communication

Subtitle: Seven Conversations for a Lifetime of Love

Dr. Sue Johnson, creator of Emotionally Focused Couples Therapy, applies attachment theory to adult relationships, and everything suddenly makes sense. Attachment relationships provide an anchor and sense of safety in the world. They feel just as essential to our survival as attachment relationships do to children, so it makes sense we fight or flee when they feel threatened.

The seven conversations are:

1. Recognize Demon Dialogues – look underneath for attachment fears, and see how both people contribute to patterns.
   • Find the Bad Guy – casting blame for distress
   • Protest Polka – one person withdraws, the other makes demands, in a cycle
   • Freeze and Flee – both people withdraw, and the relationship is on its deathbed
2. Find the Raw Spots – identify triggers for attachment longings and fears.
3. Revisit a Rocky Moment – talk through a past conversation that didn’t go well, taking into account patterns, raw spots, and deeper emotions.
4. Hold Me Tight – emotional attunement, accessibility, responsiveness, and engagement. Each person tunes into their own emotions and shares what they are most afraid of, and then the attachment longing that is live in that moment. Hopefully the partner turns toward them and fulfills the longing, creating a new bonding experience. The person who usually withdraws goes first.
5. Forgiving Attachment Injuries – relationship traumas, usually involving some kind of abandonment, need to be healed, not ignored.
   1. The hurt partner speaks their pain as openly and simply as possible.
   2. The injuring partner stays emotionally present and acknowledges the wounded partner’s pain and their part in it.
   3. Emotionally connect around this, start rebuilding trust.
   4. Injuring partner takes ownership and expresses regret and remorse.
   5. Hold Me Tight conversation centered around the attachment injury – what is needed now to bring comfort and closure. Hopefully the injuring partner fulfills this.
   6. Create a narrative that captures the injuring event and how it is being healed.
6. Bonding Through Sex and Touch – bring emotional connection, communication, and trust to touch and sex.
7. Keep Your Love Alive – name ways to reconnect when a Demon Dialogue crops up, celebrate the positive moments, discuss attachment needs and issues, make rituals for separation and reunion, create an ongoing story of the living relationship, create a vision for the relationship in the future.

There is more than one gay couple in this book! And one couple of Asian descent. Women and men are individuals, not stereotyped caricatures. The client stories are realistic, practical, and encouraging.

Despite the pop-psych title and Overuse of Capital Letters, this book is solidly researched and makes a lot of sense. Highly recommended.

Available at bookshop.org.

Also read Dr. Sue Johnson’s more recent Love Sense, which covers a lot of the same material, with more information about the neurochemistry of attachment. Oddly, she leaves out the disorganized attachment style entirely. There is an extended example of a couple repairing their relationship.

Subtitle: The Complete Guide to Restoring Trust in Your Relationship

This book really is what it says on the tin. Mira Kirshenbaum is a couple’s therapist who shares both her own and clients’ stories to illustrate the stages of responding to betrayal and rebuilding trust.

• How to evaluate whether the relationship is worth investing in
• How to manage the anger which is a natural response to betrayal
• The need for evidence that the betrayer cares
• The need for the betrayer to see the situation from the betrayed person’s point of view.
• Reconnecting with the good aspects of the relationship
• Discuss root causes without (hearing) blame
• Discuss needs and how to meet them
• The (eventual) decision to forgive

The book is compassionate to both sides. Yes, big mistakes happen. They are sometimes not forgivable. The betrayed person naturally feels a strong need to re-establish safety, and may not use the most skilled techniques to achieve that.

There are no “shoulds” about leaving or staying. While the book naturally focuses on relationships that are worth rebuilding, there are also clear call-outs for danger signs, such as people who are power-seeking for its own sake, or people who are suspicious for its own sake, or relationships that don’t have enough good in them to be worth the work.

Small ongoing betrayals such as unreliability are addressed, as well as big betrayals like affairs or squandering shared money. Ongoing power imbalances can also be a source of mistrust. There is an in-depth discussion of differences in being open or hidden causing mistrust.

I winced at the section title, “Sleeping in a Nazi’s bed.” As a grandchild of Holocaust survivors, I am emphatically not a fan of metaphorical Nazis. But the author meant real Nazis! Her mother was a German Jew who survived the Holocaust, and brought her safely out of Germany afterward. When she went back to Germany to visit as a young adult, a sudden illness caused her to accept the hospitality of kind strangers who were admittedly Nazis during the war. She talks about how trust can make sense, even though we have reason to be mistrustful.

Sadly, all the couples in this book are heterosexual, and there’s no indication they’re anything other than white. And it was published in 2012! On the positive side, the men and women are depicted as having a variety of frailties and strengths, and a variety of relationships together.

Recommended for a better understanding of trust, betrayal, and relationship dynamics.

Available at bookshop.org.

Subtitle: A Developmental Approach to Diagnosis and Treatment in Couples Therapy

Recommended to me by: Robyn Posin

This is a carefully crafted book about effective, compassionate couples therapy, including a clear theoretical framework and practical suggestions for diagnosis and treatment. I’m guessing the title was created by a marketing department, because it doesn’t fit the book at all (to my relief).

Their framework is that relationships go through stages just as children do. The stages are named symbiotic (we are so alike), differentiating (how do we work out differences), practicing (turning outward independently), and rapprochement (turning back toward the relationship). The members of a couple can be at different stages, for example symbiotic-differentiating, or symbiotic-practicing. All the stages are important and valuable. The symbiotic stage is expected and helps create a strong foundation for the relationship.

Diagnosis is made through talking with the couple, questionnaires about problems and goals, and through a “paper exercise” – giving a couple a blank piece of paper and telling them, “This represents something very important to each of you. You have 5 minutes to work out who will get to hold it.”

There are a lot of case histories, including one lesbian couple and one couple with a woman of Japanese ancestry. I would have liked to see more diversity, although I suppose this isn’t bad for a book from the 80’s.

The therapists are perceptive, compassionate, and direct. They name inappropriate behavior, and teach their clients healthier alternatives.

Recommended for people interested in couple dynamics and effective therapy.

Available at bookshop.org.

Subtitle: How to Help Someone with Mental Illness Accept Treatment

Recommended to me by: a friend with a mentally ill relative

This is a book about how to communicate better with people with mental illnesses involving psychosis like schizophrenia or bipolar disorder. The focus is on getting people to accept psychoactive drugs when they don’t believe they are ill.

Rather than assuming non-compliant patients are immature, defensive, stubborn, or oppositional, Xavier Amador documents that poor insight into being mentally ill is a symptom of being ill itself. People carry their self-image from before becoming ill and don’t update it to match their new reality. Anosognosia is the official diagnosis for lacking self-awareness of a disability.

He also presents research that early and consistent use of medications leads to better long-term outcomes than longer periods of untreated psychosis. My intuition says that there may be correlation rather than causation there.

Rather than arguing with someone about whether they are ill and need medications, Amador proposes the LEAP protocol: Listen, Empathize, Agree, Partner. Listen to what the person has to say, ask questions to clarify, and reflect it back, even if it is delusional. Empathize with the underlying emotions. Find places of agreement. Partner to meet common goals, such as avoiding repeated hospitalizations. Be an ally rather than an adversary. Recognize the person’s autonomy.

Reflective listening can be difficult when we have an urgent agenda, especially when we believe someone is delusional. It’s easy to believe we are listening reflectively while being patronizing instead, which undermines all attempts at creating an alliance.

1. Make it safe – Apologize for past attempts at coercion and indicate an intention to listen. It will take time to rebuild trust.
2. Know your fears – Many people fear worsening or joining in delusions if they are not immediately contradicted.
3. Stop pushing your agenda – Drop attempts to be in control. The agenda is to listen and learn.
4. Let it be – Don’t fan the flames of conflict. Don’t try to impose order on disordered thinking.
5. Respect what you’ve heard – Reflect back without comment or criticism.
6. Find workable problems – Find out how they see their problems, and help them address them.
7. Write the headlines – Listen for what is most important, and underlying themes.

Delay giving opinions, especially about whether the person has a mental illness and needs drugs. Say things like, “I’ll answer that, but first I want to hear more about how you’re feeling.” When giving an opinion, Apologize, Acknowledge, Agree. Apologize for having an opinion that may be hurtful to hear. Acknowledge that it is only an opinion and could be wrong. Agree to disagree. Above all, acknowledge that the person is in charge of their own body and will be making the final decisions about taking meds when not in the hospital.

Recommended for the respectful communication skills, with the caveat that this book emphatically advocates for meds, with one brief paragraph about the benefits of intensive therapy instead.

Available at biblio.com.