CASE STUDY

Most couples therapists feel quite comfortable when the pace of a session slows and partners move into a respectful and vulnerable state. It’s the reactive and combative partners, who get stuck on protecting themselves and dismissing each other’s experiences, that can put us on edge.

As the couple’s failure to connect intensifies, you know it’s just a matter of time before you find yourself pulled into their vortex of confusion, hurt, and defensiveness. It was a case I consulted on that devolved in just this way—and with profound consequences—that changed the way I work with reactive couples.

Bridgette and Doug were a couple who’d been seeing Gerald, one of my supervisees. After Gerald told me he felt immobilized by their unabating volatility, I agreed to a live consultation. Doug was a soldier with multiple deployments and Bridgette a sales rep. Married seven years and with two young children, they lived a life of near constant fighting and were contemplating separation. Their long list of stressors included previous affairs on both sides, financial discrepancies in how much money Doug made and Bridgette spent, Doug’s PTSD, and a long history of both partners using alcohol to manage their distress.

Gerald hadn’t been able to get the stoical Doug to engage, while Bridgette ruled the sessions with her long list of complaints and angry outbursts. Each outburst fueled Doug’s further withdrawal, and every one of his retreats triggered more rage in Bridgette. The pattern was getting them—and their therapy—nowhere.

Maintaining Focus Through Escalation

Many therapists are trained to listen respectfully in an initial session while the clients talk at each other, but I’ve found this tactic often results in waiting so long before intervening that dysregulation can flourish. So instead, I started Doug and Bridgette’s session off with the clear statement that it was my responsibility to take charge and prevent escalation from happening.

I began by explaining that it’s normal for partners to have different versions of their relationship story, and listening to the other person describe their narrative can be frustrating, causing partners to interrupt and argue with each other, which only leads to greater confusion and makes it harder for me to help them. That’s why I wanted them to talk directly to me, rather than to—or at—each other.

“Why don’t you decide who starts?” I proposed. “I promise you’ll each get equal time.”

Bridgette jumped in. Sitting on the edge of her chair, she raised a finger in the air and said, “I can already tell you he won’t engage in this. Nothing I do can get this man to respond! He sits on his ass all day, staring at screens, while his life passes him by.” Giving Doug a long, withering look, she then sat back and mumbled, “I don’t know how much more of this bullshit I’m supposed to take.”

I waited just a beat and said, “It must be frustrating to witness him not engaging and know there’s nothing you can do to get him to change.” I’ve found acknowledging and validating the function of each partner’s defensiveness can make it easier for them to remove their armor and expose the vulnerable feelings underneath.

As Bridgette continued, it soon became apparent that her anger provided a sense of control and agency for her. Without it, her fear was that nothing would change. With it, she believed there was at least a chance of motivating Doug to listen and change. My task would be to ground Bridgette’s anger and shift my focus to Doug’s withdrawal. So when she paused, I said, “Anyone would be frustrated, Bridgette, if as hard as you try, nothing changes. I’m also interested in understanding why Doug disengages and resists changing.”

“He doesn’t have any good reasons,” she spat.

“Well, let’s spend a few minutes trying to help Doug explore what might be getting in the way of his engagement. Sound okay?”

As Bridgette looked up at the ceiling, I turned to Doug, who’d been staring a hole in the floor this whole time.

“I noticed when Bridgette said you don’t have any good reasons to not engage, you didn’t react. What were you feeling that kept you from responding?” I asked him.

“I don’t know,” Doug said, briefly looking me in the eye. “Nothing.”

I smiled encouragingly and continued, “When someone I’m working with turns away, they usually have good reasons. Typically, it’s an attempt to avoid fighting. What do you think would happen if, instead of turning away, you started to talk with Bridgette about the good reasons you have for not engaging with her?”

Doug chuckled quietly, then straightened up and said, “That definitely would turn into a fight.”

“So it’s a move to avoid making things worse,” I affirmed. “That makes sense.”

Doug looked over at Bridgette, who’d tensed up. “I totally disagree,” she cut in. “Withdrawing doesn’t help; it only makes thing worse.”

“Yes, it certainly makes things worse for you,” I said to her. “But again, I’d like to take a couple of minutes to explore this with Doug.” Bridgette sat back begrudgingly. “Doug, when I said that your withdrawal to avoid a fight makes sense, you nodded and immediately looked over at Bridgette. What were you looking for?”

“I don’t know,” he muttered. “Maybe I was checking to see if she understands.”

“And when it seems like she doesn’t and jumps in to disagree instead, I imagine that must be hard. And if you tell Bridgette that’s hard, what do you think is going to happen?”

He looked at her out of the corner of his eye and said, “She’ll just disagree more, and it’ll lead to a fight.”

I could see Bridgette flinch at this, but she stayed quiet as I spent the next few minutes focusing on helping Doug find words to describe his emotional world. Haltingly, he explained that he spent so much time trying to figure out how to make Bridgette happy, or avoid her anger, that he didn’t have time to understand why he felt the way he did. When I pressed him a bit, he admitted he felt confusion and frustration in the face of Bridgette’s constant criticism.

The fact that Doug was a soldier compounded this aversion to his inner world: his job was to accomplish missions, and putting aside feelings was part of that. It made it doubly frustrating to be blamed at home for a skill that at work insured everyone’s safety. Ultimately, Doug said, “I know she doesn’t like it when I walk away, but it helps me stay calm.”

“And what do you think would happen if you didn’t walk away from Bridgette’s anger?” I pressed.

Doug’s eyes widened with concern. “It would be a disaster! When someone’s screaming in my face, I need to get away, or else I might say or do something I can never take back.”

“I guess I’m curious to know who’s seen what’s happening for you in those moments when you’re struggling, and how have they helped you?”

Doug looked at me with puzzlement, his brow knitting as he answered, “I never thought about it, but I guess no one sees me.”

I leaned in and told him, “I think you’re so focused on stopping something bad from happening that you can’t even imagine anyone helping you in this place. You’re so used to being alone that sharing this struggle isn’t even a viable option. What do you think it would be like for you as a dad if your five-year-old son just went away to deal with his fear and sadness on his own?”

Doug’s eyes glistened. “It would break my heart. I want him to come to me. I don’t want him to feel like I did growing up.”

“Right. You remember what it’s like when no one is there for you. What’s coming up for you, Doug?” I asked gently.

He took a breath before responding. “I remember driving home after striking out four times in a baseball game and my dad screaming that I was such a loser he wasn’t going to watch my games anymore. I was crying, and he said I’d better stop crying or he’d give me something real to cry about. So a switch went off in me and I stopped crying. I learned how to be tough, but I was a really lonely kid.”

I gave him a second and watched with empathy as he tried to stop his tears now. “That’s a powerful story, but the worst part, to me, is that in that moment you learned you couldn’t talk about your hurt. You learned to stop your tears. The root of the problem is other people let you down and trained you to hide your tears. No one was there for you, so you did what you had to do to survive. It touches me that you—”

“This is bullshit!” Bridgette shouted, shocking both Doug and me. Pointing her finger at me, she continued yelling, “You do not know what you’re talking about! Why are you implying that no one is there for Doug? Do you know how hard I’ve worked to support him? I’m the person keeping his family together! What is this crap?!”

I felt a pull not to leave Doug where he was, but I also felt compelled to deal with this outburst. Warily, I turned toward Bridgette and said, “Obviously I’m missing what’s happening for you. Why don’t you help me understand?”

We spent the last 15 minutes of the session trying to regulate and make meaning out of Bridgette’s anger. She said it was outrageous to ask more of her when Doug was giving her so little, and she reiterated she was the person trying to build connection.

I told her, “I understand that your anger at least offers you hope that you’ll get some sort of response from Doug, while staying silent guarantees nothing will happen.” I also told her that it’s difficult to put aside anger when we haven’t yet explored a healthy alternative to the real problem: Doug’s unresponsiveness to her isolation. To close the session, we all agreed that my supervisee would continue working with them to create a stronger bond.

Bridgette thanked me and shared how much she appreciated the work on understanding her anger. With a wry smile, she admitted that maybe anger was a problem for her, and even Doug laughed at that. Bridgette’s attack had felt like a bomb going off in session, and I was relieved we’d survived the explosion. After the session, I discussed with my supervisee, Gerald, helpful next steps for the couple. My hopes were high for them.

Six months later, Gerald called to tell me Doug had died by suicide.

Stunned, I put the phone down and started to replay that session in my mind. I thought back to that critical moment when Doug was sharing his vulnerability and Bridgette angrily interrupted. Why had I nervously turned to her and left Doug? Had I joined a long list of people who failed him in his moments of great emotional need?

Doug’s suicide shook me hard, but it also showed me that we therapists need better training on how to handle interruptions in session, especially with reactive couples. My unpreparedness for Bridgette’s bomb caused me to lose my focus and abandon Doug as he shared a deeply painful moment from his childhood. If, as I believe, the ultimate goal of therapy is helping couples learn that becoming open and vulnerable with each other is the key to intimacy, then Doug’s emotional state should’ve remained my primary target. I’d made a grave mistake.

Maintaining Focus Despite Interruptions

Anticipating what can interfere with our focus is crucial to maintaining it. If the most common interruption in couples work is when one partner stops the work the therapist is doing with the other, then we need tactical moves to deal with these moments. I’ve found three broad categories of interruptions we need to be ready for: empathy from a partner, a combination of empathy and mistrust, and defensiveness and hostility. I call them green, yellow, and red lights.

Green Light. Believe it or not, even reactive partners do sometimes jump in with unsolicited, empathetic responses. The therapist’s choice of what to do with these golden nuggets determines a lot. For example, imagine if Bridgette had interrupted Doug by saying, “I never knew you felt like a failure. I’m so sorry, and I want to help.”

Had I been ready for the interruption, I could’ve used it to create more safety and deepen my exploration of Doug’s vulnerability. I would’ve acknowledged Brigette’s empathy but quickly turned the attention back to Doug: “Wow, that’s beautiful, Bridgette. You see some of Doug’s hurt, and it moves you to want to help. Doug, what’s happening for you as Bridgette tries to come closer?”

It’s crucial not to allow the interruption to cause a transition away from the original target and toward a new one. For example, turning to Bridgette to explore how she might want to help Doug may have allowed her to take up all the space, and before long we’d have all stopped focusing on Doug’s pain.

Yellow Light. The most frequent interruptions are a combination of empathy and mistrust. This mistrust is often preceded by the word but. For example, imagine Bridgette interrupting Doug by saying, “I feel sad for you hearing about what happens when you get criticized, but I wish you’d told me earlier instead of waiting all these years.”

The but typically erases the impact of the empathy and leaves the partner feeling blamed, rather than supported. These mistrustful interruptions are predictable when the listening partner starts to hear something new. As the perceived bad-guy partner morphs into a more vulnerable stranger, the witnessing partner doesn’t trust either one. Being ready for the mistrust makes it easier to keep from getting thrown off when it emerges.

A good strategy when encountering yellow lights is to validate and normalize the mistrust, but not to explore it. In other words, I could’ve responded to Bridgette by saying, “Thank you for sharing that. For years, you’ve been pushing for conversations to bridge the distance between you and Doug. So I appreciate you jumping in and wanting to get deeply involved in the process. For right now, though, let’s try to focus on what happens to Doug that stops him from sharing his sadness with you.”

In the best case, Bridgette would’ve nodded her head, leaving me free to return my focus to Doug. The yellow light would’ve turned green, letting the process move forward to unpack Doug’s experience further. However, if Bridgette remained too triggered and caught up in her own experience to refocus on Doug, then we’d be in danger of a yellow light turning red.

Red Light. A red light is when the listening partner, caught up in a reactive experience and internally blocked from empathizing, interrupts with defensiveness, criticism, and hostility, as when Bridgette shouted, “This is bullshit!”

When a hostile interruption occurs while a partner is risking vulnerability, it’s time for the therapist to use an emotional tourniquet with the sharing partner before turning toward the hostile partner.

If I could go back in time to that moment, I’d have said, “Wow, Doug, your sadness seems to be bringing out Bridgette’s anger. I’m not sure what’s happening for her, although I trust she has good reasons for her reaction. Before helping her, I want to let you know that you did an amazing job letting us into your pain. Anyone would feel sad if they were always alone in their fear and the best they could hope for was to outrun it. I was so touched when you mentioned giving comfort to your son in places you never received it. You deserve comfort, too, not isolation. If people get reactive and can’t respond with empathy when you risk going to these vulnerable places, then you’re left alone again. Now, I want to help Bridgette understand what’s happening for her, so she can come closer to you. But the last thing I want to do is to leave you alone in this place, because that’s what got you into this mess. Is it okay if I spend a few minutes trying to help her?”

Getting this kind of buy-in to transition to the other partner makes the difference between someone like Doug feeling helped or abandoned. It also intentionally signals a change in my therapeutic target, away from getting Bridgette’s empathy and toward trying to identify and work through her block around listening to Doug’s pain, so she can eventually respond to his vulnerability. If her block couldn’t be worked through, then I’d again shift focus toward helping her explain what’s blocking her heart from being affected by Doug’s pain.

Imagine Bridgette saying, “I’m sorry I can’t comfort your sadness because I’m running on empty, and right now I have nothing to give.” With either scenario, responsiveness or an explanation for the lack of responsiveness is a step in the direction of connection.

– – – –

In the beginning of work with a couple, when both partners are feeling raw and defensive, empathy for each other doesn’t come easily. At this stage, it’s especially important for therapists to recognize their critical role as the safe attachment figure tracking both partners’ experience of feeling abandoned or unheard and guiding the process from there. In a sense, it means that much of the work of being an effective couples therapist is being a good traffic cop: knowing how to deal with interruptions and manage the therapeutic traffic flow.

Doing that job with clarity and purpose is a fundamental skill. It’s often the key to getting things on the right track and keeping them there. Doug’s story underlines how destructive, and even heartbreaking, mistakes in traffic management can be, with consequences that live on for everyone involved, including the therapist. I deeply regret that it took the harsh lesson of Doug’s death to bring this essential lesson home for me, but I hope it motivates other therapists to improve their skill in staying laser-focused when exposing clients’ vulnerabilities.

CASE COMMENTARY

By Peter Fraenkel

George Faller beautifully and accurately describes a central challenge of working with high-conflict couples. Although the classic pursuer–distancer pattern of conflict this couple engaged in is easy to describe, and has been well researched, it’s not always easy to disrupt. As Faller notes, when the pursuing partner is highly volatile and dismissive of the distancing partner, even when the latter is taking small steps to engage, the therapist must take charge of the session immediately. Faller did a masterful job in a one-session consultation in starting to draw out Doug, and to explore the present and family-of-origin sources of his conflict avoidant style. He also validated Bridgette’s frustration, and valiantly attempted to help her modulate her rage and start to explore Doug’s reluctance to engage.

Although Faller seems to blame himself for mistakes made in that session and for Doug’s suicide six months later, I’d suggest he’s being overly harsh on himself. Yes, he might have handled Bridgette’s interruptions more deftly and returned the focus where it belonged, on Doug—the suggestions he later makes about handling different types and intensities of interruptions are right on the mark. But he was correct in responding to Bridgette’s angry outburst; her longstanding frustration with Doug and her hopelessness about the prospects of him changing needed to be acknowledged in that moment. Faller doesn’t describe what transpired in his supervisee’s work with the couple during the six months following the consult, so it’s really not clear what didn’t work in the therapy—or whether Doug’s suicide was due to a failure of the therapy at all. His war-based PTSD and alcohol overuse may have been the main factors in his tragic death.

I would’ve spent part of the consultation, or suggested the therapist do so in the next session, briefly describing the research on typical problem patterns in couple interaction—such as escalation, withdrawal or stonewalling, invalidation, negative interpretations, and the negative effects of criticism, contempt, and defensiveness—to help them recognize what to avoid, and to realize that lots of couples get into these patterns. Then I would’ve taught them research-supported communication skills, as well as led them through some simple mindfulness practices that go straight to the nervous system to calm inner emotional turmoil.

My guess is that Bridgette and Doug didn’t have good models for dealing with conflict in their families of origin. Learning some communication tools and ways to modulate their emotional arousal would offer a concrete approach to changing their pattern of destructive interaction. When couples develop a more grounded, emotionally safe way to talk about difficult emotions, the therapist no longer needs to be the “traffic cop.” After all, there are limits to a therapist’s impact. Going home with them to direct their emotional traffic is beyond the scope of what we have to offer. Once equipped with some skills, and an enhanced sense of hope, the wonderful exploration that Faller began using Emotionally Focused Therapy practices could proceed more effectively.

Peter Fraenkel, PhD, is a clinical psychologist and associate professor at City College of New York. He’s the author of numerous publications, including Sync Your Relationship, Save Your Marriage: Four Steps to Getting Back on Track, and the forthcoming Relationships on the Brink: Last Chance Couple Therapy.

Previously published on psychotherapynetworker.org; reposted with permission.

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