Ellyn Bader

When you apply the Developmental Model in your work with couples, sometimes you will encounter issues that add an extra layer of complexity. Examples of this include addiction or severe depression. An even more common example is when one partner struggles with a severe anxiety disorder.

This month let’s look at some ways to begin a session when you encounter a couple with a very anxious partner.

When one partner is extremely anxious, the process of defining what belongs to each partner can be frustrating and quite confusing. You will notice that if you are trying to encapsulate each person’s issues, the anxious partner will continue to circle back to anxious thoughts he or she has. 

You may start to question what type of therapy makes sense. Are you able to do effective couples work? What is possible? How do you disrupt patterns that you know are keeping the relationship stuck?

First, assess whether the anxious partner has been properly diagnosed, and if the client is getting direct help with their patterns of managing anxiety. This is especially important now as there is reality to the external threat of Covid-19. 

If there is an individual therapist or a psychiatrist managing medication, can you collaborate with them? How do they view successful anxiety management for this client? Do they understand the work you will be doing with the couple and why? Will they support you when you ask your client to attend to issues that are part of healthy couples development?

If so, one of your first challenges will be explaining and keeping your couple focused on early differentiation work at a level they can tolerate. Now that couples are spending more time at home together there are multiple opportunities to strengthen their differentiation. It requires skill and practice to learn how to do so without overwhelming the anxious partner. 

You can start by providing solid education. An anxious partner often perceives all anxiety as bad anxiety. He or she may not be able to see the possibility that growth comes from anxiety and discomfort. This is a pathway you can illuminate for them.

Describe the Four Ways Anxiety Keeps Couples Stuck and Inhibits Growth

  1. One partner is anxious, and they respond to their anxiety by collapsing easily, giving themselves up and merging with the other person in order to mitigate some of their anxiety. This results in underlying tension, anger, and martyr behavior.
  2. One partner feels anxious about a particular wish or desire and does not feel entitled to their own wishes/desires. Instead they describe their anxiety as a joint problem. This makes it hard to know what part of the anxiety sits with the person who’s raising an issue versus what part if any might belong to the other partner. Any risk that would be required to pursue an individual desire is then stifled and growth stops.
  3. A partner who is anxious and uncomfortable dominates the relationship with their anxiety, getting the other partner to merge with them and give themselves up. The anxious partner may have dominated choices the couple has made for years. This results in secondary gain and the spouse tiptoeing around out of fear of increasing the anxiety even more. Over time, this results in the couple having fewer choices and a smaller life.
  4. The anxious partner becomes increasingly passive. They take little responsibility for managing their own anxious thoughts. Instead, while their passivity persists the other spouse will over-function. This may start as a loving gesture, but as it continues resentment builds. Both partners lose the ability to know when a legitimate threat exists and when anxiety can be endured, leading to growth for both partners.

How to Structure Sessions When Anxiety Is Present

When I’m working with a couple where I recognize these types of dynamics, and one partner  presents an issue, I often ask myself several questions to help me figure out how to structure that session:

  • Is the issue that’s being presented a typical problem that a couple would have and that makes sense for them to be working on together? In our work, I want them to bring up some things that are normal, real, and would be part of any couple doing early differentiation work. So, do we have that kind of problem today in what is being tentatively raised?

In this time of Covid-19, typical examples would be:

    • Developing household routines
    • Is grocery shopping okay or should food be delivered?
    • Talking about money stress and budgets
    • Managing time apart and time together
  • Or, alternatively, is the issue that’s being presented carrying an underlying message of unhelpful symbiosis? Is what’s being presented designed to get the other one to go along with something that will inhibit their growth?
  • A third option exists. The couple is engaged in healthy dialogue about real and challenging decisions. Real growth is already occurring in what the couple is telling you. They just don’t recognize their own growth. Here, you will champion their growth. You will support the couple by describing that they’re doing something new and different – something that’s good, and healthy, something that will change their dynamics and contribute to their growth.

Differentiation is both an internal process and an interpersonal process. The interpersonal part is where it gets especially messy and challenging with anxious partners. For them, anxiety has always signaled a threat! They don’t have experience tolerating tension and creating the space to handle real issues and real challenges.  

Beginning differentiation may mean you describe that they each want something different and nothing is wrong with having different desires. In fact recognizing differences is a first step in healthy couples development. Instead of avoiding these emotions and these differentiation moments, you will be helping them tolerate discomfort for long-term growth. 

Because you’re working on disentangling a lot of ongoing enmeshment, it will take time for each partner to develop the emotional capacity to do this without you. It doesn’t come easily. It doesn’t come naturally. They may spiral into confusion or uncertainty. It will take an enormous amount of structure, lots of repetition, and lots of reinforcement to disrupt their symbiotic patterns.

But you remember, differentiation matters. Anxiety is not always a negative threat signal. It’s the territory where couples learn how to build a solid sense of self as well as long-term intimacy and connection, so their relationship flourish and grows.

Please comment below. Are you seeing anxious partners facing differentiation issues during quarantine and shelter in place? What issues are you seeing these partners tackle?

 

About 

Ellyn Bader, Ph.D., is Co-Founder & Director of The Couples Institute and creator of The Developmental Model of Couples Therapy. Ellyn is widely recognized as an expert in couples therapy, and since 2006 she has led innovative online training programs for therapists. Professionals from around the world connect with her through internet, conference calls and blog discussions to study couples therapy.

Ellyn’s first book, "In Quest of the Mythical Mate," won the Clark Vincent Award by the California Association of Marriage & Family Therapists for its outstanding contribution to the field of marital therapy and is now in its 18th printing. She has been featured on over 50 radio and television programs including "The Today Show" and "CBS Early Morning News," and she has been quoted in many publications including "The New York Times," "The Oprah Magazine" and "Cosmopolitan."

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Please Comment ↴

  1. Yes, yes, yes. All of this is extremely helpful in picking apart the dynamics in the couple relationship AND remembering that the overlay of COVD19 anxiety, whether conscious or existential is SO important. I am seeing both individuals and couples in therapy who are underestimating the impact of the global impact and anxiety that dealing with COVID19 is having. It is not an excuse or singular explanation, however it absolutely has a major impact on pre-existing issues – quite a revelatory energy. Thank you!

  2. This is super helpful for me right now. I’m seeing a couple where she has Panic D/O and he is struggling with alcoholism. There was an awesome moment during an I-I when she was speaking about all of her anxieties and I simply directed her to talk about her feelings. In an instant she became calm and focused in a way I had not seen happen before. She was beginning to self-define, maybe for the first time in this marriage. Her husband was deeply affected by her vulnerability and probably tuned in to her in a way that he hasn’t been able to before. An awesome growth moment!

  3. I am so looking forward to this. Especially challenging when the person with anxiety refuses to take meds or see another
    clinician to work more extensively with the pre existing anxiety
    before an affair that brought them in …. I’m looking forward to this session very much .

  4. Excellent reading. I lead a men’s addiction recovery group weekly and anxiety management as it relates to family structures and relapse is certainly a topic I address. These guys are in a four month in house recovery program. The last 21 years of my career was in hospice work. Every family had various levels of anxiety addressing dying.