Unintended Consequences of Progress

Robert Goddard - First Rocket

Cognitive Behavioral Therapy is difficult work and part of that has to do with the distress progress can create in a family system.

Yeah, that’s right.  We’re looking at how CBT can potentially impact a family from a systems perspective.

Exciting, right?

CBT is also a short(er) term modality, involves homework and the idea of concrete change is on the table sooner than folks may expect.   To consider how this might impact the larger family system, we need to understand Homeostasis:

The concept of homeostasis means that the family system seeks to maintain its customary organization and functioning over time. It tends to resist change. The family therapist can use the concept of homeostasis to explain why a certain family symptom has surfaced at a given time, why a specific member has become the IP, and what is likely to happen when the family begins to change. link

That’s not only on the internet, it’s also out of a medical dictionary ……..on the internet, so it must be true.

This does not mean that the family is the primary contributor to the client’s issues. It can mean that, but it can also mean that the issues the client struggles with has, in some way, shaped how the family works.

Due to the (relatively) rapid and (sort of) roller coaster type progress CBT initiates in a client, the family system the individual lives in can become a bit confused and disoriented.  Family members may feel an individual is getting worse when he/she may simply be more distressed as a result of the changes they are trying to implement.  Other times, family members may feel and express disappointment to their loved one when a lapse occurs after a stretch of noticeable progress. This can feel disappointing to a client who is being asked, in therapy, to focus more on process in defining success. Family members may also fall back on historical patterns in interacting with their loved one. This may lead to increased feelings of frustration in a client and can create an environment that is more conducive to relapse.

This isn’t to say that family members want their loved one to remain stuck, it may be the product of habit.  Family members, like clients, develop workarounds to symptoms in ways they can live with and these workarounds may be time consuming, intricate and exact.

Therapists should always leave the option of family involvement on the table for clients. It’s even appropriate, at times, to include it as a condition of treatment.  With adolescents or young adults who do not wish to have family members involved, therapists may wait until the client feels distressed enough about the family’s “push back” to bring the matter of family involvement up again.

Once a family is in the room, I avoid reviewing the nitty gritty details of our work. Usually, I speak to the treatment logic that is being used and, in general terms, talk about how families can act to help or hurt the process.  Family members may need therapy themselves to adjust to the changes especially if the issues are tied to loss or addiction.

The intended takeaway here is that family members typically want their loved ones to do well, but may not be clear on their role in the treatment process.  If not addressed, a family system may interpret or react to certain changes they observe in their loved one in ways that may be unhelpful or counterproductive.  Usually, this “pull back” is not willful or malicious, but comes from concern and is a natural reaction that systems have when experiencing increased distress and uncertain change.  Depending on the level of involvement a person’s family has had in helping their loved one manage or work through their symptoms,  psycho-education that includes typical projections around progress can be helpful for both the family and the client.

Triangles and Family Systems

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“Triangle” is a term out of Bowen Family Systems theory used to describe a phenomenon in family systems whereby a third entity (not always a person) is used to stabilize conflict and distress in a relationship between two people.  Triangles are generally thought of as undesirable because it is a communication avoidance strategy or pattern that resolves the distress surrounding an issue without resolving the issue.  Triangles involve shifting alliances among three entities; these alliances always leave one of the three on the “outside”.

Triangles exist because the relationship between two individuals in a family system is regarded as the most unstable. If a significant issue between two individuals doesn’t get resolved a consistent thread of distress in the relationship that bleeds into the day to day life of the relationship can develop. This may bring some hefty long term consequences to the table (lack of intimacy, lack of communication, avoidance, infidelity etc.)

One classic triangle involves the person struggling with addiction, the rescuer and the substance. This is a useful example because the relationship between these three is usually in a consistent state of distress during the latter part of the addiction and it is during these times that triangles become more noticeable.

During times when consequences of the use or addiction is contained to the family system (work is going okay, no legal issues, etc.) the person with the addiction and the substance form the inside relationship.  The rescuer typically utilizes nagging and other use control behaviors to try to prevent the person who is using from using.  These behaviors are typically ineffective and create more distress in the relationship. In some ways it can, in the addict’s mind, justify increased use as a means of “dealing with it”.  This places the rescuer in the role of “outsider”.

Eventually the person with the addiction is going to face an external consequence for their behaviors (bank notes as finances deteriorate, employment issues, legal troubles). Each of these consequences presents as a threat to the inside relationship the addict has to the substance; he/she cannot use if they are in jail or do not have the means of supporting the addiction.  As a result of the distress created by the anticipated negative consequences, the person with the addiction may increase proximity to the rescuer to engage their help in avoiding the consequence (bailing them out, calling work with excuses, etc.).  Sometimes, the rescuer doesn’t wait to be asked; seeing that the person with the addiction is about to face a damaging consequence they may decide to step in to solve the problem.

This process acts to lock the triangle as the rescuer prevents the person with the addiction from facing the natural consequences that may act as a catalyst for treatment and sobriety – the long term changes that may be needed in order for the real problem to be solved.

Another thing to keep in mind is that one triangle usually creates more triangles, it can be lonely being the outsider and eventually folks will need to figure out some way of dealing with the distress of the issue driving the triangle.  Typically, if there is one entrenched triangle in a family there are probably several others.

Sort of like cockroaches.

Gross.

Some of the most devastating triangles are those that involve children as the go between two parents who have severed communication. Children acting as messengers or negotiators between two parents can be harmful even if efforts are made not talk “bad” about the other parent; as the inability of one parent to speak to another can carry with it certain meaning to the child and places an added level of distress the child has in their communication with each parent.

All that being said, every family triangulates sometimes and sometimes it can produce very good results.  The key is to make sure that the patterns of triangulation aren’t entrenched; that direct communication is typically how a family deals with problems – triangles should really be an exception to the rule.

Because triangles are difficult to identify and family relationships are typically our most proximate and comfortable, getting caught up in them isn’t too hard.  A general rule of thumb in avoiding triangles is to be mindful of problem ownership.  If you don’t own at least part of the problem then there isn’t much you can do about it. You can be supportive but getting directly involved provides an easy entry point into bad dynamic. If you’re going to someone else about an issue and they weren’t involved to begin with, be clear as to whether their involvement is appropriate and tame your expectations with regard to what you feel they should and can do about it.

Sometimes the method of delivery is better than the gift itself…

So our Christmas gift to our daughters this year is a trip to Disney World and we wanted to do something a little creative to let each of them know. For our oldest daughter we decided to let her watch the following video…

She was very excited about the news but had a lot of questions surrounding the authenticity of the clip.

And They’re Off!

The pursuit-distance phenomenon is a concept born out of systems theory and is used to describe a pattern that occurs between two individuals who, as a result of emotional fusion, are unable to gain healthy proximity in a relationship.

The tendency towards emotional fusion is inherited from a person’s family of origin. People who are fused are triggered to emotional flooding by the emotional reactions of other people. This flooding negatively affects a person’s capacity for reason and objectivity. Typically, couples who find themselves in the cat and mouse game (pursuer-distancer) react to this flooding differently. The pursuer seeks stability and connection while the distancer seeks space and isolation. rowing race

Flooding is the force that upsets the ability of members to successfully negotiate the normal tension that is the product of an individual’s desire to belong and his or her desire to act from self interest.

The pursuer tends to value proximity and can come across as clingy and needy. The distancer usually comes across as detached or cold. The manner in which the pursuer seeks proximity from the distancer causes the distancer to move away, frustrating the pursuer who reacts by increasing their effort in the chase. While the distancer appears calm and detached it’s important to understand that he or she is operating from the same “stuff” as the pursuer. It’s also important to note that a pursuer in one context may move to distancing behaviors in another even in the same relationship. A pursuer at home may be a distancer at work; one who distances him or herself when it comes to emotionally supporting a spouse may become a pursuer when it comes to finances or sex.

This chase becomes problematic when the pattern results in a family member escalating to a point where they act in ways that cannot be ignored (screaming, aggression, leaving the house for extended periods of time). It can also be the stuff that triangles (something we’ll talk about soon….I promise) are made of as the distancer will seek a third object to escape to and the pursuer will seek a third object in getting their needs met. It also creates problems for the pursuer as, depending on how the behavior manifests itself, it can create greater vulnerability to be manipulated and controlled. If you come across as needing me more than I need you, I can use that in ways that are less than noble.

One way to break the pattern is for the pursuer to just stop pursuing; this tends to make it safer for the distancer to approach as perceived expectations and intensity are ramped down and the distancer feels that he or she can gain proximity on more mutual terms. Obviously, the other way to break it is for the distancer to remain present and tolerate hearing the pursuer’s needs; this could reduce the pursuer’s need to chase and works to reduce the anticipatory anxiety they experience leading up to the pursuit that can make their presence feel overwhelming to the distancer.

For some folks this is like telling Little Debbie to stop making delicious snack cakes.

Just stopping the pursuit doesn’t mean changes will happen immediately or that the change will be enough for all parties. One reason skills are such a big part of the work with couples and families at my shop is that increased capacity to tolerate the urges or desires that drive maladaptive relationship patterns are many times necessary before people feel change, even small change, is realistic. Thanks for checking in!