Couple-holding-hands-001Attuned Relationships

A woman we have seen for years, who has been experiencing a strong sense of disappointment and loss because her highly anxious mother was never able to really attune to her needs, told us that her son who is about 7 years old, recently told her that he felt deeply disappointed that she was not giving him what he needed emotionally.

Our conversation turned to the topic of this universal wish for a perfectly attuned relationship and resulting disappointment. The closest we get to this level of desired attunement is right around birth when we are completely dependent on our parents; if our parents are relatively present and healthy. As we mature and become more independent, increasingly able to stand on our own two feet, there is an increasing and healthy distancing between us and our main caregivers, which contributes to maturation.

It was a difficult conversation because she had trouble with these two facts:

  • It is not possible to be perfectly attuned, It would require mind reading and completely giving up caring for their own needs.

  • If it were possible to provide that perfect attuned response, the other person would never learn to deal with disappointment and to live independently, which is not good or truly helpful.

Another woman, also a mother, was talking about her disappointment in her husband and how often he fails to respond to her needs. This led to a frank discussion about how disappointing I am as a therapist sometimes. The tricky part of that conversation was that she had to deal with truly horrendous absences and lapses on the part of her parent. She has done a heroic job trying to provide security for her daughter. When I suggested that the strongly unrealistic wish for perfect attunement was a barrier to getting the positive things that she could get from relationships, she became extremely upset and angry.

Finally, one of the people we saw was a young man who commented that Beauty and the Beast offers a terrible lesson to children: the idea that it is possible to really transform another person and to make up for their failings by providing love.

All of this is not to say that it is not important for parents and partners to try to be as empathic and attuned as possible (or for that matter, benefit). It is a recognition that the wish have a perfect relationship is an impossible one and, to some extent, a dangerous one.

Making New ConnectionsUnknown

Thanks to neuroplasticity, the brain has the ability to rewire and make new connections. According to Linda Graham, MFT in her article Bouncing Back :Rewiring the Brian for Maximum Resilience and Well-Being, we must follow the 5Cs of coping: calm, clarity, connections to resources, competence, and courage.

I took particular interest in her description of connections to resources. Graham believes that having a sense of bonding and developing healthy relationships with others increases our ability to be resilient in times of trouble. Relationships allow us to reflect on what we like about ourselves and feel as if we have a place in the world. It is the interactions with the mature prefrontal cortices of different human beings that allow our own prefrontal cortex to grow and repair.

However, there is a catch to the positive effects of relationships on resilience. The relationships must be positive and made with other resilient human beings. Spending time with people that do not demonstrate resilient traits will not lead to the improvement of our own resilience.Although we may be unaware at the time, we mirror the actions of those around us. If someone we are close to is very resilient, we are likely to mimic his or her behavior.

These role models are described by Graham as true others. True others are people who appreciate the essence of who we are. They accept our faults and embrace our inner goodness. Being around these kinds of people allows us to engage in self-love and learn to move forward in life, reborn with resilience.

Resilience allows individuals to take on different challenges with a positive and confident attitude. With a good support network and loving relationships, many problems in life will turn from mountains to molehills.


Right in the midst of working with a young woman who has been struggling with how to accept the possibility that a new relationship might have to end (her boyfriend is still caught up in thoughts and feeling evoked by his ex, who sounds like the kind of intense woman who can easily trap a young man in a prolonged on and off kind of relationship), we received an email from Rick Hanson that is all about possessiveness in relationships, beliefs, and life and how it destroys life and love.

The post is called “Cling Less and Love More” and it talks about how we can examine this experience and perhaps change it.

Rick has this to say about that perpetual wish to control and how it destroys the very things it seeks to preserve –

Recognize the costs of clinging. It’s never relaxed and always has a sense of strain, ranging from subtly unpleasant to intensely uncomfortable. It sucks us into chasing problematic goals, like stressing out for success, getting rigid or argumentative with others, being hooked on food or drugs, or seeking rewards in relationships that will never come. It clenches and contracts rather than opens. And clinging today plants the seeds of clinging tomorrow.

We were reminded of the book “The Collector” by John Fowles. It is the story of a man obsessed with “collecting” people, things, relationships. In order to preserve these lively, beautiful, and ever changing things, he had to kill them.

We also recalled the writings of Eric Fromm, who talked about the impulse to control as ultimately destructive to all that we value in life, and most especially to love.

Rick wrote that –

Most fundamentally, clinging puts us at odds with the nature of existence, which is always changing. The American Buddhist teacher, Joseph Goldstein, likens the stream of consciousness to a rope running through your hands: if you cling to any bit of it, you get rope burn. But if you let it run free – if you let experiences come and go – you feel peaceful and happy. Your mind and body open, and love flows freely, the natural expression of the unclenched heart.


Freud came up with the term libido to describe the sum of all the human instincts related to love.

In his view, there was a limited amount of this libidinal energy and it was important to use it wisely. Invest it in the wrong activities and you could end up with nothing to show for it. This notion of limits and scarcity seems to suffuse Freud’s thinking and could perhaps reflect a somewhat depressive aspect of his personal character.

Later, Carl Jung expanded the meaning of the term to encompass not just love and sex, he felt that libidinal energy was really life energy.

I have been thinking about life energy for a while. Noticing how there are some people who seem to overflow with it, how it crests when people are manic and falls when people are depressed, but also how illness and aging affect it.

I met with an older attorney this afternoon. He’s a delightful widower who recently returned to world of dating. One of the challenges that he has had to face is the reduction in his capacity for sex. This is a very important issue, pleasure and libido has always been important to him.

There is a strong relationship between life energy, pleasure and vitality, not only psychological vitality, but physical health as well. One of the observations that I have often made about people who are getting older is that the decline in their physical health is often preceded by a decline in their life energy, their interest in creative and pleasurable activity, traveling, sex, romance, etcetera. I think this may not be a coincidence.

Recently I came across an intriguing study that suggested that levels of gonadotropin releasing hormone (the brain hormone that regulates the levels of the sex hormones estrogen and testosterone in the body) correlated with memory and brain function. Of course, this intriguing finding is no more than a tantalizing hint about how libido and aging may interrelate.

Another interesting relationship is between exercise and life energy.

Recently, the New York Times ran an article highlighting new research that shows how exercise radically affects how our genes are transcribed. This provides a biological explanation for the long noticed fact that continued exercise, or physical activity, is one of the most important predictors of healthy aging. Physical exercise is, in fact, a better way of preventing brain atrophy than doing puzzles or challenging the brain in other ways.

Talking with the widower attorney, I noticed that his reduced sexual ability correlated with a shift in his mood towards a mild depression. Along with that shift, had come a noticeable reduction in physical exercise and how much he was involved in pleasurable activities such as going to concerts and listening to music.

I suggested that he might focus on reversing some of these changes (getting more physically active, going outdoors more, doing more pleasurable things) before he turned to focus on the more purely physical aspects of sexuality.

Freud’s notion of a limited amount of libidinal energy seems clearly contradicted by the evidence that the more we do, the more active we are (in many spheres and dimensions) the more we seek and use life energy, the healthier and stronger we are. In other words, husbanding our energy, leading more and more constricted and constrained lives, is exactly the opposite of what science suggests leads to long life and health.

Getting Alongimages-1

Asked to talk about why things are going better with her husband, a woman who has wrestled with depression for many years says that he is suddenly doing things that make her happy. She really enjoys it when he does work around the house. She remembers how she was attracted to him because he was so handy.

Later on in the conversation we are talking about how different she finds it working with her boss, who is very good at recognizing her unique abilities, as opposed to her husband, who tends to get frustrated that she can’t do things that he finds easy – for example, things involving spatial ability – seeing complicated drawings in 3 dimensions. She notes that he is “very good with people…” and again it seems to me, listening to her, that she is at the mercy of whether or not the person she is spending time with values her.

Ten minutes later, as she describes how she has been really recognizing her husband’s work around the house, and I can see from her smile and excited way of talking that this enthusiasm is really infectious, it occurs to me that she is actually pretty “good with people…” and in particular is usually very generous in recognizing each person’s unique contributions and strengths.

So I point out that probably some of the good feeling that she is experiencing because of her husband’s rekindled interest in working around the house is probably due to how she has expressed her appreciation for that effort. In other words, I point out how she has some influence or control over what happens to her.

She changes the subject to another topic which is along the same lines as her original observation – another way that she is benefiting from her husband’s changed behavior.

This tendency of depressed people to not notice the influence and control that they do have on the environment has been most articulately described by [CBASP REF].

Changing this pattern is hard work… but it is worth it. Because when someone starts to notice how the “glass if half full” (they do have some control) it leads to a pattern of behavior that prevents further depression.

images-2Moving Forward after a Bump in the Road

I’ve been working with a very successful attorney who has been struggling to find a way of staying in his marriage for a couple of years.

The heart of the problem is that his wife had a serious health problem (which is now resolved), but through the process of dealing with this health problem she became depressed and discouraged about her health and had to face the fact that she probably would not ever have children. She is a very different person now than she was when they married four years ago. She does not take care of herself physically, she feels unattractive, and they have had no sex for three years.

He is in his late 30′s and it is difficult for him to imagine never having a sexual relationship again. On the other hand, they love each other, and both of them feel a great sense of loyalty towards each other.

She has resisted his suggestions that she get a psychiatric assessment. She did go see a counselor for a few sessions, and the two of them have been going to couple’s therapy for the last six months but that seems to be, by mutual agreement, not going anywhere either.

Thinking about this dilemma once again reminded me of how much context influences our ability to solve problems.

This young man is a supremely competent negotiator.

But he has never approached this problem with the kind of energy and determination that he might show when tackling a difficult work situation. The pattern between the two of them has been that he would try a little to make things better, and then get discouraged and stop, then she might try a little and quickly get discouraged and stop. There was never any ability to make a consistent effort.

Thinking about the strange feeling of disempowerment that he experiences trying to resolve this problem got me to thinking a bit “outside of the box.”

They had identified they had a relationship problem and gone to see couple’s counseling but that hadn’t worked. Was I missing a creative solution, I wondered as we talked about where he stood.

It occurred to me that the principles embodied in at least three books by Kevin Leman (New Kids by Friday, New Teens by Friday, and New Husband by Friday) might be useful.

These books have at their core certain principles of how one goes about changing behavior.

Dr. Leman suggests that behavior doesn’t change as the result of fights. He strongly encourages people to avoid overt conflict with their kids or partners.

Behavior changes because good behavior gets rewarded and behavior that is not so good results in the loss of a reward.

The example he gives is of a parent with a child who spits her food across the room. The parent doesn’t say anything but leaves the room and leaves the child alone.

The lesson is that if you misbehave your parent goes away for a while.

This approach is much more powerful than fighting or arguing or punishing.

It also requires more effort. You have to think before you react.

But it is my experience that if you consistently apply these principles to close relationships things do indeed improve

Relationships and Mood Disorderskiss

The wife of one of the people I work with sent me a short note saying that her husband was energized (not quite hypomanic), and she was finding it hard to cope with his constant animation and enthusiasm.

It got me thinking about scale and how we constantly change the way we talk based on our audience.

I am in a good mood today, but if one of the people I will see today is feeling sad, I will have to quickly shift gears to match their energy.

The self-monitoring that is required to scale back from a very animated state to one that is more subdued is something that is harder for someone who is in an energized or hypomanic state. I have talked about this as a loss of the awareness of “risk” in the choices we make, but it is more than that, it is also the loss of awareness of potential irritation or upset feelings in another person.

The good aspect of this loss of awareness is that too much awareness of potential irritation or upset can make us immobile.

The difficulty that her husband faces with email when he is depressed is a pretty good example of that. His inbox gets filled with messages, and he feels helpless to keep up.

I suspect that he gets caught up in thinking about all of the potential misunderstandings that could emerge out of an email answer. Will this person understand what I am saying, will it be helpful, should I write it at all…these are all examples of thoughts that get in the way of taking action and expressing oneself when one is depressed.

This is why hypomania is often associated with periods of great productivity. Who cares what the world thinks, I have a great idea to share….

This is not just a problem of dealing with someone who is bipolar. A lot of what happens in a family or in friendships can be seen as a problem of scale.

My son comes roaring into the house after an exciting game and I am sitting in my office reflecting about a troubling conversation with a patient, there is a huge mismatch between my ideal level of energy and his. Sometimes I will be so caught up in what I am doing that I have to set a firm barrier to avoid what almost feels like a physical pain to me.

Or I wake up in the morning filled with energy and enthusiasm, but my wife is feeling a bit sad about some news that she heard about her beloved aunt.

There isn’t necessarily a “right” level of energy, although generally intimate conversations more often have a small scale and conversations with more people usually need larger volumes and levels of energy.

But there does need to be a way of talking about mismatches in energy… and a way of dealing with patterns of mismatch.

As my son has entered adolescence and as I have gotten older I find that we more often are in different places in terms of level of energy. I have responded by trying to schedule activities that I can “psych up” for which are loud and boisterous (to meet his needs) and I have been similarly looking for quieter activities that I can get him interested in.

When there are mismatches it may be necessary to put more time and energy into planning activities, whereas when two people have the same level of energy things can be more “spontaneous.”

And it may be necessary to spend more time apart.

This is sad for me. But I don’t see a way around it. When I am doing something that requires quietude I can’t have my son racing around the room or playing loud music.

The challenge that this woman faces is that her husband’s level of energy varies much more than most people’s. This sets them up for more frequent disappointment.

Her husband may be filled with enthusiasm. He wants a companion who can match his excitement, but his wife is not feeling that way. She may be wanting some intimacy and gentle conversation and he is not able or willing to scale down his energy to match that need.

In this kind of situation it is easy for most of us to fall into the trap of feeling that we have lost a special quality of the relationship forever. “My husband is never going to be the wonderful and sensitive person that I married….”

That isn’t true, he regularly shifts mood from hypomania to mild depression. And when he is depressed he is much more attuned to her needs. But in the moment it can feel that way.

I suggested to the wife that she pay some attention to how she can support herself psychologically in order to avoid getting caught up in the sense of overwhelming sadness that comes from feeling that the two of them won’t ever experience the magic of a quite moment of intimacy again.

One of the values of journaling is that it allows us to more easily remember recent times when things were different.

At the same time, there needs to be a way of expressing the feeling that something is missing from one’s life when one’s partner has been filled with energy and enthusiasm for weeks in a row.

It might make sense to try to find some time to review the previous week… Begin by recognizing things that are positive, but also talk about what is not working as well. How else can your partner see the whole picture of how moods work and what their effects are? Most people with bipolar welcome a chance to “debrief” because they very much want to preserve their intimate relationships.

car-accident-liability-and-faultWho is at Fault?

“Is it my fault?”

This is one of those questions that seems to easily dominate conversations between people in a romantic relationship who are having trouble getting along.

It is also a question that is usually impossible to answer (who decides? what standards do you use?) and quite unhelpful.

I was talking with a recently married woman yesterday about her problems with her husband. In the middle of the conversation it occurred to me that the discussion more or less assumed that who was at fault would then determine who would have to change.

That seems “fair” somehow, but it may not make any sense. For example, it is easy to imagine a scenario in which the person who is “at fault” is not the one who is able to make a change… Someone while drinking gets severely injured and is no longer able to do the household chores that are his responsibility.

Whose fault is it is really about figuring out who is to blame for the failure of the relationship, and might be relevant or interesting in summarizing the experience after it is all over, but is quite unhelpful when the goal is trying to see if things can be made to work out.

In fact, since every relationship has rocky times, we suspect that one of the key attributes of a relationship that is going to last is the ability to focus instead on problem solving when things in the relationship get rocky.

The trouble with problem solving is that it involves risk, and a level of honesty that might seem uncomfortable. For one thing, you have to be thoughtful about what you can do to make things better, and the demands that you have of your partner that might be unrealistic. And in the heat of the moment you might prefer to adopt the stance that there is nothing that you can do…

Ultimately, though, the risk of doing that is not only that the relationship might fail, but also that you might end up convincing yourself that you are really as unable to make things better as you said you were.

In other words, you might find yourself trapped in a depressive stance (there is nothing I can do, I have to hope that I find someone who will be incredibly chivalrous and never take advantage of me, or get angry at me).

Your anger at your partner (it is all his fault, I am not going to do anything for that jerk) can morph into feeling helpless.

Problem solving might not be effective (after all there is only so much one person can do) and there is a risk of getting trapped in what has been called a “co-dependent” stance (I will do everything to make things OK for the other person).

The solution is to make sure that you have an opportunity from time to time to review whether the relationship is worth it (in other words, pause from time to time and consider whether on balance the relationship is reciprocal, the other partner is doing their part, etcetera). This review is usually best done either on your own or with the help of someone (other than your partner) who you trust (a therapist, a really good friend).

At the end of this process you will be able to feel good about having done your best to make things work. You won’t have second thoughts about whether it could have turned out differently (if the relationship doesn’t work out). And you won’t inadvertently have placed yourself in the helpless position, fearful about any future relationship.

The Scapegoat Scenario2735666916_scapegoat_answer_2_xlarge

I had a conversation with two women today about their relationship with their husbands and children. They often find themselves feeling scapegoated for things that go wrong in the household.

While I was talking with them, I recalled many other women who have described similar experiences. I started to wonder how this happens, and what can be done about it.

Both women, for different reasons, had developed a tendency to look for problems in their relationships (always scanning the environment to find the evidence that someone was not happy), as well as a tendency to blame themselves internally for those problems. At the same time they resisted the suggestion that they might be responsible when it came from others.

We were intrigued by was the way that the internal scapegoating (blaming themselves) contributed to and, perhaps, made possible the family’s scapegoating of them. In other words, the fact that they told themselves that perhaps they were flawed and inadequate as people, wives, mothers, facilitated or made possible a process whereby their husbands and children tended to project onto them blame for things that they really didn’t have anything to do with.

One of the women assumed that what I meant was that she was responsible for the scapegoating. She got irritated with me.

I tried to make it clear that I wasn’t saying that she was responsible for what was happening, but I thought that there might be things that she could do to change the cycle. The first thing was to reject the internal scapegoating. To have a realistic appraisal of what she contributed to the problems in the family that was not black or white (feeling totally responsible, or denying any responsibility).

To have that realistic appraisal (I might be contributing to the problem in this way, but my daughter is doing X and my husband is doing Y), (and to be comfortable with considering what she might be doing), she needed first to silence the harsh internal critic that thought she was probably entirely at fault. Because what motivate the denial was the need to fight back not so much against her family’s blame but against her self-blame.

If she could do this I thought she might be able to interrupt the cycle and model more mature behavior for her children (and perhaps her husband) – very rarely is anything entirely one person’s fault.