Clinical Case: Couples Voice
Therapy
Janet and Fred, a couple in their mid 40s, requested marital
therapy, citing problems communicating. Other than this concern,
both
claimed to love each other and to be satisfied with their
marriage. Further enquiry indicated that there was little
connection between
them. What little conversation they had was limited to information
exchange about work and their young adult children. Typically
after
dinner, Fred, a teacher, would retire to his office to mark
or prepare lessons. Recently, he had started spending more
time on the
internet, and was masturbating up to four times a week to
pornographic images. Janet, an office worker, would spend
her time reading or
watching television. She also used alcohol to relax while
preparing dinner, and had up to a bottle of wine throughout
the evening. What
little affection they showed was confined to brief foreplay
when they had sex. Sex was infrequent, occurring several
times a month.
When asked to describe his parents through the eyes of himself
as a 5 to 7 year old, Fred, an only child, stated that his
father was a "
great guy", and his mother "always there".
Fred's father, a salesman, had been sociable and funny, but
largely absent because of his
job. He recalled that his mother, a homemaker, had been unhappy
much of the time. Through the eyes of himself as little Fred,
he
couldn't recall his parents showing him affection. He did
recall his mother disciplining him by hitting him with the
fly swatter, and
his dad occasionally using the belt. He remembered how frightened
he felt when this happened. When he felt hurt, afraid, or
alone, he
didn't recall either of his parents helping him with his
feelings. Fred's view of the parents of his childhood as
more ideal than they
were reflects the fantasy bond that helped him survive as
a child.
When asked how he spent time as a child, he reported playing
alone a lot, immersing himself in an imaginary world he had
created. He
preferred to play alone rather than with the neighborhood
kids.
Through the eyes of herself as a 5 to 7 year old, Janet,
the youngest of three sibs, described her dad as "angry
and controlling", and
her mother as a "saint". Her dad, an alcoholic,
was unpredictable. When not drinking, he was sullen and withdrawn;
when drinking, he
would become loud and abusive. Her mom worked hard to provide
a stable home. Janet couldn't recall her dad showing affection;
she did
recall her mom trying to make up for her dad's outbursts
by buying her things. She didn't recall either parent helping
her with her
feelings when she was afraid or upset. Rather, she recalled
trying to console her mom after her dad's tirades.
When asked how she spent time as a child, she stated that
she tried to be invisible. She would do this by going to
her room and reading
or coloring for hours. She didn't have much contact with
her older sibs. They tended to avoid being home as much as
possible.
An exploration of both of their childhood experiences, then,
indicated the tendency to take care of their own feelings
and to gratify
themselves internally. This is reflective of the defense
of inwardness, a self-protective state in which children
gratify themselves.
An exploration of the role of the voice in their defenses
indicated that both "listened" to a negative thought
process about the self.
Fred's voice attacked him for being uncreative in his work,
for being unsociable, for being a lousy husband. His core
voice or belief
about himself was that he was unlikeable. He would tell himself, "I'm
too dull, too boring and uninteresting. "
Janet also listened to negative voices about herself. Her
voices berated her for being unattractive, for not doing
more with her life
(she had wanted to be a writer). Her core belief about herself
was that she was unloveable. She would tell herself, "I
don't deserve
love. I'm unappealing. Who would love me?"
Both also listened to a negative thought process about each
other. He told himself, "She's a cold fish. She doesn't
care about my sexual
needs." She told herself, "He doesn't care about
me. He's more interested in his work and computer than me." Listening
to these negative
voices predisposed them to distort how they saw each other,
resulting in mistrust and alienation.
The more alienated Janet and Fred felt, the more they withheld
giving and receiving positive responses. Each listened to
a negative
thought process mediating withholding behavior. He told himself, "Why
bother being warm to her. I'll just be rejected". He
also listened
to voices preventing his receiving the positive responses
she tried to show him: "She's just being nice because
she wants something from
me." She listened to similar voices: "I'm not going
to show him affection. He'll start clutching and pawing."
Both listened to voices that mediated their self-feeding
behavior, and beat them up for this behavior after the fact.
He told himself, "
I've had a tough day teaching kids who don't want to learn.
I'll go to a porn site, relax and pleasure myself." After
self-stimulating,
he would berate himself, "I've wasted time again. I
have no self-control." She told herself, "He doesn't
want to talk to me. I'll have a
drink and relax." After drinking, that same voice would
assault her, "There I go again. I'm just like my father,
a drunk."To recap, to some extent we form psychological
defenses that make it difficult to tolerate love. We have a
negative
thought process, the
voice, which regulates our defenses. If this is the human
condition, how do we learn to tolerate love? It goes without
saying that there
is no magic bullet, no quick fix. Learning to love is a process,
a journey of maturation. Although I will describe the steps
of this
process in a linear fashion, in actuality they are overlapping
and recursive.
The Process of Change
The first step in learning to tolerate love is to confront
oneself by acknowledging one's defenses to a closer attachment.
This means to
recognize the fantasy bond with one's partner. It is also
important to confront one's other defenses: inwardness, self-feeding
behavior,
and withholding. These are the defenses that maintain the
emotional distance between partners.
Janet and Fred found confronting themselves about their
fantasy bond a painful process. It was not easy for them
to let go of the
illusion of closeness, and to face the insecurity and fears
of separation that ensued when they admitted they weren't
as close as they
had imagined. Once they realized that confronting the fantasy
bond didn't mean separation, but the opportunity to learn
to tolerate a
closer connection, they experienced the relief that comes
with openly admitting what they both had known implicitly
but hadn't spoken.
Janet recognized her self-feeding behavior in the form of
excessive reading and abusing alcohol. She also recognized
her withholding,
especially sexual withholding. She had a harder time facing
her inwardness. She had always seen herself as a people person,
an
extrovert. Gradually, she come to see that she used her extroversion
as a way of being with people but maintaining emotional distance.
She recognized that she wasn't very open or trusting with
people.
Fred also accepted that he engaged in self-feeding behavior
through over-functioning at work and compulsive masturbation.
He had a
harder time admitting his pseudo-independence. Growing up
as an only child, he had prided himself on his self-sufficiency,
his being
able to take care of himself. As he gradually realized what
he had missed because of his pseudo independence, he experienced
profound
sadness.
Having begun to confront oneself by acknowledging one's
defenses to intimacy, the second step in learning to tolerate
love is to
confront the negative thought process that regulates one's
defenses. As previously stated, the "voice" refers
to a well-integrated
pattern of hostile thoughts and attitudes about self and
others. The voice is construed as a destructive overlay on
the healthy self, an
alien point of view about the self and others. Because it
is internalized at a young age, people experience it as compelling,
highly
convincing, even comfortable. Because the voice is only partially
in awareness, people are often unaware of it or its adverse
impact.
Confronting the voice requires separating this destructive
thought process out from one's healthy point of view about
self and others.
What is required is a paradigrn shift from uncritically listening
to the voice and falling under its influence, to separating
it out and
holding on to one's healthy point of view. Firestone has
developed a procedure for doing this. He suggests "saying
the voice" in the 2nd
person, "You", as if someone else is talking to
the person. He also suggests saying the voice in the 2nd
person with the affect or
emotional tone that it has in one's head. By following this
procedure, people have an experience of the voice as a hostile,
alien point
of view about themselves that is not in their best interest
to listen to. Once people separate out the voice, they are
encouraged to
counter the voice from their healthy point of view in the
Ist person singular, "I". The steps in this procedure,
then, are: 1) awareness
of the negative voice, 2) separating the voice out by saying
it with the associated feelings in the 2nd person, "You",
and 3) affirming
one's healthy point of view in the I st person, "I".
Rather than telling himself in the Ist person, "I'm
too dull, too uninteresting. Who would like me?", Fred
learned to say, "You're too
dull, too uninteresting. Who would like you." He identified
the affect of this voice as angry and contemptuous toward
himself. When he
did so, he felt considerable sadness about how he was treating
himself. Recognizing the hostility of the voice toward him,
however,
helped him to feel compassion for himself and to rebut the
voice in the Ist person. He countered, "I know that
I'm OK. I know that
people who get to know me like me."
In a similar fashion, Janet learned to separate out the
negative voices that attacked her as unloveable and to counter
them from her
healthy point of view.
Discovering how Fred's voice attacked him had considerable
impact on Janet. She felt more compassion for him than previously.
This was
also true of Fred's response to discovering how Janet's voice
attacked her in a vicious manner.
Both Janet and Fred also learned to confront the negative
voices that attacked each other, using the same procedure
they had learned to
counter voices attacking the self. For example, Fred separated
out his voice attacks against her by saying, "She's
a cold fish. She
doesn't care about your sexual needs." He countered, "I
know that she wants to respond to me sexually. When I am
warm and attentive to
her needs, she is more responsive." Janet separated
out her voice attacks against him in a similar fashion: "He
doesn't care about you.
He'd rather work or play on the computer than talk to you." She
then affirmed her healthy point of view about him, "I
know he cares
about me. When I appreciate him and let him know what I need,
he is attentive to me."
As Janet and Fred countered their voice attacks against
each other, and held on to their healthy points of view about
each other, they
started to calm down inside. Rather than talking themselves
up into feeling angry, mistrustful, and alienated, they learned
to soothe
themselves inside. As they soothed themselves, they also
started to have more positive feelings for each other.
The ability to soothe oneself internally is critical because
as people begin to have positive experiences, to move toward
each other,
the psychological equilibrium of their defenses is imbalanced.
When this occurs, people experience an increase in voice
attacks against
each other, which results in distancing behavior to re-establish
the equilibrium. Learning to tolerate love requires the ability
to
soothe ourselves inside by countering the negative thought
process as we experience more love.
They were encouraged also to disclose their negative voices
about each other. They were surprised by how taking responsibility
for their
voice attacks against each other enabled the partner to listen
non defensively. For example, Janet would say, "Fred,
I'm having a
negative thought process about you. I know this is a voice
and not my healthy point of view about you. I'd like to 'give
this voice
away' by telling you about it." As they disclosed their
voice attacks, both felt relief about bringing into the open
what they had been
suppressing but their partner had sensed none the less. They
had the experience of being more fully known and accepted,
which created
greater intimacy. Giving their negative voices away was particularly
helpful when the voice was obsessive, making it hard for
them to
counter it internally.
The third step in learning to tolerate love is to risk moving
toward one's partner and close relationships for greater
connection. This
involves taking a chance again by giving loving responses
and asking for the love one wants. Because the psychological
equilibrium is
sensitive to even small changes, it is best to take small
steps in giving and asking for love.
Janet and Fred decided to risk giving and receiving more
love by countering their tendency to withhold positive responses.
Whenever
either was aware of the impulse to make a positive comment,
or to show affection, they determined to follow through.
As they expressed
more loving communication and affectionate behavior, they
learned to "sweat out" the negative voices that
previously had blocked their
following through. When Janet had the impulse to ask Fred
for a hug, she separated out the voice that said, "Don't
bother asking for a
hug. He's preoccupied. You'll just be rejected," and
asked anyway. When Fred noticed that Janet looked pretty,
he separated out the
voice that said, "Don't (you) bother complimenting her.
She'll think you want something from her," and complimented
her anyway.
There were times when they acted lovingly or asked for love
and didn't get the response they wanted. When this occurred,
they learned to
counter the voice that said, "He/she doesn't care about
you", and to soothe themselves inside by holding on
to a healthy point of view
about the partner. For example, when occasionally Fred didn't
respond to Janet's request for a loving embrace, she would
affirm, "I know
he cares about me and will respond another time."
The sexual relationship proved to be the most difficult
area in which to tolerate more love. Fred had become used
to gratifying himself
through self-stimulation. Janet had convinced herself that
sex wasn't important to her, and gratified herself in other
ways. Over time,
Fred learned to tolerate Janet's pleasuring him and giving
to him sexually. Janet learned to allow Fred to feed and
give to her by
tolerating his stimulating her to orgasm. Previously, she
had been inorgasmic with him.
By taking small steps toward each other, "sweating
out" the voices that emerged, and soothing themselves
when they didn't get the
responses they wanted, they gradually experienced a more
loving connection. They reported more open communication,
kind and respectful
interations, increased affection, and feelingful sex.
Expected Outcomes
The changes Janet and Fred experienced are typical of the
outcomes couples report. Partners often describe the following
outcomes:
-
increased communication and understanding of partners'
feelings and wants,
- greater ability to self-soothe by
countering
voice attacks
against the partner when one doesn't get the response one
wants,
- more affection and loving sex, and
- more respectful
interactions
(less conflict and reactivity).
Conclusion
Learning to tolerate love is a difficult journey. By confronting
oneself by acknowledging one's defenses to a closer attachment,
by
confronting the negative voice that regulates the defenses,
and by taking a chance again to risk loving behavior, we
do make progress.
It is helpful to remember that our defenses were formed at
a time when we really were helpless and dependent. As adults,
we are neither
helpless nor dependent. We discover that risking loving is
not as scary as we had imagined. What is required is that
we draw on the best
in ourselves and the best in our partner throughout the journey.
Couples Voice Therapy
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