attachment figures that trigger and reinforce repetitive self-destructive behavior. (This would obviously be inappropriate for use with other types of disorders in the DSM such as bipolar disorder, which is primarily treated with medication. Some other disorders like panic disorder can be a byproduct of dysfunctional family interactions and be treated both medially and psychotherapy using my model).

My model addresses several important processes that were first described by the other major therapy models, in new, integrative ways. To greatly oversimplify, within a family, family behavior (family systems) leads to behavior in individuals which is reinforced on a variable intermittent reinforcement schedule by parents (behaviorism) which then creates a false self in individuals who are trying to stabilize unstable parents (psychodynamic). Patients keep the false self in line using defense mechanisms (psychodynamic) and irrational thoughts (cognitive). If they do not do this and try to “self-actualize” or follow their own muse (emotion-focused) they become subject to existential terror (existential therapy). Therapy aims to help patients understand family behavior through extensive family history (genograms) so that they can use empathy and a variety of strategies to get past parental defenses to discuss the whole process with them and put a stop to it.

Now, if only we all could just get the rest of the psychotherapy field to pay attention to this stuff.

Pathological Narcissism and Pathological Altruism: Two Sides of the Same Coin

 

 “A good life balances our own self-interests with other people’s needs…Healthy narcissism is where passion and compassion merge, offering a truly exhilarating life.” ~  Craig Malkin

Balance in life. Lately, that seems like an unknown concept in our black-and-white, all-or-none thinking times. 

In his book, Rethinking Narcissism, Dr. Malkin distinguishes healthy versus unhealthy narcissism, the latter being characterized by the (dictionary) definition of excessive interests in one’s own importance and abilities. (In fact, as a described in a previous post, its base [in Narcissistic Personality Disorder] is often a subconscious sense of inferiority combined with a sense of not being appreciated by others).

On the other hand, caring for others at one’s own expense also has healthy and unhealthy versions. I’ve also written about, using Barbara Oakley’s term, pathological altruism - in which one’s sacrifices not only lead to misery or deprivation for the giver but also backfire and lead to harms for its objects.

Although it’s a bit of an oversimplification, I also illustrated it with something I called the Mother Teresa Paradox: if she’s right and giving to others is life’s greatest reward, then by not allowing others to give anything to her, she is in effect depriving everyone else of what she herself defines as the best life has to offer. 

A common example in our culture is: the whore/Madonna complex, in which even married folks feel they are evil if they enjoy sex too much with one another. Especially women. Men at times and in certain social circles have been allowed to enjoy it with non-spouses, who are nonetheless derided as whores, because of a need by their group for them to have sins to atone for on Sundays.

I believe, and my Unified Therapy psychotherapy paradigm is based on this, is that this sort of craziness is a result of the evolution of individuality out of collectivism over the last three centuries, as described in the marvelous book Escape from Freedom by Eric Fromm. Sometimes it’s best (and was especially in the past) for the survival of our species if under many circumstances we sacrifice ourselves for the tribe. But that has become increasing less necessary and even counterproductive as science and technology have taken center stage. Nonetheless, we are still primed by our genes to do it (due to kin selection), but it is becoming more and more counterproductive. 

Our own family interactions sometimes don’t keep up with changing environmental contingencies, leading to something called cultural lag, which leaves families confused and conflicted over which standards to follow in this regard.

This in turn can lead parents to give destructive mixed messages to their children. We do have the power to use our critical thinking skills to get everything back into a healthy balance, but are often severely invalidated by our own families whenever we try, leading to a horrible sense of not knowing who we are or what we are supposed to do any more (called anomie or groundlessness).

In situations in which a whole family is conflicted over some issue, this is often indicated when people behave compulsively in one extreme way or in the opposite extreme way, or bounce back and forth between the two extremes.

Problems like these have to be discussed if they are to be solved, but people are often too ashamed or defensive to do so. The countermeasure is empathy, which comes from doing research into one’s family background in order to understand why our parents are driving us crazy. How to employ this is described in both my psychotherapy paradigm for self-destructive behavior (which by definition cannot be selfish unless an individual is nearly brainless) and in my self-help book for somewhat more functional families.

It was really impressive when my patients had an “a-ha” moment that led to the reaction of “So THAT’S why they act that way!" It was very liberating for them, although that freedom can still easily be undone by aggressively invalidating family attachment figures. I teach strategies for getting the parents to stop doing that.

If you are in a cycle of self-destructive behavior, such as, say continually going back to an abusive marriage because your parents seem to be blaming you for it (and if you have been going back, it is not “blaming the victim” to say that you bear some responsibility for your own plight), my message to you is to learn about this stuff and how it has affected you personally and your family, and to take charge.

New Podcast, Part II. Family Dysfunction Effects Not "All in Your Head"

New podcast, Part II, discusses my family dysfunction model in more detail. Your problems with it are not "all in your head."

https://www.youtube.com/watch?v=pjG5LbV26ps

I am Interviewed on Two New Podcasts

 I'm interviewed on two new podcasts. 

The first describes my background and how I got interested in the family dynamics of self-destructive behavior (particularly borderline personality disorder) and its psychotherapy:

https://www.youtube.com/watch?v=XPQdl664QgM

In the second one, I talk about my self-help book, Coping with Critical, Demanding, and Dysfunctional Parents: Powerful Strategies to Help Adult Children Maintain Boundaries and Stay Sane:

https://www.youtube.com/watch?v=MLM6tvLe_Oo&list=PLOSSy_bIynJqUnE3ilzI9UR7J92aYeCI2&index=42

New Podcast Interview about My Psychotherapy Paradigm

I am interviewed by Serge Prengel, LMHC about the history of and the philosophy behind my ideas about psychotherapy with patients who have personality disorders: https://relationalimplicit.com/allen-2/ 

Successfully Confronting One's Family of Origin Members: What Comes Next?

A commenter on one of my blogposts posed what I thought were some very good questions. The post itself was about how some other therapists think I'm a horrible therapist because I send my patients who come from highly dysfunctional or abusive families back into the hornet's nest to confront and hopefully change ongoing repetitive dysfunctional interactions with family of origin members.

The anonymous commenter asked: Even if a patient is able to confront or dialogue with their parent to stem the abusive behavior, wouldn't that be just the beginning of the work of patient? Just because Mom and Dad have stopped being the insufferable fools that they are, a) they don't necessarily understand the family dynamics at work and b) their corrected behavior is not going to help the patient with his habitual emotional responses that have hampered his life. Once Mom and Dad have been more or less straightened out, what is the patient's next move?

I realized that, although I covered this in detail in my books for therapists, I had not really addressed the answers to these questions here in the blog. So here goes:

First of all, the dialog with the parents usually does include an empathic discussion of the family dynamics and the reasons for the parents' problematic behavior (metacommunication). The goal is to do this without condoning any of their past or current damaging behavior. That problematic behavior is the most powerful trigger and reinforcer of the patient's dysfunctional role within the family. (Many of these roles have been described in detail in previous posts, and are models for the various personality disorders).

How individuals play the dysfunctional roles in everyday life is based on a model in their heads of how to respond to various social situations with significant others. These models are called role relationship schemas. These schemas and the resultant behavior are performed automatically and subconsciously in response to various pre-determined social cues, and are therefore performed thoughtlessly in most situations.

When the parents stop feeding into and/or triggering someone's schemas, this seems to start to free the person up to experiment with alternate ways of relating to others. While going through this process, however, the individual may often also experience something called post-individuation depression or groundlessness in which they come to the realization do not seem know who they are any more. They have yet to become acquainted with the true self that they had been, before this, invariably suppressing throughout much of their lives. Paradoxically, their role behavior or false self feels real, while their true self feels false!

As a therapist, I explain this feeling to them and reassure them this horrible feeling will soon pass.

Many patients will then spontaneously start to experiment with new ways of relating to others. If not, typical cognitive-behavioral psychotherapy interventions from the therapist - which would have before this point been quickly overpowered by the reactions of family members - suddenly become very effective in moving patients forward.

Finally, the patient is instructed on how to handle the issue of family relapses. It is almost inevitable that they and the parents will at some future point fall back into their old dysfunctional habits. As we all know, long-time habits are indeed quite hard to break. However, once the earlier metacommunication had taken place, it is fairly straightforward to bring the relapse up with the parents and refer back to what had been discussed and decided upon earlier. The patient is instructed to wait until everyone cools down before attempting this maneuver.

Before I terminate therapy with a patient, I praise the patient for taking what we had discussed in therapy and employing that which we had decided to do so effectively. I believe it is important that patients take a realistic view about giving credit where credit is due, so they can have confidence that it was they who had actually accomplished the goals of therapy. This reassures them that they can therefore carry on without the therapist's help - and without the therapist having to pretend that the therapist had nothing to do with it at all, as some family systems therapists recommend.

Reader's Therapists Disagree With Me

"Letters, we get letters

We get lots and lots of letters"

Yet another interesting letter came to me in response to my posts that make the recommendation to adult victims of abusive families that they find a therapist who can help them confront their abusive parents about the family dynamics in ways that get the parents to stop any ongoing dysfunctional interactions. 

A therapist actually fired the reader from his practice because the patient did not want to divorce her mother!

As I have said repeatedly, I never recommend that patients continue to be abused by their families. However, I do not think that divorcing your family is the only other option, and it is certainly not the best option. This is because, unfortunately, you continue to carry your parents around with you in your head for the rest of your life. 

Fear tracts and other tracts in the brain's limbic system that determine the way we all normally respond to the interpersonal environment - and that are highly resistant to fading away through the normal processes of neural plasticity - come from, and respond more strongly to, one's parents than to anything else in the environment. 

It does not take much parental contact at all to reinforce them - even once every few years might do it. Contact from other family members in which messages about the parents are provided also works quite nicely in this regard. In fact, anyone else who behaves in any way that is even somewhat analagous to the way the parents behave will also trigger and reinforce them - and the pathways are very powerful in shaping our usual behavior.

Even if you stop interacting with parents altogether, you are very likely to pass on repetitive dysfunctional interactions to your own children despite your best efforts. Often people go to the opposite extreme from their parents in the way they interact with their children, yet end up with kids with exactly the same problems, as described here. Other children from abusive or neglectful households decide never to have children themselves for fear that they might turn out acting just like their own parents.

As mentioned, divorcing a family and continuing to be abused are not the only two options. There is a third: the one I mentioned in the first paragraph above. It is certainly not an easy thing to accomplish, or patients would have done it themselves long ago. It takes a lot of patience and persistence. And doing it badly is worse than not doing it at all. Nonetheless, with one's family of origin members, where there is a will, there is a way.

Unfortunately, the majority of therapists these days do not really understand family dynamics at all, are unaware of the above risks involved in recommending a "divorce" from parents, and do not know the techniques for helping their patients overcome multiple resistances and invalidation from family members when the patients attempt to discuss family dynamics with parents in a constructive way.

Interestingly, just after a received the letter from the reader mentioned above and went on to answer it, I got an extremely nasty missive from a psychotherapist on this very subject. Perhaps it was even the reader's prior therapist. I mean, who knows? I won't mention the therapist's name, but she even signed it. The letter read:

As a therapist I can say you are an awful therapist; truly terrible. The best thing a person who has been abused as a child can do is get away from their parents, make peace with it. Suggesting that someone that has been abused, goes back to the abuser and does the work to try and repair damage is abusive and shocking. I am shocked.

This therapist apparently thinks patients who were abused as children are just too weak and damaged to stand up to their family members. How invalidating! That's probably what the abusive parents think of their adult child as well.

Anyway, here is the letter from the reader complaining about a therapist just like her. My answer is written below in amber color.

My parents abused me, physically, sexually and emotionally. As a result I

have a traumatic brain injury. I was put in foster care when I was 13. I am

now 35. I have gotten help. I am getting help still. My last therapist fired

me after I reconnected with my mother.

My mom has apologized and she has changed! It took awhile as in years but we now have a great relationship. I have a new therapist. I am scared because over Christmas I reconnected with my father who has also apologized and changed for the better. I have closure.

I have my family. I am scared that if I tell my therapist she is going to

freak on me, shame me, guilt me and or fire me. I am seeing her for help for

my own bad choices and the resulting trauma. I know she hates my family but I

don't understand how a therapist can tell me that I can change while insisting my family who they have never met can't [right on!]. It doesn't make any sense. I am not sure how to tell her.

I can't comment on your situation specifically without personally evaluating you and your family extensively, and without knowing a lot more about your experiences with your therapist, so the following are general comments that may or may not apply to you:

As you may have guessed from my blog, I am a firm advocate of my patients reconnecting with their families, even if the family had been abusive, as long as the abusive or invalidating behavior has been stopped and has been openly discussed by the involved parties, with the result that everyone has some idea of where the dysfunctional patterns came from and what purpose they had served. Before that goal has been accomplished, I coach my patients on how to get through the family’s often formidable defenses against having such conversations, so that they can get to that point.

Of course, I make sure that my patients have a safety plan for themselves (and their children if any) if this process starts to take a wrong turn, in which case we try to figure out what went wrong and how to get things back on track. I almost never give up. However, if a patient puts their child in danger (like leaving a young one with a grandfather who had sexually abused the patient as a child), we have to work on that issue first.

Unfortunately, there are a lot of therapists who still believe that divorcing one's family is the best course. My recommendation in such a case is to find another therapist. Unfortunately, therapists familiar with dysfunctional family dynamics are getting harder to find.

Also, if someone is afraid to be honest with their therapist, that in general ties the therapist’s hands, so there is almost no point in continuing. A good therapist may certainly question a patient’s decision but should never attack them personally for having made it.

Dr. Allen's Second Book Back in Print

My second book, Deciphering Motivation in Psychotherapy (which was originally going to be titled Ulterior Motives) is now available in paperback at a reasonable price on Amazon for the first time. It is actually my favorite of the ones I've written, but by far the least read.

It was out of print for a time, and then back out but at a ridiculous price. (A different publisher had bought out the original publisher, then re-published the book without even letting me know!)

It was meant for therapists but is written so lay people can understand it.

This book explains some basics about the theory behind Unified Therapy, including the core concept of dialectic causality.

The main topic is the use of language in dysfunctional family interactions, and how the true intentions and meanings of individuals who are being ambiguous or misleading can be discovered. If you want to see things that have been said to you repeatedly by difficult relatives in a whole new and surprising light, this is the book for you!

Why Does Psychotherapy with Patients With Personality Disorders Take So Long?

The type of psychotherapy I do with my patients who suffer from personality disorders is called Unified Therapy. It integrates ideas from all of the main schools of psychotherapy about both the causes and the treatment of significant and ongoing self-destructive as well as anxiety-producing and/or depressogenic behavior patterns. 

Briefly, it posits that the parents in the patient's family of origin experience ambivalence and emotional conflicts about the demands of certain family roles that they have learned are required of them. They learned these roles from their own families of origin. 

The roles were initially culturally determined. As a consequence of this ambivalence, they make contradictory demands on, and give double messages to, other members of the patient's family of origin about what is expected of them.

The ambivalence in the parents, in turn, is created by learned and ingrained family rules which became obsolete when the ambient culture changed quickly. In other words, the family rules lag behind changes in the requirements of the ambient culture.

The double messages are believed to reinforce (in the behaviorist sense and on a variable intermittent reinforcement schedule) the patient's intrapsychic conflicts and the resultant dysfunctional behavior. The patient's responsive behavior then simultaneously reinforces ambivalent, dysfunctional behavior in the rest of the family.

Most of the psychotherapy treatment protocols for significant personality disorders practiced today require long-term therapy, and my model is no exception. It usually takes between 70-120  sessions - sometimes more - which take place at a frequency of once every two weeks (most other therapy paradigms are based on weekly sessions). I wish I knew of a faster way to help these patients. If I could find one, please believe me, I would be the first to employ it.

So why does it take so long? 

The first reason is that, in the beginning of treatment, the therapist has to gain the trust of the patient. Most of these patients have been betrayed in one way or another by their own close family members - the very people whom they are supposed to be able to trust the most. Furthermore, they feel ashamed of both their own and their family's behavior.  

Even more important, they feel guilty if they don't keep the family's deep dark secrets to themselves.  

Given their experience, they would have to be idiots to trust a therapist - a complete stranger - right out of the box.

Even after they begin to open up, it also takes quite a while for the patient and therapist to understand what motivates all of the patient's family's bewildering behavior. Even figuring out the right questions to pose can be a challenge for the therapist. 

The reasons that problematic patterns exist usually involve historical events that have taken place over at least a couple of generations, and sometimes start even further back than that. Important historical events which might explain them better may not be discoverable because there are no longer any relatives alive who are old enough to know about them.

However, these are not the primary reasons for the length of therapy. The main reason is because personality disorders are not only highly complex and complicated, but extremely well ingrained into the brains of sufferers. As I have discussed in previous posts, behavioral reactions to the social environment are literally branded into the primitive part of their brains known as the limbic system over many years due to repetitive interactions with parents and/or other primary caretakers.

Patients may in some cases change their problematic behaviors fairly quickly over the short term, but the changes often do not last. Doing short-term interventions may seem to work if one does not follow the patient for very long, but these interventions work sort of like a fad diet. Those who go on fad diets lose a lot of weight quickly, but if you look at them a couple of years later, they usually have gained it all back. Often they gain back even more weight than they initially lost.  

Psychotherapy outcome studies that do not look at the frequency of certain behavior patterns and psychological symptoms two years after treatment has ended are highly misleading.

Dealing with family members who feed into the patient's self-destructive behavior, whether inadvertently or on purpose, leads to a whole new level of complexity. Their behavior patterns are also branded into their brains for the very same reasons! Not only that, but as family-systems therapists first pointed out decades ago, the whole group of family members automatically pushes back against someone attempting to change the old patterns. 

This is called family homeostasis. Everyone literally gangs up on the poor patient with invalidation of their new behavior. It is accompanied by the implicit instruction, "You are wrong, change back." I listed some of the ways this is done in a previous post.

Altering these dynamic family interactions is like a game of three dimensional chess, only with even more dimensions. Whenever I coach a patient on strategies concerning how to respond to a parent's problematic behavior, each move leads to a counter-move on the part of the parent which is designed to keep everything unchanged. 

These counter-moves do not necessarily occur immediately after the patient initially does what we have decided on in therapy sessions, but may occur suddenly at any time - often when least expected.

For therapy to work, the therapist and patient have to come up with a whole series of moves and responses in order to address each of the countermoves. Countermoves may also include a parent trying to rope in a third party - such as the other parent or a sibling. Sometimes the patient and I can figure out two or three of these moves in this game in advance, but not usually.

Furthermore, all of us have a seeming natural reluctance to discuss sensitive family dynamics with our parents and other primary attachment figures, so this whole process is usually interrupted by significant periods of time in which patients cannot seem to get their homework assignments done before the next session.

This type of therapy therefore requires a major investment of time and money and energy. It requires courage, nuance and subtlety as well. The alternative, however, is not only the continuation of the patient's personal misery, but the likelihood that dysfunctional patterns will be passed through to future generations of the patient's family.  

An Interview

An audio interview with me about my psychotherapy treatment, Unified Therapy, can be found at:

http://www.somaticperspectives.com/conversations/2011-04-allen.htm

It is called:

David M. Allen: Unified Psychotherapy: Placing Persons in Their Ecosystem

Does One Need to Forgive Abusive Parents in Order to Heal?

One of the most frequent questions I get when I start working with patients on altering ongoing dysfunctional family dynamics with previously abusive parents or other primary caretakers is, "Do I have to forgive them?"

"Well, no, you do not have to...," I answer,"...but if this goes well you will probably want to." Forgiveness is not an end in itself but a byproduct of the process of reconciliation.

My patients also tell me, when I am encouraging them to re-establish contact with abusive parents, that they do not want their parents in their lives.  I reply, "That's because of the way that they treat you now. I don't blame you.  However, if they stopped treating you like that, you probably would want them in your life."  Having no loving family to call our own is not a predicament that we are naturally built for.

As I described in my June 11 post, How Can You Be Empathic With a Child Abuser, the most difficult and time-consuming part of doing the type of psychotherapy I do, called Unified Therapy, is convincing my patients that it is in their interest to find a way to metacommunicate with their family of origin members. That means attempting to get past everyone's formidable defensiveness, denial, and resistance and talk about their family dynamics.  This reluctance is especially acute - and understandable - if the parents had been severely abusive to the patient when the patient was a child.

Patients think I am asking them to somehow change the past.  That is obviously impossible.  However, we can change the effect the past has on us. The goal of the process is to change how things are right now, in the present.

The problem is, in fact, not in the past at all.  Dysfunctional family patterns, in modified forms, usually keep going on long after children grow up. Unless something is done, they have a strong tendency to go on and on until the parents die, although the patterns often do mellow somewhat as time goes on.

Although we may not want to or be able to forget past misdeeds, most of us could readily find it in our hearts to forgive family members for bad past behavior if only they would let us.

But if the offending family members are still mistreating you, acting as if the abuse never even happened, or are in some other way invalidating you if you even bring it up, how can you possibly forgive them?  If they blame you for their past misdeeds, how on earth can you possibly forgive them?  If they demand you leave your children in the care of an abuser and act as if you are unreasonable for refusing to do so, ditto.  Again, this is a problem not in the past but in the present.

In order to "get over" the abuse and move forward without passing on negative family interactional patterns and conflicts to future generations, I believe it is extremely important to come to a mutual understanding with major family of origin members.  Whether you want to continue having a relationship with them after metacommunication is successful, or whether or not you decide you want to forgive them, is in a way besides the point. But you probably will.

How to Disarm a Borderline, Part I

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If you are an adult in a relationship with another adult, either through blood or through a romantic liaison, who fits the description of a patient diagnosed with borderline personality disorder (BPD), then you already know that you have your hands full.  A New York Times blog post about BPD drew 470 rather contentious comments (http://well.blogs.nytimes.com/2009/06/16/understanding-borderline-personality-disorder/?apage=1#comments) from people who were dealing with BPD relatives and other people who themselves have the disorder.  Although I am in neither category (hopefully), I wrote a few posts myself. 

I wrote about some of the ideas that I describe below.  A couple of people who said they were dealing with BPD parents did not like what I wrote, but showed that they had adopted some of the very behavior they were complaining about in their parents, as evidenced by their responses to me (more on why this might happen shortly).  I was being nice, so I didn't point that out to them.

Some people say that the only way that you will surely survive a relationship with someone with BPD is by cutting all contact with the "toxic" individual.  Some therapists even say this.

If you are in a romantic relationship with a person with BPD, that might indeed be the best course.  Has the relationship already been going on for quite a while?  You won't like hearing this, but this means you: you need to ask yourself why you are attracted to such a difficult person in the first place.  Please don't give me the usual crap like, "I didn't know what (he or she) was like that at first, but now I'm involved and I can't get out.  (He or she) was so charming at the beginning of the relationship!" 

Puh -leeeze!  You are like the wife who insists her husband is not having an affair while she looks for the stain remover to get the lipstick off her husband's shirt collar. Sorry, but most people run at the first sign of BPD behavior.  It is not subtle, and one does not often have to wait very long before one first sees it.

Well, you might object, the person threatens suicide if I tell them I'm going to leave them!  So, let me get this straight.  You're planning to sacrifice your whole life because someone might stab themselves in the heart in front of you and then quickly hand the knife to you before they die so your fingerprints are all over it?  If you feel so responsible for other people that you respond to this kind of threat by caving in to it, please, get some therapy.

When it comes to parents with BPD, however, the strategy of divorcing one's family, while better than remaining in a toxic relationship with them, creates other problems.  First of all, it's kind of lonely to have no family.  You will be faced with a cavernous hole in your life. 

Second, you came from them.  If they are monsters, what does that make you?  You undoubtedly share at least some of their toxic behaviors whether you like to admit to it or not, because one can not grow up in a toxic household without adapting to it in ways that are both problematic themselves and very hard to stop later on in other social contexts. 

Especially with your own children.  Attachment studies clearly show that the best predictor of one's relationship with one's children is......one's relationship with one's parents or other primary caretakers.  Some people from abusive households wisely decide not to have children for fear that they, too, might become abusive.  But is that what you really want to do?

Besides, you cannot completely divorce yourself from your family, because you carry them around with you in your head. Literally. We in the biz call these mental representations schemas.

Your choices are not just limited to these two:
1) To either to continue to be mistreated, or
2) to cut off all contact with your family.

A third choice is to change the nature of your relationship with your parents so that you are not being mistreated but are still in contact with them.  Impossible, you say?  I disagree.  While you do not have the power to "fix" your parents, you do have the power to fix your relationship with them.  If you change your approach to them in a consistent manner, that will force them to change their approach to you. 

However, there is a big problem that you will face in doing this: since you have been in a relationship with them your whole life, they have developed a whole repertoire of behaviors, include recruiting other family members, to give you the powerful message, "You're wrong.  Go back to responding the way you used to."  If one strategy does not work, no worry.  There are plenty more where that came from. Scary to be sure, but not insurmountable if  you can enlist a therapist who knows something about the family dynamics in people with BPD.

Therapists like myself who work primarily with patients with BPD, regardless of their "school" of psychotherapy or their theoretical ideas about the causes and cures for the condition, all have independently developed some ways of getting BPD patients to be more cooperative with them.  (That is, cooperative just with the the therapist. Unfortunately, not with anyone else). We seem to have all come up with these little tricks of the trade independently, yet they are all very similar, as I described in a paper called, "Techniques for Reducing Therapy-Interfering Behavior in Patients with Borderline Personality Disorders: Similarities in Four Diverse Treatment Paradigms" (Journal of Psychotherapy Practice and Research 1997; 6:25-35). 

Marsha Linehan of DBT fame, Otto Kernberg of psychoanalysis fame, Lorna Smith Benjamin of interpersonal therapy fame, and myself (with my not-at-all famous treatment paradigm called Unified Therapy) all do pretty much the same things at the beginning of treatment.  (We then start to diverge considerably).  These strategies are survival skills for us.  Therapists used to come up to me all the time and ask me how I could stand to work with several patients with BPD at the same time, but it really is not a big problem if you know the "tricks."  I had to devise them a long time ago because I built up a private practice by taking referrals of these patients whom no one else wanted to treat.

As I mentioned, it is much harder for someone who is already enmeshed with a relative with BPD than it is for a therapist who has just met a patient with BPD.  One reason is the aforementioned repertoire of behaviors they have designed over many year specifically with you (the enmeshee) in mind.  They know all of your weaknesses and exactly how to take advantage of them.   Second, as a therapist, I do not have to deal directly with a bunch of interfering relatives like the enmeshee does.

The third reason has to do with something behaviorists call a variable intermittent reinforcement schedule.  This schedule is why slot machines in casinos are so successful.  You never know when the damn thing is going to pay off, and it pays off just often enough, so you keep pulling the lever until you lose your shirt.

I should mention that, as John Rosemond is fond of saying, people are not lab rats that blindly respond to rewards and punishments. However, if a person has a goal, and their behavior helps them to reach it, reinforcement schedules kick into play. It is not the person being "rewarded," but the behavior. It is not rewarding to have people hate you.

The goals of the worst of the behavior exhibited by people with BPD, for reasons I will not discuss here, is to cause in their targets one of three reactions.  The first two of these invariably lead to the third.  The three reactions they shoot for in their targets are a sense of anxious helplessness, a sense of anxious guilt, and overt hostility. 

The great big secret, however, is that folks with BPD are often highly ambivalent about getting these reactions.  They will try like hell to get them - and believe me, they are real professionals at it - but they secretly wish to fail. (How do I know this?  Experience.  But I can not prove it - because there is literally no way to set up an "empirical" experiment that would fill the bill - so readers can call this highly speculative if they wish).

If the persons with BPD succeeds at getting one of three reactions, they will continue to draw for it.  Pull out all the stops in order to get them, in fact.  If they fail at getting the reactions, however, they will suddenly become more conciliatory.  However, because of the variable reinforcement schedule, if they only occasionally succeed in getting one of the reactions with a person with whom they have already been interacting for a long time, they will keep trying much longer. 

Therefore, if you already have a history with them, and they have a track record of making you react in any or all of the three ways, their behavior will get much worse before it gets better.  If you can not keep your cool and occasionally react the wrong way, it becomes even harder to get the BPD's to change their behavior toward you than if you react the wrong way all the time!

In later posts, I will share with readers the therapist's tricks for avoiding "rewarding" the bad behavior of persons with BPD, but most people who are already enmeshed with a BPD family member will find it nearly impossible to employ them successfully without the help of a therapist who understands the family dynamics of those who suffer with the BPD traits, and who can prepare them for your "adversary's" formidable defenses.  I will start in an upcoming post with what not to do.