O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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What to Do After a Fight and How to Repair

One of the most important skills you can learn to better manage conflict is how to make a repair AFTER you’ve had a fight, big or little. I’ll tell you right now, just saying you’re sorry is not going to cut it. In fact, even if you do get off the hook by simply apologizing, you won’t learn anything about how to improve things in the future. In my work with couples, we’ll take several sessions to build a kind of template, the “Aftermath of a Fight” exercise. Developed by Dr. John Gottman, the technique gives a way to talk over emotions and background issues after a recent argument in a more compassionate and productive way. By recent, I mean some time after the fight, when you’re no longer flooded with feelings.

Making Up After A Fight

Although at first you may feel awkward, you’ll find that the exercise becomes more automatic with practice.  You won’t have to go down the same rabbit hole with every disagreement. You’ll be able to understand each other better, and not just repair the current situation but also help prevent future arguments.

The guiding idea of the Aftermath of a Fight exercise is that there is no absolute reality in any relationship conflict, but rather two subjective realities or points of view. Both are right. By using the six key components of a post-fight debriefing, you’ll have a  help you to process without getting back into the fight.

“There is no absolute reality in a disagreement, but rather there are two subjective realities and points of view”

Aftermath of a Fight or Disagreement Debrief

Let’s look at each of the 6 key components for making effective repairs after a fight:

  1. What were your feelings during the argument?
  2. What was your subjective sense or reality about the argument?
  3. Can you find something you can understand about your partner’s position?
  4. Are you flooding as you talk about it during the debrief?
  5. Admit your role. What was your contribution to the fight?
  6. How can you each make it better in the future?

Step 1 is to describe what you were feeling during the argument. It’s important to follow the rules of active listening by using “I” statements — that is, describe simply how you feel without blaming your partner. So, you’d say “I felt worried,” not “You worried me,” or “I felt lonely,” not “You made me feel lonely.” Saying “I felt like you made me feel…” is cheating!

Also, keep Step 1 brief. Avoid the temptation to explain at length, justify yourself, total up points, or add a laundry list of grievances. When that happens, I gently stop the partner and remind them to just say, “I felt” — fill in the blank. PERIOD. Long explanations just make the other partner defensive and get more flooded all over again. Yes, it’s very hard to own your own stuff, and much easier to project onto your partner. But I’ll tell you, that won’t get you anywhere but two steps backward.

I can’t tell you how often I’ve been with couples and seen how, as they listen to their partner express their feelings in a clear and non-blaming way, they react with much deeper empathy and understanding. This alone makes a huge difference.  

In Step 2, each of you  expresses your subjective reality or point of view in a couple of sentences. Sometimes condensing and consolidating your experience during the fight is an art in itself, because so often we want to bring in everything else that has angered us over the last months, or years! Step 2 gives  practice in knowing yourself and using mindful attention to be concise.                                

Step 3 is about empathy: how well can you understand your partner’s point of view? It can be hard to put yourself in someone else’s shoes — even, or maybe especially, your partner. You want to be able to say“I can see how you feel” about such and such, or “It makes sense that you can feel that way.” 

In Step 4, you check in with yourself to determine if you’re getting flooded. Many times when couples debrief after  a fight, they just get angry all over again, defeating the purpose.  In therapy, I might ask at this point if anyone is flooded. If so, Iwe stop the exercise for a few minutes until they can bring their heart rate down and then they can reengage in the discussion. This may seem like a small or unnecessary thing; even experienced couples’ therapists can neglect it. But believe me, it’s crucial.  Again, for more information please see my video covering this topic.

Step 5 is admitting how you contributed to the fight.This is one of my favorite steps; from my work with couples I can say that this alone is eye-opening for both people. It’s also  something you can take with you into any other relationships with family and friends. 

Admit your role! It is essential that each of you takes some responsibility for what went wrong during your discussion and what made it go sideways. As with Step 1,  you’ll also use a simple, brief sentence. For instance, you might say something like “I’ve been very stressed,” or “irritable,” or “overly sensitive,” irritable,” or “I haven’t expressed much appreciation toward my partner lately.”  Or “I need to be alone,” or “I haven’t made time for good things between us.”

So often in life we get caught up in being busy,  or stuck in our resentments, and we don’t reach out to our partner. Then we’re surprised that they have no idea how we’ve been feeling! The common denominator of Step 5 statements is that they fill in the blanks and show the backdrop to what contributed to the fight.

Finally, in Step 6 you consider how you could do better next time. So, you ask yourself very directly, what is one thing my partner can do differently next time? And what is one thing I can do differently next time? Answering these questions takes some emotional intelligence, first to figure out how you can ask directly for what you need, and then  to accept what your partner says would help them.

This is very different from just saying “I’m sorry we got into an argument last night.” I won’t kid you that this is easy. Even though it’s easier in a therapist’s office, it still takes practice at home. I also want you to remind you that this repair never works if you get flooded again. That’ll just reignite the original fight, and if this pattern continues, you’ll only compound your difficulty managing conflict and build even more negative feelings about the marriage and your partner.

The example to follow goes something like this:  “I want to apologize for my role in our disagreement last night. I’ve been thinking it over and I realize I came on really strong because I was feeling worried about finances. I got worked up and didn’t really listen to what you wanted to say. I can see that you may have felt dismissed by me and I want you to know that I didn’t mean to be dismissive of your ideas for our vacation,” or garden — you fill in the blank. “I think I have been very preoccupied lately with my job stress and I haven’t been giving you much attention and making time for you.“ 

Overall, then, this is a process, but it’s  a powerful one. When I work with couples, I give them a written summary of the steps so they have it handy and can practice it together after a fight. You may need to do it together in a formal way with the six steps for a few times, or a few dozen, but it really will become imprinted and integrated into one clear and heartfelt repair.

Try it, and good luck!

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Third Ear Listening: Ethics and Teletherapy in Quarantine

Social distancing due to COVID-19 has caused a radical shift in our work as psychologists. In talking with other therapists, I’ve found that many of us are feeling the strain of doing therapy by teleconferencing. Talking with our clients via a one-dimensional digital representation lacks the subtle interpersonal interaction and relationship that characterize psychotherapy. By now, we’ve created a facsimile of our psychotherapy office that accommodates teletherapy where we try to listen with free hovering attention sitting in front of a screen with a camera, microphone, and perhaps earphones.

Video can be taxing due to the way digital images are encoded, which cause artifacts such as blurring, freezing, and audio that doesn’t always sync. We miss the powerful nonverbal communications that shed so much light on the intangibles of what might be contributing to a person’s issues. A blush, an eye-roll, a tear welling up, the fidgeting of someone with a secret, the nervous giggle, or shy smile—these nuanced communications can give us insight and aid our understanding of unconscious dynamics.

Whether in person or over the phone, we can still be attuned to our clients in the moment. In my psychotherapy practice, I have been influenced by Theodor Reik and his book Listening with the Third Ear (1943): 

We are… encouraged to rely on a series of most delicate communications… collecting all our impressions; to extend our feelers, to seize the secret messages that go from one unconscious to another. . . . The student often analyzes the material without considering that it is so much richer, subtler, finer than what can be caught in the net of conscious observation. The small fish that escapes through the mesh is often the most precious. 

Important in adjusting to providing teletherapy that most approximates in-person sessions is solving technical problems while paying attention to ethics (see updated information on ethical practice from the American Psychological Association) and HIPAA compliance. Some of these issues include:

  • Deciding on a HIPAA- compliant secure videoconference platform such as VSee, Zoom, Doxy, or Simple Practice (which I use.) 
  • Ensuring good WIFI (I had to buy an extender because my home office’s connection was sluggish and intermittent) and closing all other browser windows 
  • Learning how to code for insurance reimbursement
  • Giving clients clear instructions on how to access our video link and what to do if we get disconnected
  • Creating  a telehealth consent form and discussing potential risks and limitations of treatment 
  • Discussing safety plans
  • Confirming with clients how to ensure privacy and security before, during, and after our video call. 
  • Clarifying how to send payment
  • Asking for ID from new clients to confirm they live in California (unless we’re licensed to provide service in another state)

Other telehealth considerations have to do with making the session work visually. We’ve learned to position screens so the camera catches us from above and doesn’t show a double chin. To see each other clearly,  we’ve learned to position the lighting behind our screen, and when necessary, have instructed clients to do the same. To lessen distraction and be better present in the session, we avoid glancing down at our own image. Though it’s impossible to make real eye contact in a video call, we can better focus on a patient’s facial expressions by minimizing their image and moving it up the top of the screen nearer to the camera. This helps with connection, even if we can’t pass a tissue when we see our client cry. I have also discovered that sitting a little way back more clearly echoes sitting somewhat apart, as we would in person. There is more of a space between us. 

But there’s no new thing under the sun, and telemental health has been used for decades. Before smartphones, video chat, FaceTime, or Zoom, therapy via landline improved access to care, offering a cost-effective alternative to in-person therapy in many situations and populations. In Mules of Love (2002), Ellen Bass — poet and co-author of The Courage to Heal — wrote about the possibilities for therapeutic connection even across a seemingly impersonal, clunky telephone line:

Phone Therapy

I was relief, once, for a doctor on vacation

and got a call from a man on a window sill.

This was New York, a dozen stories up.

He was going to kill himself, he said.

I said everything I could think of.

And when nothing worked, when the guy

was still determined to slide out that window

and smash his delicate skull

on the indifferent sidewalk, “Do you think,”

I asked, “you could just postpone it

until Monday, when Dr. Lewis gets back?”

The cord that connected us—strung

under the dirty streets, the pizza parlors, taxis,

women in sneakers carrying their high heels,

drunks lying in piss—that thick coiled wire

waited for the waves of sound.

In the silence I could feel the air slip

in and out of his lungs and the moment

when the motion reversed, like a goldfish

making the turn at the glass end of its tank.

I matched my breath to his, slid

into the water and swam with him.

“Okay,” he agreed.

During this global crisis, doing psychotherapy so differently from our usual way of working requires facile adaptability, even once the practicalities are solved. But we can rely on our ethical principles to give us, and our clients, a safe and secure way to experience the moment. By endeavoring to listen and respond with the Third Ear, we strengthen our ability to make a healing therapeutic connection. In fact, being forced into this situation may reveal the usefulness of teletherapy that will last well beyond COVID-19.

This article was originally published in The Contra Costa Psychological Association Newsletter, May 2020.

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Micro-cheating’s Seductive Quick Fix … and why it’s a bad idea

In a committed relationship, cheating comes in many forms. It can be as big as a long-term affair with one’s best friend. It can be as small as texting a co-worker. “Micro-cheating,” as it’s called, can include:

  • Keeping an active dating profile
  • Poring over an ex’s social media
  • Dressing up for someone not your partner
  • Sending flirty texts that your partner doesn’t know about
  • Keeping a secret Facebook account to exchange hot photos with an ex
  • Flirting with a co-worker
  • watching porn via Skype

It’s easy to see how the lines get blurred in a world where we advertise our every move: the airport we just checked into via Facebook, the food we’re eating sent by Instagram, or the random thoughts we tweet without the benefit of thoughtful reflection. When we constantly expose our private selves indiscriminately, we become emotionally desensitized.

Meanwhile, our actual relationships have to compete with smartphones,  addictive video games, and online pornography to suit every taste. Social media’s quick boredom fix is always within reach; micro-cheating is another such fix, and secrecy is part of the thrill. And kissy faces and hearts, or playful comments, can give way to romantic fantasies.

That’s the problem with flirting via text message. Some may justify it as just one screen talking to another, but secret flirting is an unhealthy way of growing our fantasies about someone outside of our committed relationship. And those musings sometimes don’t feel unhealthy; in fact, these fantasy relationships can actually feel closer to our authentic selves (or the selves we think we should be). New love makes us come alive again; it’s risky and exciting, pushing our established boundaries.

To be clear, there’s nothing wrong with some fantasy and flirtation. You don’t have to tell your partner every romantic idea that crosses your mind. That would stifle fun and creativity—qualities that we can take back to our partner because we feel good about ourselves and our desirability. But with micro-cheating, the fantasy is based on something other than the trust, commitment, and intimacy of a real relationship. It’s easier to exchange sweet talk and confidences with someone we barely know (or more likely, think we know) than it is, for example, to have an intimate and difficult discussion with a spouse of 10 years about unhappiness in the bedroom. But it’s in just such ways that real love is made.

Even new relationships are not immune to the need for self-disclosure and uncomfortable discussions; most people get on each other’s nerves after two weeks of being alone together. Maintaining romance is tough when we become acutely aware of our partner’s belches and farts and annoying habits we didn’t notice when we were dating. It’s easy to see why the new, mysterious other person is alluring and fascinating, and why we can more easily present a self-flattering front, especially when nothing much is required of us but sending a sexy text when and as we please. It’s a low-cost endeavor because it exists in fantasy—but no real person can compete with a fantasy.

Originally published on WebMD

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Using Softened Startup in Conflict Discussions

Dirty Dishes in the Sink, Smelly Socks on the Floor

Sometimes the things that drive us most crazy in a marriage are the most mundane and trivial: dishes piled up in the sink, socks dropped on the floor. We may complain, criticize, and yell, but the end effect is that the dishes don’t get done, the socks eventually migrate back to the floor, and we end up feeling even more distanced and angry toward our partner. If complaining doesn’t work, neither does ignoring what drives us crazy. Over time, a couple can see their relationship with what John Gottman describes as “negative perspective.” We get so focused on the negative that we become unable to recognize even neutral or positive actions from our partners, snowballing our unhappiness.

As a couples therapist for many years, I’ve seen the situations that bring clients to treatment range from catastrophic events like affairs and severe illness to the mundane, like smelly socks and cluttered countertops. A sampling of conflicts:

 

  • An older couple squabbles over the bedcovers: the wife says her husband hogs the blankets, leaving her freezing much of the night; she feels her husband is selfish and inconsiderate, while he thinks she should just tug harder on the covers.
  • A young husband says that his stay-at-home wife leaves dirty dishes in the sink for days on end and he ends up cleaning the kitchen every night, even if he made the meal; he feels his wife is lazy, and she feels he’s ignoring the work she has done.
  • A couple complains that they’ve stopped sleeping together because their child is too afraid to sleep alone and needs to be consoled, even at age eight. The father, now sleeping on the couch, feels left out of the closeness and warmth that mother and child enjoy, and soothes himself through weed, drinking, and internet games or porn; the mother feels she must put her child’s needs first and co-sleeping is best.

 

Without help, such situations can drive a wedge between couples that can go on for years. Research has shown that couples wait an average of six years after becoming aware of problems in their relationship to seek counseling. That’s a lot of water under the bridge, and a lot of built-up hurt, anger, and distance. By the time couples do come to counseling, their relationship has usually crumbled, with deeply entrenched negative thoughts about the marriage. Fighting about the dishes is no longer about the dishes–it’s about a partner’s poor character. “She is so self-centered”; “He is so lazy.”

How does a couples therapist help when each partner blames the other and feels like the victim? Taking sides is not an option: the partner who feels ganged up on will bolt from therapy, and nothing will change. There may occasionally arise a need to confront one partner about issues that are causing harm, such as abuse, but in my practice, that is rarely the case. That said, helping untangle years of accumulated misunderstandings is not an instant fix. Everyone becomes invested in seeing things our own way, so opening our eyes to a partner’s viewpoint is something that takes time and skill. The good news is that these skills can be taught by a therapist who helps change the dialogue.

Softened Start-up Rather than Harsh Start-up

One of the most useful and yet seemingly simple skills to teach is to complain without blame and to begin a conflict discussion with a softened start-up.

How does this look? Well, take the older couple who fights about the blankets. With a harsh start-up, the freezing wife might say “You have no idea how selfish you are! You take all the covers every single night, leaving me with just the sheet—and a thin sliver of a sheet at that!” Her husband becomes defensive: “Well, what a complainer. Just tug on the blankets, and quit blaming me! I’m asleep, I can’t help it.”

It may feel momentarily satisfying, but coming out swinging engenders a harsh reply and an unhelpful one at that. A seemingly small squabble becomes gridlocked. A softened alternative might go like this: “I realize you’re asleep and unaware of my getting cold at night when I have no blankets. It probably happens as you roll over several times during the night, leaving me uncovered. When my sleep is disturbed, I get grouchy the next day, and unfairly blame you for something you’re unaware is happening. I wonder if we can come up with a solution?”

Of course,  her partner might try to laugh it off with  “Why don’t you just sleep in the guest room?”  But, soothed by a soft start-up, he could reply sincerely, without defensiveness: “I know this has been a problem for you for awhile, and I’m sorry. I don’t want you to be uncomfortable and cold at night. Maybe we can devise a way to fix this together. Let’s go to Target and see if there are blanket fasteners or something, and if not, let’s buy a fluffy down comforter and duvet.”

It would be misleading to suggest that this conversation can happen during the first few sessions. To change the way you talk about the blankets, it’s important to realize that the blankets aren’t really the problem. A skilled couples therapist will further the discussion so that each partner feels heard and understood. By uncovering what’s underneath the blankets, so to speak, the couple can see what’s really been covered over.

For the wife in my example, blankets were just one of many ways she felt her partner had been selfish and uncaring. When we discussed some of the feelings that surrounded the blanket-stealing, she was able to see things in a new light. She took ownership for communicating this and her other needs, and responsibility for doing it in a better, less judgmental way. As for her husband, he was able to see that he had in fact been acting with self-interest and ignoring his wife’s needs in many situations. But—and this is equally important—they were also better able to see each other’s good attributes once negative thinking wasn’t squeezing out relationship-enhancing thoughts.

When the concept of a softened startup is introduced in therapy, many partners will exclaim, “But that’s not the way I talk, it isn’t me!” or “Won’t I need a frontal lobotomy to talk this way?”

I chuckle, saying, “No, nothing that drastic.” It takes practice, but eventually, this way of bringing up conflict becomes second nature and feels good. A partner who joins in with a positive response helps to sustain and reinforce this healthier way of handling conflict.

What I love about doing this work with couples is the ripple effect. Not only does the couple change the way they talk to each other, but they model this better communication for their families and children. It’s important to remember that kids pick up both the good and bad things we do in front of them.

The first workshop I took with Dr. John Gottman was in 2000. I began practicing this softened startup with my husband before trying it with couples. We had a CD with practice prompts, and listened to it on a long car ride, with our kids in the back seat. Eventually, our twin daughters began answering the prompts with the softened alternative. We made it a game—yet it became a powerful tool for dealing with conflict. When the girls left home for college, they noticed that most of their dorm-mates were not able to handle conflict so well. The techniques work beyond the family setting.

You don’t have to be a psychologist (or have psychologist parents) to practice these techniques yourself. Take the dirty-dishes example—a frequent conflict for roommates as well as couples. You come home from work and see the dishes stacked high in the sink, overflowing onto the countertops. You think your stay-at-home partner should have done them. A harsh startup would be, ” I can’t believe you still haven’t done those dishes! You’re such a lazy slob.”  To that startup, a defensive comeback would be,  “Well, look at you! You’re not doing them either. So you devalue what I do all day long just because you work outside the home? I work too! You’re so full of yourself!”

You can imagine how the rest of that conversation goes—but it doesn’t have to. Practice coming up with a softened startup for this situation from what you’ve learned so far—try it out!

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I’ll give you one way to do this, but it’s not brain surgery; you’ll find many ways to phrase a soft startup in your own words:

“You know I tend to be a neat freak. When the kitchen counters and sink are dirty, I feel uncomfortable. I know you work hard and having clean counters isn’t as important for you, but I wonder if we can together find a way to stay on top of it, as a team?”

The key to all this is to know yourself, take responsibility for your feelings and reactions, and speak about your needs and feelings without leveling a global character assault on your partner.

Now, imagine one of your ongoing conflicts, and try out in your mind a way to communicate using a softened alternative. It’s a surprisingly powerful technique.

 

 

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Anxiety Knows No Age Limits: Each moment is all we really ever have

We all get anxious from time to time. Even mild panic that’s morphed from mere anxiety is normal. Most often, though, anxiety will peak right before an event that makes us worry, such as an exam or dinner party—a kind of anticipatory anxiety—and then fade 10 minutes into the event. The ebb and flow of anxiety can be unpleasant but usually isn’t a major concern.

But the usual ebb and flow can worsen. According to the American Psychiatric Association’s most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), normal anxiety becomes diagnosable as generalized anxiety disorder when:

  • Excessive anxiety and worry occurs more days than not, for at least six months, about several events or activities (for example, performance at school or work)
  • Controlling the worry is difficult
  • The anxiety/worry includes at least three out of six symptoms (in diagnosing children, just one of these symptoms is required): restlessness or feeling on edge; being easily fatigued; difficulty concentrating, or the mind going blank; irritability; muscle tension; sleep disturbance
  • These symptoms cause significant distress in functioning
  • The disturbance isn’t related to medication, drugs, or a medical condition
  • The disturbance isn’t explainable by another mental disorder

I recently saw an 88-year old woman who was referred by her internist for anxiety. Her primary symptoms were her mind going blank, trouble letting go of thoughts, and agoraphobia (the desire to avoid leaving her home). The usual culprits were ruled out: hyperthyroidism, a medication side effect, or, given the client’s advanced age, dementia.

Composedly, my client said her anxiety came from feeling pressured to do more, and a sense of failure for not being good enough. This surprised me; I had expected her to talk about a fear of approaching mortality.

It’s a psychologist’s job to ask the hard questions, the ones that seem most obvious—the ones most friends and family wouldn’t touch for fear of making the person feel worse. So, I gently inquired if some of her anxiety could be related to thoughts about aging and death. But my client was quite definite that that was not the case! Her physician had assured her she would live to be 94 years old. I did a quick calculation—math was never my strength as I still count in my head with little dots—and determined that would give her five more years. Wouldn’t such a short countdown to death be enough to bring about anxiety, I still wondered?

Another job of a psychologist is not to jump to conclusions or make assumptions. Using inquiry, we ask for further thoughts, feelings, and associations. Some of her anxiety, she acknowledged,  was longstanding, but a new worry was that she was no longer as interested in venturing from home. What was this about?  Was she worried about taking a fall, breaking a bone, and ending up in the hospital? Again, no, it wasn’t fear that losing her balance and falling would lead to death because she knew that it most likely would. Anyone who reaches the age of 88 has seen in their own peer group how a broken hip can spiral downwards to a skilled nursing facility, with all the loss of dignity that brings.

Perhaps the most important part of our job as a psychologist is to trust that our clients know what they’re talking about. That trust is huge because it eventually leads us to an understanding of what is going on inside, in the deeper places we can touch if given time and attention. It turned out that my client’s anxiety was about just what she’d said it was. She was feeling like she should be doing more, going out more, and accomplishing more. Until she retired 23 years ago, she had been very productive in her job as an accountant. She loved her work, and she loved her retirement. She hadn’t slowed down in retirement until recently. She couldn’t understand the desire to just stay home. It was unlike her, and she felt she should be keeping up the pace she was accustomed to.

We discussed her symptoms; a mind going blank can be due to anxiety, and also to what my neuropsychologist husband refers to as benign senescent forgetfulness. (He tells me I have a mild case of it—our brains shrink as we get older, it’s entirely normal.) I also recommended that she turn off CNN. I wasn’t being flippant: Non-stop watching the news these days is making a lot of us anxious. Being bombarded with daily images of worldwide pain and suffering pervades our senses and creates disturbances that go deep into our unconscious minds, harming emotional health.

What about not wanting to leave the house? She wasn’t worried about going outside, but rather, as we figured out together, she desired to retreat from the world, to reflect and take time to appreciate her many gifts: a life well lived, a 65-year marriage to a good man, and her overall sense was that she had had a good, if not perfect, life. It was time to turn inward a bit more and let herself off the hook. Over the next several weeks, we explored how she could do just that.

Acceptance of who we are, imperfect and flawed, allows us to live more fully each moment, for as is said in mindfulness practices, each moment is all we really ever have.