Jonathan Shedler Ph.D.

Psychologically Minded

The Therapy Relationship in

Psychodynamic Therapy versus
CBT
A good therapy relationship is more than warm feelings.

Our earliest attachments provide the templates for our subsequent relationships. As
a result, we repeat relationship patterns throughout our lives. Because they are
present from the beginning, these patterns can be as invisible to us as water to a
fish.

Therapy is a relationship, and patients bring their templates and patterns into it. As
therapists, we enter the gravitational field of patients’ problematic relationship
patterns, experiencing and participating in them. Through recognizing our own
unavoidable participation in these patterns, we can help our patients understand and
rework them.

This is therapy that changes lives. This is the heart of psychodynamic therapy.

Caroline, a woman in her late thirties, is elegant, educated, successful. She carries
herself with a regal bearing and looks and dresses like a Vogue model. She is
pursued by the kind of men most women only fantasize about. Yet she is lonely. She
has been unable to keep an intimate relationship and she suffers from bouts of
depression.

Caroline has attempted therapy several times. She says, unhappily, that it has never
changed anything, and the therapists always end up wanting her approval.

Colleagues trained in CBT and other “evidence-based” therapies rarely attach much
significance to Caroline’s comment about her past therapy relationships. Some
venture Caroline may need a secure therapist who won’t be intimidated by her looks
or status.

It is irrelevant whether Caroline’s therapist is personally secure or insecure. She

doesn’t need a secure therapist. She needs a therapist with the self-awareness and
courage to notice that twinge of insecurity in Caroline’s presence, treat it as
information, and use it in the service of understanding.

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Such a therapist might say: “You know, you have come here for my help and yet in
many of our interactions, I am aware of a vague feeling of wanting to impress you or
gain your approval, which of course doesn’t help you at all. I’m trying to figure out
what it means, and whether it could be a window into understanding something
about what happens in other relationships. Perhaps this is something that feels
familiar to you.”

And there, real therapy may begin.

Caroline could not have described what went wrong in her relationships: The things
she did to try to draw others closer were the very things that precluded connection
and intimacy. Women were envious or deferential. Men viewed her as a conquest or
out of their league. Either way, intimate connection was impossible.

Caroline couldn’t tell her therapist this; she showed him. What the patient does in
the room with the therapist reveals lifelong relationship patterns. And in the therapy
relationship, these patterns can be recognized, understood, and reworked.

This is central to psychodynamic therapy and notably absent from other therapies.

A prominent CBT author and thought leader wrote an article about myths and
realities of CBT. One myth, according to the author, is that CBT downplays the
therapy relationship. To counter this, the author explained that CBT therapists “do
many things to build a strong alliance. For example, they work collaboratively with
clients… ask for feedback… and conduct themselves as genuine, warm, empathic,
interested, caring human beings.”

I expect that much from my hair stylist or real estate broker. From a psychotherapist,
I expect something more. The CBT thought leader seemed to have no concept that
the therapy relationship is a window into a patient’s inner world, and a relationship
laboratory and sanctuary where lifelong patterns can be recognized and understood,
and new ones created.

Some people may be satisfied with therapists who “work collaboratively” while
conducting therapy according to an instruction manual (read my blog about
"manualized" therapy here). Those who want to change their destiny will want a
therapist with the self-awareness, knowledge, and courage to see and speak about
what matters.

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Randi Gunther Ph.D.
Rediscovering Love

How Anger Affects Intimate Relationships

The ten most common anger styles and how most partners respond to them.

Angry exchanges are bound to happen between intimate partners. Ranging from
mild to explosive, they often likely to create cumulative damage over time.

Anger is a “puffer-fish” phenomena. It serves to make people feel more powerful

when they can’t express their more vulnerable, underlying emotions. Most often they
are preceded by feelings of frustration, hurt, unmet needs, or perceived injustice.

Because the partners on the other end of angry expressions cannot see those
hidden feelings, they too often react defensively to the anger, itself. The result is a
downward spiral with two upset people misunderstanding the underlying reasons for
why they are in dispute.

In working with couples for over four decades, I have often witnessed these angry
exchange patterns and noted how predictable they have become. Each partner
typically employs a particular anger style and response, and activates the other
partner’s similar predictable reaction.

So many of the couples I’ve worked with are not conscious that their angry
interactions are foreseeable and reciprocal. They also, too often, don’t realize the
underlying, more vulnerable emotions that drive them. Once the partners are in an
angry interaction, they rapidly go from friends to adversaries and cannot see beyond
each of their own emotional survivals.

In order for couples to successfully resolve their differences, they must stop using
unsuccessful angry exchanges. Instead, they need to understand what underlying
emotions are driving those angry emotions, how they each traditionally express
them, and what effect they have on the other partner.

The easiest first step to eliminate negative angry patterns is for each partner to
identify his or her anger style and what deeper and vulnerable emotions he or she
may be feeling underneath them. The second is to become aware of their effect on
the other partner. It is only then that angry emotions can be understood and replaced
by more successful resolution behaviors. Expressing differences from a calm place
without fear of being erased is crucial to any more positive outcome.

Over the years, I’ve compiled the ten most common anger styles and how most
partners respond to them. Some people use only one while others may employ a
pattern that utilizes several at the same time. Whichever pattern is employed, they all
appear to have the same goal, to get the other partner to do what the angry partner

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needed, but could not successful obtain before his or her anger became the cover-
up vehicle.

Following are the ten most common anger styles and how most partners respond to
them.

Style One – Snapping

This anger style is often more of a bark rather than a bite. Still, this type of angry
expression is meant as a warning sign; “do not approach.” There many reasons why
people employ this rapid-fire reaction, and it is critical that the partner who barks
understands why he or she is pushing away all attempts by the other partner to
connect.

Most partners on the other end of this anger style do interpret these bursts of
negative emotion as clear signs to back away but will initially try to keep the
interaction going. If they cannot get resolution and the snapping becomes a
consistent pattern, they will eventually pull away or respond with their own anger
style.

Style Two – Nitpicking

Some people can only express their resentment by sniping, sarcasm, criticism,
nagging, mean-spirited teasing, or snarky comments. They want their needs to be
met, yet are unable to ask for them directly, or don’t feel they would be met if they
did.

The other partners’ most typical responses to these erosive remarks is to defend by
similar counter-attacks, attempting to reverse the constant criticism. Over time, they
are likely to become inured to this behavior, and seek more positive support from
others.

Style Three – Slow Burn and Eruption

Perhaps because they have difficulty asking for what they want, some partners
swallow their resentments, disappointments, and thwarted desires, until they can no
longer tolerate the way they feel. At that point, they are likely to erupt into a tirade of
rageful accusations and explosive threats.

The other partner may have no idea that these feelings are brewing prior to the
venting. Or, they do sense them and try to resolve them before the blow-up. In any
case, these types of eruptions often cause serious cumulative damage.

Style Four – Rapid-Fire Extermination

This mode of expressing anger appears intended to annihilate the other partner’s
status in the relationship. It is a focused attack, a verbal machine gun, using
whatever is more likely to undermine and devalue any defense on the part of the

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other partners. Partners who use this anger style need to win at any cost by silencing
the other, then disconnecting immediately afterwards.

If they are not triggered into their own angry reaction, the partners on the other side
of the rapid-fire exterminator have learned over time to stay silent during the tirades.
They know that it has a predictable pattern of intensity and duration, and often just
wait it out.

Style Five – Hit and Run

Angry partners who are fearful of their partner’s response often wait to express their
own negative feelings when they can rapidly disconnect before facing retaliation.
They depend on their partner’s being less defensive at a later time.

These styles can cause the other partner to become increasingly resentful. It
depends a lot on how quickly the attacked partner recuperates, or whether he or she
becomes a counter-predator when the relationship resumes.

Style Six – Cold Withdrawal

Partners who exhibit this style of anger exhibit patronizing, robotic, silence during
their angry interludes. Their behaviors may last for a short time or for days, and
usually do not end until he or she gets what they want.

Partners on the other end of this behavior can be severely traumatized if they have a
history of rejection by others. If they have the confidence to weather the other’s
attempt to control by withdrawal, they can still be available to connect when the
boycott ends and the perpetrator has “self-thawed.”

Style Seven – Martyrdom

Continuous, repressed, anger that is blamed on the other partner can easily turn into
martyrdom. Martyrdom is a silent, self-effacing anger style but effectively
communicates cumulative distress. People who fall into this behavior are often trying
to appease or to adapt to the other’s demands, hoping their pain will be recognized
without their having to express it directly.

Partners on the other end of martyred anger styles rarely win. They don’t always
know what they’ve “done” that caused the silent suffering. Secondly, they are denied
information to help them understand whether to agree or to deny the charges. Third,
that martyred partner may actually feel noble when they sacrifice their needs, and
become wedded to that role.

Style Eight – Escape

Some people cannot bear any kind of angry interactions. They will use any means to
avoid them. The most typical of those escape behaviors is to abuse alcohol or other
drugs. But any addictive escape behaviors can be just as effective, even those that

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appear on the outside to be more legitimate like intense working-out, spending huge
amounts of time committed to work or hobbies. What is in common is the way and
when those escapes are utilized.

People on the other end of partners who refuse to engage in any kind of negative
interaction know they are being avoided. But their partners’ use behaviors that do not
lend themselves to resolution. The escape experiences are evidently preferable to
engaging, and often impossible to challenge.

Style Nine – Bank Shots

People who express anger by “bank-shots” by bringing in the “troops” for additional
support during any angry interaction. When they feel they are losing an argument,
they bring in the opinions of others their partners respect.

The unfortunate people on the other end of these anger strategies often feel self-
doubt when confronted by “all the others who feel the same way about them as their
partners do.” They begin to wonder whether their own thoughts and feelings have
merit, and then give in.

Style Ten – Revenge

This anger style is the most damaging to any relationship. The partners who use it
are intentional in their goal to inflict damage and to vanquish the other partner. ”

They do so by using wipe-out statements, character assassinations, attacks on the

other’s most vulnerable states, and threats of abandonment or exile. In their focus to
retaliate, they intend to annihilate the other in any way they can.

If the other partner argues back, they escalate their need to win. They may even try
to bait them if they don’t. Many of the attacked partners remain silent, hoping to
lessen the intensity and duration of the tirade. Others attempt to disconnect, but will
have trouble doing so until the predating partner feels they have suffered enough.

Anger styles are predominantly learned from early childhood but can also be caused
by mood disorders such as depression or other genetic inheritances. They are also
affected by a person’s current underlying state, prior upsets, or triggers from past
negative experiences.

If people can learn to understand and share their underlying drivers for their anger
before they express it unsuccessfully, most partners do respond positively to
listening and caring for those underlying vulnerabilities, and will strive to help heal
them.

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 How Do You Know When It's Love?

Defining love can help you figure out if you're in love. by Theresa E
DiDonato Ph.D.

You know "love at first sight"? Two strangers see each other, feel immediately
connected, and this instant attraction begets a forever relationship. People who
experience love at first sight seem to realize, right away, that they're in love. But
what if that's not your story? What if your relationship has more a gradual unfolding?
How then, do you know if you're in love?

Whether you believe in love at first sight or not, its emphasis is not actually on what
scholars would define as love. Rather, the spark that defines a love-at-first-sight
experience is better described as a strong attraction accompanied by an openness
to a future relationship (Zsok, Haucke, De Wit, & Barelds, 2017). Romantic love is
more involved, encompassing emotional, cognitive, and behavioral components. It's
also not something that generally happens instantly, but rather, it usually tends to
emerge over time.

Why is it important to know if you're in love?

Questions about love are often, although not always, anchored to behaviors or
choices. For instance, determining if you do (or do not) love someone could help you
decide:

Do I want to start an exclusive relationship with this person?

Am I really unhappy in this relationship, and should I leave?

Should I say "I love you" to the person I am with?

Should I hold out for something else, or is this it?

Am I ready for a deeper commitment to this person?

How do you know if you love someone?

In order to figure out if you love someone, consider how researchers define romantic
love. Many scholars see love as an emotional attachment (Hazan & Shaver, 1987),
and as such, they consider the quality of a relationship rather than viewing love as a
"yes/no" question. In other words, how would you characterize your relationship with
this person? How secure and safe do you feel? Are you preoccupied with this person
and anxiously concerned that he or she will leave you? Importantly, you can feel
deeply attached to someone, even if it is an experience colored by anxiety or
avoidance. The presence of romantic love does not depend on a secure experience.

Others view love as reflecting varying levels of passion, intimacy, and commitment
(Sternberg, 1986). In this case, you might ask yourself these questions, which reflect

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the ideas central to Sternberg's model, but are merely samples to spark thought;
they are not a validated measure of love:

1. How often do you think about this person?

2. Do you miss him/her when you're not near him/her?

3. Is it exciting, thrilling, or otherwise physiologically stimulating to see this person?

4. How connected do you feel to this person?

5. To what extent does this person know your emotions and feelings?

6. Do you have a strong level of mutual understanding?

7. Do you feel personally responsible for this person?

8. Are you "all-in" when it comes to being with this person?

The first three questions target the idea of passion, which is tied to sexual attraction.
Mutual sexual desire might promote romantic love, but sexual interest can be found
in other relationships (e.g., short-term flings, friends-with-benefits) in which someone
would not say they love that person. In other words, sexual attraction is often viewed
as necessary, but not sufficient, for defining romantic love.

The next three questions focus on intimacy. Intimacy is tied to liking. While most
people agree that liking is a part of romantic love (Graham, 2011), it is also a critical
component of close friendships and therefore, like passion, it is not exclusive to love.
The final three questions target commitment, which is a decision (Sternberg, 1986).
If passion is "hot," and intimacy is "warm," then commitment is the "cold" component
of love, in which someone chooses to be with someone else. Sternberg (1986)
argues that consummate love reflects all three aspects of his love triangle: passion,
intimacy, and love.

When people try to understand whether they are, or are not, in love with someone,
clarity can sometimes be elusive. Instead of asking "yes" or "no," think about "how
much" love you feel and to what extent the relationship fulfills the many different
needs we try to meet in our romantic relationships.