A common scenario that many of us see in our practices is the over-functioning wife with the anxious-avoidant husband. He is a highly anxious procrastinator  and is often not accountable for what he says he will do.

Working with this dynamic can be challenging because of the extensive intrapsychic issues that exist with the longstanding painful pattern of avoidance and criticism  between the two partners. Last past month in my online training program, a therapist presented a case with this pattern.  Here are just a few of the challenges presented by the husband:

• He self-sabotages and doesn’t stick with anything.
• He has social anxiety and has difficulty looking for work.
• He smokes pot to manage his anxiety and fear. Chronic pot smoking prevents him getting motivated to do the things he wants to do. He uses his chronic substance dependency to sabotage his efforts to do things and he has a hard time committing to giving it up.
• He has never been faithful in relationships.
• He has an approach-avoidance relationship with his mother. He can speak to her freely on the phone but can not tolerate being with her.

Pete did a role play, transcribed  below, to demonstrate how to start uncovering the value of his anxiety.

Husband:  I don’t know, I think sometimes anxiety gets to me – social anxiety. I have things that build up in my head that aren’t true. I think of turning my application in and talking to someone. I think of a million reasons why I shouldn’t. It’s not that I don’t want to. I get real bad social anxiety about how the person is going to deny my application anyway. I can talk myself out of things. It’s my fear of failure without trying. I get caught in these cycles.

Pete:  First of all I appreciate your insight and your awareness on this. Good for you. You may not even fully appreciate the value of your anxiety. Do you have any idea what I’m talking about, that your anxiety might serve a useful function?

Husband:  No.

Pete:  Wow, well if I share my observations how it might be useful. Is that ok?

Husband:  Sure.

Pete:  Think about this for a minute. If you get anxious, what happens is you don’t move forward or take action. Is that right?

Husband:  Right.

Pete:  And if you don’t take action, then you don’t risk getting what kind of feedback?

Husband:  Negative feedback.

Pete:  Yes, negative, painful, critical, judgemental feedback. If you don’t take action you avoid that negative feedback. How much negative feedback did you get growing up?

Husband:  Lots.

Pete:  Lots. So if I’m in your shoes I don’t want to put my finger back in that pencil sharpener again and risk emotionally getting rejected, humiliated, or embarassed with negative feedback. So as painful as it is not to take action, it’s even more painful to take action and get that kind of rejection. So in one sense, I imagine  your fear serves a positive purpose for a part of you…                                                                           What do you begin to feel as I say this to you?

Husband:  Wow, you’re completely right. It helps me this way.

Pete:  Fear often serves a purpose for some  part of us, and you got such a belly full  of criticism, rejection, beatings, no wonder a part of you says, “I don’t want another helping of this.” So if I’m in your shoes, why would I want to sign up and risk another helping of that? I don’t think I would.

Husband:  That’s exactly what happens.

Pete:  Yeah, now here’s what’s interesting. We can go back  to some of those early times in your life when you felt that fear –  that huge painful judgement –  and I can help you  take some of the pressure and pain out of the emotional brain so you can remember without as much emotional intensity from that memory. This may free you up to take more action that relates to what another part of you wants to do to get on with your life. How does that sound?

Husband:  That sounds great.

Let’s review what is behind Pete’s interventions.

First he does the unexpected. He gives the husband a compliment (being insightful) instead of jumping in immediately to challenge the symptom of avoidance.

Then Pete proceeds to uncover the positive element of the anxiety instead of approaching the problem head on as something that needs to be mastered or controlled. He asks the husband if his anxiety might serve a useful function.

It is rare for partners to appreciate the usefulness or value of their symptoms. Internally they create a struggle in an attempt to dominate or eliminate the symptom. This dynamic is unfortunate as it mostly increases their distress.

Sometimes therapy minimizes the value of the symptom and focuses on more empowered thinking as a better way to cope. But minimizing the protective function of the symptom paradoxically slows down the incorporation of new perspectives.

When Pete asks if he could share his observations, it subtly suggests that the husband is in control and has the power to say yes or no. The reality is almost no one will say no. However, Pete is sowing the seeds to create effective collaboration. So far Pete’s interventions are subtle and nuanced but they add up to making substantial inroads in a short time frame.

Pete then says, “Think about this for a minute.” Basically Pete is instructing him to get out of a helpless emotional state and shift to more effective engagement.

Pete asks what kind of kind of feedback the client avoids. Pete continues to engage the thinking brain and reduce the regressive pull into victimhood. He empathically embellishes and justifies the client’s desire to avoid negative, painful, critical, judgemental feedback.

Then Pete makes the connection between the client’s current avoidant symptoms and his early life experiences, connecting the dots and describing why his symptoms have a positive intent.

Next Pete checks out the impact of his interpretation by asking the client what he feels.

Pete continues to describe the value of the symptoms which potentially helps reduce some of the shame and guilt. Then Pete sets the stage to do two-chair gestalt work along with EMDR or energy psychology work to enable the two alter egos to be collaborative instead of adversarial.

In summary, it is a skilful example of helping a client move from resistance, shame and passive-aggression to effective participation in therapy. Pete makes it look effortless.

He repeats the process later with respect to a different issue – potential infidelity. I’d like to share Pete’s explanation and then use it as a springboard for discussion.

Pete says, “The part of you that’s afraid you’ll be unfaithful is understandable, and one of the ways I understand it is that thinking about infidelity gives you an escape hatch from having to depend on your wife. You feel less trapped. It’s totally understandable. One part of you really wants to connect with your wife and do things differently and another part of you gets so scared. You start getting really tight around the collar when you think about being trapped, you hear ongoing criticism. And there’s no way out. Infidelity is your escape hatch – it’s totally understandable that a part of you would feel that way.”

Do you think Pete’s explanation will help stimulate change? Why or why not? Can you think of other situations where couples might benefit from your explaining the value of their symptom?

I always look forward to reading your responses.

A special thanks to Jozeffa Greer, a Sacramento-based Couples Therapist, for bringing this case forward.