Cherry Hill Counseling is a counseling practice that services people of all ages for individual, family, group, premarital and marital counseling. They counsel with the highest level of professional care, competency and community support blended with a creative, artistic and holistic approach.
One challenge that clients sometimes face in counseling is deciding whether they want to go deeper in the treatment process than was initially anticipated necessary. At times, the counselor may recognize a need for more in-depth work to be done, and the counselor and client must then decide together whether this is the appropriate time for such work. However, clients can become incredibly impatient and demanding of themselves, wishing that they could skip ahead to the happy ending. This seems to be particularly true of those who have experienced complex trauma. They need a much greater degree of safety in the counseling relationship in order to continue to unpack their experiences. This has led me to pursue more understanding of the nature of complex trauma.
Complex Trauma vs PTSD
Heather D. Gingrich (2013), in her book Restoring the Shattered Self, delves into the nature of Complex Trauma Stress Disorder (CTSD) from her clinical experience working with clients struggling with CTSD. Historically, clinicians only talked about Post-traumatic Stress Disorder and Acute Stress Disorder which must be linked to a specific, isolated event in a person’s life (American Psychiatric Association, 2013). However, these diagnoses seem to fall short when attempting to capture the breadth and depth of the impact of repeated trauma events perpetrated by someone intimately involved in a person’s life, such as ongoing childhood sexual abuse by a family member (Gingrich, 2013) or being a hostage or concentration camp survivor (Herman, 1997). Regardless of the specifics, complex trauma is “best conceptualized as a qualitatively more severe subset of traumatic events” (Wamser & Vandenberg, 2013). Even so, the term CTSD is only useful to the extent that it informs treatment. It can never define the person or encapsulate the person’s entire experience.
Before presenting more of Gingrich’s material, I want to caution against the over-application of the word “trauma.” This word is often used casually to include experiences that may have indeed been awful but do not represent trauma. If this word is overused, there is the risk of minimizing the experiences of those who have actually endured trauma and eliminating the distinction between what needs to be treated as trauma and what does not.
CTSD and Human Developmental Tasks
There is considerable overlap between the symptoms for PTSD and Complex Trauma, but Gingrich (2013) helps explain what makes Complex Trauma complex. She argues that the timing of trauma is critical in understanding the impact on the person’s development and current functioning. According to Erikson’s theory of development, young children must learn to trust, then exercise autonomy, take initiative, and gain confidence socially and intellectually (Wong, Hall, Justice, & Hernandez, 2015). If trauma is ongoing anywhere in this process, it can hijack the person’s ability to trust, cope with emotions, and develop a clear sense of identity (Gingrich, 2013). Let’s look at each of these individually.
Trust: The need for safety and security is central to the process of building a secure attachment style. Nothing wrecks a child’s view of a safe world quite as much as having the primary caregiver also be the person representing danger to him or her. The child then becomes very confused who to trust in life because “the source of both safety and danger…resides in the same person” (Gingrich, 2013, p. 32).
Emotions: Without a primary caregiver to turn to for help with handling emotions, children have to learn other ways of dealing with distress. Gingrich (2013) points out that almost every mental health concern has emotional regulation involved, leaving those who have experienced complex trauma more prone to be labeled with a whole host of disorders and reinforcing the unhelpful narrative that they have something innately wrong with them.
Identity: The third aspect of trauma that I want to address from Gingrich’s (2013) writing is the “integration of self” (p. 37). For a person to form a cohesive identity, he or she must be able to apply information learned in one setting to another setting. These are called states. For example, every day we experience states of hunger and tiredness. With a trauma state, the mind and body learn to section this state off from the rest of the person’s experiences as a way of survival. Parts that can be sectioned off or compartmentalized in the person are behaviors, emotions, sensations, or knowledge (Gingrich, 2013). For example, if trauma memories are triggered in an adult who typically is fully functioning, the person will begin to operate according to the only survival skills they had in the midst of the trauma. This often involves freezing. It is as if the mind knows that the person has survived the trauma, but the body does not know that the trauma is over. As Bessel van der Kolk (2014) explains, the time-keeping portion of the brain is deactivated in a trauma state, resulting in the person having no sense of the trauma being in the past.
Attachment, emotional regulation, and identity touch every area of a person’s life as does trauma. However, trauma need not hijack the person’s story indefinitely. It takes much courage to begin the journey of recovering from trauma, but it is possible for the person to begin bringing the parts of their story together, learn again to trust, and feel safe enough to explore their emotions. In fact, they may even discover strengths they have that were forged in the midst of the trauma. This process is best done with a counselor who is specifically trained in trauma and knows how to attend to the client’s cues of needing greater safety. If you or someone you know is looking for a trauma-informed counselor, please reach out to Cherry Hill. We want to support you as you undertake this work of pursuing more healing.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
Gingrich, H. D. (2013). Restoring the shattered self: A Christian counselor’s guide to complex trauma. Downers Grove, IL: IVP Academic.
Herman, J. (1997). Trauma and recovery. New York, NY: BasicBooks.
Herzog, J. I., Niedtfeld, I., Rausch, S., Thome, J., Mueller-Engelmann, M., Steil, R., … Schmahl, C. (2019). Increased recruitment of cognitive control in the presence of traumatic stimuli in complex PTSD. European Archives of Psychiatry and Clinical Neuroscience, 269(2), 147–159. https://doi-org.ezproxy.tiu.edu/10.1007/s00406-017-0822-x
Thomaes, K., Dorrepaal, E., Draijer, N., de Ruiter, M. B., Elzinga, B. M., Sjoerds, Z., … Veltman, D. J. (2013). Increased anterior cingulate cortex and hippocampus activation in Complex PTSD during encoding of negative words. Social Cognitive & Affective Neuroscience, 8(2), 190–200. https://doi-org.ezproxy.tiu.edu/10.1093/scan/nsr084
Van der Kolk, Bessel A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Random House.
Recently, I was asked to write a blog article for the Cherry Hill Counseling website. The topic? Adoption. Makes sense. That’s my area of expertise. The families and individuals touched by adoption have been the centerpiece of my whole social work career, in many ways.
Whether it was finding services for birth parents in my role as a foster care case manager, responding to pages (yes, we used pagers back before smart phones) and picking up newborn babies from hospitals as a foster care intake coordinator, or interviewing and writing home studies for prospective adoptive parents as a foster care licensing worker, I had the privilege of seeing all vantage points of the adoption triad (birth parents, adoptees, and adoptive parents).
After obtaining my Master’s degree in Social Work, I went right back into the mix and soon began working as an Adoption Preservation Therapist, providing in-home counseling to post-adoptive families and children. This area has remained my passion long after I burned out of that rather intense job and moved into private practice at Cherry Hill.
And yet, I found myself at a loss for where to start and what to say when asked to write on this topic. I started asking myself why? What is the hesitation? Isn’t this my heart? Don’t I have a lot to share? Then the answer came to me. It is because of what mainstream culture, and even many adoptive parents, believe about adoption. It is often seen through the lens of adoptive parents and the journey they took and how blessed they feel to be able to adopt their children. A quick children’s book search on Amazon will reveal what I’m talking about. You will find titles like I’ve Wished for You, I’ve Loved You Since Forever, and God Found Us You.
Has anyone, other than those close to this issue, ever stopped to think about the adopted child? The birth parents? The amount of grief and loss that exists within the adoptee and birth parents in order for that child to be available for adoption is indescribable. And maybe that is exactly why we skip past it. We jump ahead to the “happy ending” of the story. It makes us feel better to see that an abandoned or abused child will be loved and nurtured as he or she so desperately needs and deserves. And, of course, I agree! I have been in the court rooms countless times with families as the judge signs the final adoption decree paperwork. There is so much joy, and for many foster children or internationally adopted children who have been in multiple homes or orphanages, they finally get some permanency in their lives. So much to rejoice on that special day. But does that joy mean that we erase, ignore, or never talk about the sadness and loss that is also present?
What I have discovered is that, sooner or later, these feelings of grief absolutely surface for adoptees. It might not take the form you would expect with lots of tears and anguish. It can look like anger, defiance, ambivalence or outright refusal to attach with adoptive parents. Or it comes in the form of people-pleasing and wearing a “false” mask (because being my true self left me rejected or abused by my birth parents. So I can’t show that ever again for fear of a second rejection). Nancy Verrier (2019), author of The Primal Wound and Coming Home to Self, describes it this way to adoptees:
You as adoptees have no reference point. For most of you, your trauma occurred right after birth, so there is no “before trauma” self. You suffered a loss that you can’t consciously remember and which no one else is acknowledging, but which has a tremendous impact on your sense of Self and others, your emotional responses, your behavior, and your world view. Your brain synapses connected according to your perception of your environment which seemed unsafe, unfamiliar, and in need of constant vigilance. This need for vigilance may have filled you with anxiety. Some of you became compliant and tried to be perfect, while others of you acted out and tested everyone who was important to you.
Some adoptees explain a phenomenon termed as “coming out of the fog” when they, in essence, stop believing the “happy ending” story they have been told all these years. Instead, they realize that they have lost a tremendous amount by being forever separated from their family (and sometimes culture and race) of origin. Without intervention, this delayed grief can develop into more serious forms of mental illness and/or addictions as well. Sadly, adoptees are often over-represented in mental health treatment centers, substance abuse treatment centers, and jails. In a research study, Keyes, Sharma, Elkins, Iacono, and McGue (2008) discovered that adopted adolescents were twice as likely to have Attention-Deficit Hyperactivity Disorder or Oppositional Defiance Disorder as their non-adopted peers. They were also more likely to have had contact with mental health professionals.
While my experience with birth parents is more limited, I know how they have also suffered loss. Whether by choice or not, these parents have lost the opportunity to care for their children, be in their lives and watch them grow up. It is a loss they often cannot talk about with many people for fear of being judged for the part they played in the process. Maybe they did not even tell their loved ones about having a child they are not parenting, due to shame or fear of rejection. Maybe they are experiencing a bit of “survivor’s guilt” in a way, if they found stability in their lives over time and/or went on to have and parent additional children.
Many adoptive parents have also experienced loss before making the choice to adopt, including infertility, miscarriages, and/or physical health problems. They have brought these burdens with them into the adoption process.
It is high time we start looking, listening, and validating these losses with everyone we know who has been impacted by adoption. Just having someone acknowledge what they have lost can have a life-changing effect. For the first time, their grief is identified instead of ignored! Therapy can also be a tremendous help for all members of the adoption triad. For adoptees, they can connect with and find comfort for that inner child who is grieving the separation from their first family, race, and/or culture. Adoptive parents can be heard and validated about their experiences, while also being given the tools to provide a safe, emotional space for their adopted child to express the feelings of loss. And birth parents are given the opportunity for their story to be heard and to make peace with the choices or circumstances that led to the adoption.
References and Recommendations
Keyes, M. A., Sharma, A., Elkins, I. J., Iacono, W. G., & McGue, M. (2008). The mental health of US
adolescents adopted in infancy. Archives of Pediatrics & Adolescent Medicine, 162(5), 419–425.
Verrier, N. (1993). The primal wound: Understanding the adopted child. Lafayette, CA: Gateway Press.
Verrier, N. (2010). Coming home to self: Healing the primal wound. (UK ed.). British Association for
Adoption and Fostering.
Can you remember the first time you flew? Perhaps it was with great excitement or maybe even some trepidation. But for some who grew up as third culture kids, the thought of going through security, boarding the airplane, and settling in for yet another international flight is mixed with so many more feelings than just excitement. Sadness, a twinge of bitterness, and exhaustion from all the goodbyes. Or maybe just numbness because he or she is worn out from attaching and detaching with every transition. They have just had to say goodbye to familiar sights, sounds, smells, people, and places. They do not know where to call home and yet, in some sense, the whole world is their home. And when they step off the plane, there will be family, strangers really, who embrace them exclaiming “Welcome home!” Home? Here in their country of origin, they might look like everybody else, but it is a far cry from feeling like home. Everyone expects them to be able to fit right in and are confused when a simple trip to the grocery store is overwhelming.
Complicate the goodbyes with the reason for having to leave, and this is a recipe for even more distress. A whole host of factors could have contributed to leaving. Maybe the country erupted into war, and they had to evacuate, with only what they could carry, and not knowing if they will ever see their friends alive again or if they will even be able to return. Maybe the country refused to renew their visas, their parents are burnt out, or a family member needs greater medical care than can be provided there. As a result, the TCK may also be dealing with guilt, shame, helplessness, and fear.
Who Is a TCK?
David Pollock offers this definition of third-culture kids “[A] person who has spent a significant part of his or her developmental years outside the parents’ culture. The TCK frequently builds relationships to all of the cultures, while not having full ownership in any” (Pollock & Van Reken, 2009, pp. 15-16). This includes missionary kids, military kids, and any other families that are frequently on the move due to business. Although some TCKs may come to see the richness and value in their experiences, for others they wrestle with bitterness because they did not choose this lifestyle and yet had to learn how to cope with being uprooted repeatedly.
TCK Pattern of Relationship Building
Because of the regularity of goodbyes both from leaving or being left, TCKs often adapt the manner in which they approach relationships. How long they will get to enjoy a friendship face to face is always in question. This uncertainty leads TCKs to make the most of the short time they have with others. There is no time for trivial matters and superficial conversation in the mind of a TCK. They want to connect much more deeply in short order and can become frustrated when someone is reluctant to share from their heart. Michele Phoenix explains this well, “Introducing The Time/Depth Dilemma: whereas MKs [missionary kids] and TCKs generally require depth in forming relationships, mono-culturals require time to form meaningful connections.” On paper, it looks like this:
(Phoenix, 2014, n.p.)
This skill of developing friendships quickly can be both a gift and a problem. TCKs tend to be adept at relating to people wherever they go. This is their best chance at establishing a sense of “home.” Home is not a place as much it is people. This ability in building community does not mean, however, that they feel refreshed from these interactions. Rather, they often feel the pang of being different and that others do not “get” them. They frequently have the sense of being on the outside. This is not necessarily due to others intentionally excluding them or the TCK refusing to engage socially. Rather, the disconnect naturally arises from the fact that the TCK is always bridging cultures unless they are relating to a fellow TCK.
Constant cross-cultural engagement is exhausting, and this is no less true for the TCK. Unless, the TCK attends to their emotional needs, this exhaustion may lead to burnout socially and result in the TCK numbing their emotions. The work of attaching emotionally to someone with the knowledge that this person could be taken away from them at any time becomes too much of a risk. Remaining emotionally distant becomes a necessary survival strategy to prevent getting buried alive in grief.
This grief and the pressures that come with being a TCK could be lessened in intensity if others were more aware of their needs and responsive to their pain. Consider these six permissions that are important for any TCK to receive: the permission to be kids, to fail, to grieve, to dissent, to doubt, and to redefine significance (Phoenix, 2015). Why these six? Because these children are often held on a pedestal as mature beyond their years, and particularly for MKs, are under pressure to not do anything that would taint their parents’ ministry.
So if you have the opportunity to relate to a TCK, be a person that they can trust to acknowledge both the beauty and heartache of their experiences. Let them find a home in your heart where there is no need to be perfect or avoid their grief. Bridge the gap to meet them in their culture rather than expecting them to meet you in yours.
Phoenix, M. (2015). Six permissions most MKs need. Retrieved from http://michelephoenix.com/2015/05/six-permissions-most-mks-need/
Phoenix, M. (2014). MKs & relationships: The time/depth dilemma. Retrieved from https://michelephoenix.com/2014/09/mks-and-relationships/
Pollock, D. C. & Van Reken, R. E. (2009). Third culture kids: Growing up among worlds. (Revised ed.). Boston, MA: Nicholas Brealey Publishing.
Maybe you are experiencing some behavioral issues with your child, or they have recently been diagnosed. Perhaps the school or your pediatrician has recommended that your child should go to counseling. Maybe your child has anxiety and, as a result, has trouble sleeping, or they are grieving the loss of a loved one. Children at any stage can benefit from counseling when placed with the right therapist. In fact, there are therapists who are trained to work with children starting as early as infancy. Perhaps you are wondering where to start.
It is important to find a therapist that is trained to work specifically with children as the therapeutic approaches to working with children are unique for younger, less verbal clients. A skilled therapist, trained in these approaches, can target and customize the therapy process to the developmental needs of the child. Children, even of the same age, land across a wide spectrum of verbal expression. There are many reasons for this variability, including developmental processes or exposure to trauma. The brain is affected by trauma, and this can make a difference in a child’s emotional and cognitive development (Booth and Jernberg, 2010). Child therapists understand this variability and have a toolbox of techniques to help a child express themselves, whether verbally or through play. Working with children in therapy will look different than working with adults, but still yields the same positive results.
When children come to counseling, they may be feeling upset from stress in their lives and anxious about coming to therapy, but a skilled child therapist will help create an environment for kids that is calm, safe and fun. We can learn a lot from children, and play is the therapeutic “work” that children do in order to heal and express emotion. Depending on the situation and the therapist, parents and caregivers can be invited into the space with the child to restore relationships as well as assist the parents in developing skills to help their children. There are a variety of therapies that aid a counselor in discovering what a child thinks and feels. Some of the therapies I will briefly address here are play therapy, Theraplay, and sand tray therapy.
What are Play Therapy, Theraplay, and Sand Tray Therapy?
Each of these therapies are vast and have much to offer. Play therapy focuses on creating a unique therapeutic relationship between therapist and child so that the child can feel empowered to express him or herself through a variety of activities and toys in the playroom. A child’s natural language is play. Children sometimes replay a scene using puppets, show the effects of a divorce through dolls, or use figurines in a sand tray to show how they see their world and how they are feeling both metaphorically and literally. “Often children have difficulty verbalizing their feelings when directly questioned, either because they are guarded or they do not connect with those feelings they find most threatening” (Hall, Kaduson, & Schaefer, 2002, p. 515).
When working with a trained play therapist, the toys in the play therapy room are specifically selected to help children express themselves and not just to keep them “busy.” Children are not cognitively developed to the point where they can fully express themselves through words. Sometimes adults assume that children are not affected by certain experiences because they have not shared about it and seem to be doing fine, but that is not always true. For this reason, it is important to find a therapist who can enter the child’s world rather than forcing the child to enter the adults’ world, in order to better understand the child (Sweeney, 1997).
Theraplay, an interactive, relationship based, and multisensory therapy, is designed to help families “reconnect and fully engage” with one another. Because the focus is on attachment and improving relationships, it is effective in working with a variety of issues, including children from foster homes and those who were adopted (Booth & Jernberg, 2010, p. 343). Theraplay involves the parents or primary caregivers in the sessions, leading parents and children to become closer through playful interactions. The “emphasis on attunement and empathy” helps create a space in which “true and sensitive connection” forms where children and parents are able to love and care for each other. (Booth & Jernberg, 2010, p. 343). When such connections are made, the child’s needs for comfort, nurture, and support are met, and a secure base from which the child can explore the world begins to form. This kind of play “between parents and children…nurtures a lifelong capacity to relate to others in harmony and joy” and “prepares the child to find his/her place in the world of relationships”, (Booth & Jernberg, 2010, p. 343).
Sand tray therapy is an expressive and projective therapy that is both flexible and adaptive. It can integrate a wide variety of therapeutic approaches (Homeyer & Sweeney, 2017). One of the goals of sandtray therapy is to “…help the client process the presenting issue-nonverbal or verbally-with sand tray therapy as the processing tool or approach”. Similar to the toys in the play therapy room, the miniature figurines in sand tray therapy should be intentional and deliberate. These figurines can enable a child to show and tell their view of their world and feelings. Whether it is a distant parent figurine far away from the rest of their family, or a certain miniature picked to represent someone they feel unsafe around, the results can be enlightening to the counselor. Sand tray therapy can often help when dealing with clients who have suffered some sort of trauma or abuse as well (Homeyer & Sweeney, 2017). These sorts of methods are critical in order to help children process their emotions and experiences that talk therapy can not always do alone.
Some Concluding Thoughts
With time and patience as the natural therapeutic process unfolds, issues come to the surface, and solutions will follow once the therapist gets to the core of what is going on in the child. In general, children are just learning how to feel, come to grips with their emotions, and then struggle at times with how to express and regulate them. This is where the properly trained therapist can be most beneficial in discovering the mind, heart, and soul of a child. At Cherry Hill Counseling, we have therapists who are trained in each of these therapy modalities for children. If you are interested, please feel free to reach out to us at Cherry Hill.
Booth, P. & Jernberg, A. (2010). Theraplay helping parents and children build better relationships through attachment-based play. (3rd ed.). San Francisco, CA: Jossey-Bass.
Hall, T., Kaduson, H. & Schaefer, C. (2002). Fifteen effective play therapy techniques. Professional Psychology: Research and Practice, 33(6), pp. 515-522.
Homeyer, L. & Sweeney, D. (2017). Sandtray therapy. (3rd ed.). New York, NY: Routledge.
Sweeney, D. (1997). Counseling children through the world of play. Eugene, OR: Wipf and Stock Publishers.
“It’s time to go! Grab your stuff” calls mom from the kitchen. A muffled “Okay, just a minute” comes from the other room. With a sigh, mom peers into the living room and is greeted with the familiar sight of her daughter transfixed by her phone. She does not even look up when she reiterates, “Come on; we’re going to be late.” This all-too-familiar scene leaves many parents frustrated and unsure how to help their kids engage the social media world appropriately. The introduction of the iPhone heralded a massive shift in the social world that children and adolescents are now growing up in. This exciting development in technology was welcomed by our culture with wide open arms. Many did not even question how this could negatively affect communication styles and relational connection. With the iPhone came unlimited access to social media, but simultaneously erased previous natural communication boundaries regarding one’s time and availability.
Adolescents today have never known a life without social media and screen time. Some of the more prominent platforms–including Snapchat, Instagram, Facebook, and Twitter among many others–are ubiquitous in modern culture. While social media has become a vital tool in the lives of both teens and adults, views on how it should be used vary among each group. Facebook is the social media platform most used by adults to keep up with current events and family/friends. Adolescents are generally more interested in Snapchat, Instagram, and Twitter.
It’s clear that social media plays important role in people’s lives, regardless of age. But is there such a thing as too much social media?
Teens Beliefs About Social Media
Social media–a type of electronic communication through which users create online communities to share information, ideas, personal messages, and other content–can be very powerful and a positive tool for adolescents. According to a Washington Post survey, many teens believe that social media, in spite of its flaws, is mostly positive and can be used in many positive ways. The survey found that teens believed social media was a positive tool in terms of:
allowing them to have a voice and to do good in the world
strengthening friendships and relationships
fostering a sense of belonging
providing genuine support
How Much is too Much?
Yet many parents are concerned about the amount of time their children spend on their phones and other platforms–not to mention the potential dangers that lurk down these avenues of communication. Some parents, worried their children are addicted to their screens, are anxious about how much time they should allow them to spend on social media.
Even teens themselves are starting to understand they may overindulge. According to a study by Pew Research Center, 60% of teens aged 13-17 believe they spend too much time online. More than half of those teens say they personally spend too much time on their cell phones.
In another study, Common Sense Media found that teens spend an average of nine hours a day online. That sure is a great deal of time spent staring at a screen! Although advanced technology now allows parents more control over the amount of screentime their children get, adolescents are smart–and they find ways to get around those barriers.
In spite of its utility, social media is affecting teens lives’ in unhealthy ways. Some of the major concerns that teens face include:
body image/body satisfaction
peer pressure and peer victimization
inability to focus on schoolwork or other tasks
Social media demands can push an adolescent to feel or act a certain way that may be untrue to themselves. At its worst, it can be used to abuse and bully others, personally or anonymously, from behind the safety of a screen. Social media can distract adolescents from more important priorities in place such as school, sports or clubs, and friendships.
So, Where Does That Leave Us?
While social media can be a useful and healthy tool for teens, it is important to help them learn and understand the dangers and problems it can cause. If you fear your child is using social media too often or in negative ways, and are struggling with helping them to make healthier choices, consider reaching out to a therapist that specializes in working with adolescents. Therapists that work with this age group can be great allies in helping your teen to weigh the various advantages and risks of technology. Together, we can form a more positive relationship with, and self-control over, social media.
In Part 1 of this 2 part series, Zero to 60, I shared a bit about the nature of the distress that fuels our patterns of conflict and disconnection in marriage or romantic partnership. The fact that these attachment relationships are so central to our emotional and physical well-being amplifies the intensity with which we react to any perceived danger in the relationship. This impacts whether, and how, we reach for our partners for emotional support and care over time. I also shared that psychologist, Susan Johnson, has pioneered an approach to healing these distressed patterns in relationships called Emotionally Focused Therapy (EFT). She has now offered them to the world in the form of a treatment approach to couples’ therapy that is being used by thousands of therapists internationally.
If your relationship is in distress or if you and your partner find yourselves “stuck” in the same repeating patterns of conflict or disconnection, this is likely leading to pain, anger, frustration, or doubts about the relationship. As you explore the possibility of entering into couples’ therapy with your partner, you may be interested in learning more about this highly effective approach that has been validated by research over and over again.
Why Emotions Matter
Sarah and John have been married for 14 years. They are struggling and unhappy because their relationship has become plagued by cycles of conflict and disconnection. Here are statements that might be made by each partner at the beginning of therapy:
Sarah: “I am so angry and frustrated with John. He is in his own little world most of the time. When I need his support, I feel like I have to shout to even get his attention. I don’t like having to fight so hard to connect with him. I feel like I’m the only one who cares.”
John: “Our marriage is so full of conflict and I hate it. Sarah is never happy with me. She seems to continually find fault in everything I do. I feel like I can never get it right and so I shut down and try less and less over time. I know this is not good for us, but at least if I keep my distance we are not fighting.”
These primary positions between Sarah and John appear to be in opposition to one another. When we explore underneath these positions, we find that Sarah and John are each struggling to find ways to cope with vulnerable emotions and a deep longing for a secure connection in the relationship.
Here are some more vulnerable emotional “subtitles” to above statements that Sarah and John are currently unable to share with one another (In fact they may not be fully aware of these feelings themselves yet):
Sarah: I feel sad and afraid about our relationship. I long for more closeness with John but I don’t know how to get that from him. Deep down I’m afraid that he doesn’t really want to be close to me and maybe that he doesn’t really love me any more.
John: I feel overwhelmed and sad about the state of my marriage. I know that Sarah is unhappy with me. When she expresses her unhappiness I immediately feel like a bad husband. I continually feel like I am not able to give her what she wants from me.
The iceberg graphic below helps us to understand the nature of these emotional statements and the way that the visible (above the water line) versus unseen (below the water line) experiences of each partner fuel the negative patterns in the relationship.
What is Emotionally Focused Therapy?
Susan Johnson (2019) has shared that as she worked with couples early in her career as a therapist she recognized that methods such as teaching communication and negotiation skills to couples fell short of creating lasting change in the distressed dynamics that couples were dealing with. Johnson reports that when the survival system becomes activated, couples are just not able to access this information effectively to put these skill-based behaviors into action. But through her work with couples she also observed a phenomenon that did seem to create significant “shifts” in the relational dynamic between partners. As she tracked these experiences she noted that these shifts occurred when couples had opportunities in sessions to share vulnerable emotions such as fear, hurt, sadness, and loneliness in an authentic way as partners became increasingly able to be open to and responsive to these emotions. These experiences created bonding moments between partners that act as fuel for increased trust and ability to share these feelings in future moments. This observation became the spring board for the development of the 3-phase treatment model called Emotionally Focused Therapy.
If you’d like to learn more about the specific nature of EFT directly from Susan Johnson, take a look at this short video interview: VIDEO CLIP
The Process of EFT – What Should I Expect?
At the start of therapy the goal of your therapist will be to establish a positive, safe working relationship with both partners. In addition to this primary goal, the therapist will begin the process of assessing the relationship distress as described by each partner. The experience and even description of the relationship will likely be very different for each partner. Your EFT therapist may request one or more individual sessions with each partner as they work to assess the relationship. In this stage the therapist is gathering the information seen above the waterline in the iceberg graphic above.
The early stage of therapy will be devoted to identifying and understanding the negative interactional patterns within the relationship and the emotions underlying and driving these patterns. Partners work together with the therapist in sessions to understand their own emotions beneath their anger or withdrawal and begin to share them with one another. The therapist is beginning to explore and organize the information that is seen below the waterline in the iceberg graphic above. This process allows each person to make sense out of their partner’s behavior in new ways, allowing for new and different responses. As clients begin to make sense out of these reactive patterns the cycle of reactivity often begins to slow down and even shift naturally creating less conflict and reactivity in the relationship.
Towards the middle stage of therapy couples are increasingly able to access and talk about emotions in sessions with some confidence that their partner will be receptive and responsive to hearing and understanding their experience. The therapist is supporting the couple as they talk with one another about the emotions below the waterline. During this stage the therapist will continue to facilitate and guide these interactions, helping couples as they struggle to access their own emotion and to accept the experiences of their partners. This struggle is normal in the therapy process as couples continue to grow in their ability to access and share emotion. Clients will likely still fall into the old patterns, however they will become increasingly able to reconnect and quickly repair on their own as therapy progresses.
The final stage of therapy is designed to allow couples the opportunity to practice their new ways of relating to one another through new challenges and to celebrate all of the growth and progress they have made together as a team. The couple now understands the content both above and below the waterline of visibility and can more easily discuss emotions that live below that line most of the time. As couples are able to tell their story of healing they are able to describe their relationship in the “stuck” phase of distress, the process of learning to emotionally connect in new and healing ways, and the new experience of relating to one another in more secure ways (Johnson, 2011).
Where Should I begin?
If Emotionally Focused Therapy sounds intriguing to you and you’d like to explore possible next steps, here are a couple of recommendations…
I recommend just diving right in and getting started with therapy. It is important when selecting a therapist, that you find one that has specific training in Emotionally Focused Therapy. EFT trained therapists learn this model directly from certified instructors in a training process that is both rigorous and experiential. Look for a therapist that has minimally participated in a training called an EFT Externship, which is a 4-day intensive training with certified instructors.
With the assistance of a therapist, you can conquer the negative patterns that exist in your relationship and move forward together with new hope and a stronger bond.
Johnson, Susan (2019). Attachment Theory in Practice: Emotionally Focused Therapy (EFT) with Individuals, Couples, and Families. New York, NY. Guilford Press.
Johnson, S. & Sanderfer, K. (2016). Created for Connection: The Hold Me Tight Guide for Christian Couples. New York, NY: Little, Brown Spark.
Johnson, Susan (2011). Hold Me Tight: Seven Conversations for a Lifetime of Love. New York, NY. Little, Brown & Co.
If you are married or in a committed romantic partnership, the chances are very good that you have had a conflict with your partner that has left you baffled about how and why it became so intense so fast. It started with a seemingly small, “benign” issue such as a dirty dish left in the sink, a small purchase made without prior discussion, or an unexpected work commitment. It may have moved forward with a single comment, look, or even a sigh. And then before you knew what happened the two of you were both arguing as if your life depended on the outcome. You went from zero to 60 in just a few seconds. When the dust settles on moments like these in our relationships we are often left feeling confused, hurt, and discouraged. “What just happened? How did we get here? What on earth even started this? This is ridiculous. Something must be wrong with you, or me, or maybe us? Why do we end up in this crazy conflict pattern so often?”
If these incidents happen often enough in a relationship it can cause us to feel defeated, isolated, and disconnected from one another. Over time these feelings can even lead to depression and despair. What is really happening here? What is all of this about?
The Critical Nature of Secure Attachment
Researcher and psychiatrist John Bowlby pioneered the concept of human attachment theory in the 1950’s by studying the nature and impact of attachment relationships between children and their primary caregivers. From his work we know that attachment bonds are formed starting in infancy by a primary adult caregiver that is consistently attuned and responsive to the needs of the child. Bowlby (1958) proposed that attachment can be understood as an innate response system through which the caregiver provides safety and security for the infant. Attachment is adaptive as it enhances the infant’s chance of survival.
Culturally, it has been accepted that as children mature through adolescence and become increasingly independent from their primary attachment figures for care, they outgrow this emotional interdependency in adulthood. However, recent research by psychologist Susan Johnson and colleagues is expanding and extending our understanding of the importance of secure attachment in primary relationships across the entire lifespan. We now know that security in the bond of our romantic partnership/marriage leads to a multitude of positive outcomes for human flourishing. This research reveals that the security and emotional responsiveness within our primary relationships is one of the predominant factors in emotional health and well-being. Recent research tells us that these same relationships have a significant impact on our physical health as well, including measures such as heart health, blood pressure, gastro-intestinal health, and immune system functioning (Johnson, 2019).
We have a wired-in need for emotional contact and responsiveness from significant others. It’s a survival response, the driving force of the bond of security a baby seeks with its mother. This observation is at the heart of attachment theory. A great deal of evidence indicates that the need for secure attachment never disappears; it evolves into the adult need for a secure emotional bond with a partner. Johnson (2009)
When Negative Reactive Patterns Take Over
If you have had a few zero to 60 moments with your partner, you can probably tangibly recall the physiological distress you felt due to a fully engaged fight, flight, freeze response. Your survival system became fully activated. The good news is that, even though it feels terrible, THIS IS NORMAL and universally HUMAN. The discouragement you feel at being overwhelmed and helpless to these interactional patterns is understandable and it is a result of the reality that this relationship matters so much to your well-being; this person is so important to you.
When these reactive interactions begin to increase in frequency and intensity it can start to feel like the pattern of reactivity is taking over the relationship or that partners are no longer able to find their way out of these moments of conflict. The environment within the relationship can start to feel like a continual state of threat sensitivity and overreaction. Partners usually fall into predictable patterns of blaming and criticizing (fight), withdrawing (flight), or shutting down/going silent (freeze). Each partner has a mostly typical pattern that they default to when coping with the distress of these negative interactions. As these patterns develop and impact interactions between partners it sets up a “dance” or cycle that is predictable and somewhat rigid (Johnson, 2009).
The Way Out of This Vicious Cycle
Susan Johnson has pioneered the study and understanding of these patterns that are so frequent in adult romantic partnerships. Over years of working with couples and observing these patterns of behavior and also patterns of repair, she developed and formalized a treatment approach that is now being utilized in couples’ therapy with great success. This approach, Emotionally Focused Therapy (EFT), is empirically supported as a highly effective treatment protocol for distressed relationships but additionally for individual concerns. A secure, supportive, emotionally responsive partner offers much to enhance the health of each individual within the relationship as well.
In Part 2 of this blog, coming next week, I will explain the process of Emotionally Focused Therapy and how it helps to repair these painful patterns in relationships.
Bowlby, J. (1958). The nature of the child’s tie to his mother. International Journal of Psychoanalysis, 39, 350-371.
Johnson, Susan (2019). Attachment Theory in Practice: Emotionally Focused Therapy (EFT) with Individuals, Couples, and Families. New York, NY. Guilford Press.
Johnson, Susan (2011). Hold Me Tight: Seven Conversations for a Lifetime of Love. New York, NY. Little, Brown & Co.
Johnson, Susan (2009, January 1). Hold Me Tight. Retrieved March 9, 2019, from https://www.psychologytoday.com/us/articles/200901/hold-me-tight
She looked away as I asked her to tell me more. Her arms clutched the pillow, and I waited. But she was silent, isolating herself in her shame and refusing to let anyone reach her. Maybe you have been there, wanting so badly for someone to recognize the shame that you carry and for them to reach out with tenderness and acceptance. But you find yourself shutting down or lashing out as soon as someone gets too close to that part of you, because shame is insisting that your only safety lies in your ability to isolate.
Shame’s Agenda: Isolation
Likewise, the antidote to shame that entangles us is secure attachment, but the attachment and community that we long for becomes our greatest fear (Townsend, 1991). Shame works to cut people off from any source of healing, like a sentry guard that “cannot distinguish the enemy troops from the Red Cross” (Townsend, 1991, p. 168). As a result, relationships suffer; walls are built, and the bigger the shame grows. Thompson (2015) puts it this way, “’Shamed people shame people’” (p. 121, ebook version). Like a virus, shame rapidly reproduces and infects entire communities.
Hiding in Plain Sight
Some people are not even aware that they are hiding from connection. They love to be the life of the party and would much rather be in a large group of people than alone at home. But they have never experienced the emotional closeness with someone that requires them to be vulnerable about their fears and insecurities. One of the best places to hide is in a leadership position. Leaders can hide behind the cloak of expertise, power, and prestige. And unless, leaders seek out individuals with whom to be vulnerable, they can go through life very alone and cut off from healthy emotional connection.
Three key components of any attachment are that the attachment figure must be accessible, responsive, and engaged with the person’s emotional needs (Johnson & Sanderfer, 2016). In other words, in the case of a parent and child, the parent must be attentive to notice the physical and emotional needs of the child. But not just notice. The parent must consistently be timely in his or her response to the child’s needs and show in their response that they love and value the child unconditionally. If one of these components is missing in the relationship, the relationship begins to suffer.
In my previous blog post on anxiety (see blog “But What if?“), I noted that we never outgrow our need for attachment. If this need is not met through secure relationships, it will demand being met elsewhere. Townsend (1991) argues that bonding to nothing is not an option. People bond to work, substances, caretaking, technology, adventure, and so much more. The longer this need is not properly met, the more likely it is that the person will first condemn his or her need for attachment and then deny it. Thompson (2015) calls this shame’s narrative. It begins subtly enough by celebrating self-sufficiency, and it is reinforced then by others who are also carrying shame and admire your ability to be independent.
But if you are to begin experiencing freedom from shame’s grip, you will have to let other trustworthy individuals enter into your story. To sit with you in your weakest moments. To cry with you in your pain. And to not let you push them away. Maybe, just maybe, one of the most precious gifts you could give to those who love you is not your talents, or whatever else you take pride in, but your willingness to let them see you in your weakness and not run from it.
Johnson, S. & Sanderfer, K. (2016). Created for Connection: The Hold Me Tight Guide for Christian Couples. New York, NY: Little, Brown Spark.
Thompson, C. (2015). The Soul of Shame: Retelling the Stories We Believe About Ourselves. Downers Grove, IL: InterVarsity Press.
Townsend, J. (1991). Hiding from Love: How to Change the Withdrawal Patterns that Isolate and Imprison You. Colorado Springs, CO: NavPress.
Cherry Hill Counseling invites you to an interactive training: Harm Reduction Skills for Therapists. This training will offer Compassionate strategies to effectively assist clients with addictive and risky behavior, trauma, and other mental health issues.
Date: Thursday, February 21, 2019
Location: Lake Zurich Police Department, 200 Mohawk Trail, Lake Zurich, IL 60047
Cost: $25 for 1.5 CEUs (IAODAPCA) – Lunch will also be provided
To register email: email@example.com
Or call: 847-438-4222
This training is designed for psychologists, social workers, professional counselors, addictions counselors, graduate students, recovery coaches, and patient advocates.
This training will explore the current revolution in addiction treatment. This consists of moving away from the disease model toward a bio-psycho-social process model for understanding addiction and a shift from an abstinence-only to an integrative harm reduction approach to treatment.
Current status of addictive behaviors and treatment
Description and clinical rationale of integrative harm reduction approach to treating substance misuse and other risky behaviors
Bio-psycho-social model that considers the role of meaning, habit, relationships, social context, and biology
Specific skills and strategies applicable to each therapeutic task