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19th December 2018 

ARTICLES

As you probably know from previous articles, I like to keep up to date with research and new treatment ideas. As in every area of professional work, time doesn’t stand still and there is always room for improvement. Here are some thoughts on new coping techniques and links to recently published interesting articles:

ANXIETY TREATMENT – ONE DOESN’T FIT ALL

I recently attended a workshop by Christine Padesky, one of the leaders of CBT treatment developers in the USA. Over the last years, CBT has been established as the number one treatment for anxiety and depression, but what was new in this workshop was the revelation that there are two main categories of anxiety which need to be treated slightly differently.

Christine clusters anxieties into danger disorders (OCD, Panic and Health anxieties) and coping disorders (General anxiety disorder, phobias and social anxiety). The focus of the treatment of danger disorders as suggested by Padesky should be exposure to the perceived danger in combination with stopping avoidance and safety behaviour because these just keep the disorder going. As a result, anxiety beliefs and threatening images can be reframed and the perceived danger is reduced. Coping disorders treatment, in contrast to the above, will start with developing new coping strategies which replace avoidance, worries and safety behaviour with new ways of addressing the perceived threats. Once the coping strategies are in place, the "triggers" will be tested and exposed to the new behaviour.

What both treatments have in common is the use of images as these might provide better insight into the perceived dangers of the client than words alone will ever give.


MIRROR, MIRROR ON THE WALL…
Or how to survive the influences of your narcissistic mother

Snow White is haunted by her narcissistic stepmother until she comes of age and finds herself in a position (with a little help from a love struck prince) to liberate herself and live the life she wants. I have always been fascinated by this fairy-tale and puzzled by some dilemmas:
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Why does Snow White’s father give his new wife the power to hurt his beloved daughter?
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Why does no one challenge the stepmother’s wickedness?
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How does a princess know how to care for seven dwarfs?
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Why is she hiding instead of fighting her cruel stepmother?
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In my private practice I have come across many clients (both male and female) who put up with wicked mothers (and fathers) despite the fact that these people, who are meant to care for their children (or stepchildren), constantly put them down, criticise them or ignore them. Abuse comes in many disguises and it is particularly damaging when it is done “in the child’s best interest” because it leaves the child feeling guilty.

Last week, I came across a book which was like a revelation to me. I was looking for some literature which could help me and some of my female clients to better understand the following dilemma: Despite being financially secure and having interesting careers, these women still felt empty inside and “never good enough” no matter what they are achieving (e.g. career, children, relationships). Mostly, these women are highly motivated to engage in therapy, and lots of insight is gained rapidly - until we hit on their relationship with their mothers. Initially, mothers are often described as the women’s best friends. And then it transpires that these friendship only work in one direction: As long as the daughter focusses her attention on the mother, things are going relatively smoothly, but the minute the daughter dares to put herself at the centre of attention, the mother can’t cope. The women feel that they owe their mothers and that it is their responsibility to make their mums happy. But somehow, however hard they try, their mother will belittle or plainly ignore these efforts, or act as if this kind of behaviour is what the daughter owes her anyway.

Karyl McBride, explains this phenomenon in her book “Will I ever be good enough? Healing the daughters of narcissistic mothers.” (2009). She describes how daughters of narcissistic mothers either turn out to be high-achieving (and still not satisfied) or self-sabotaging (e.g. through their behaviour or unhealthy relationships). I wouldn’t agree that it is only daughters who are affected as I have seen many male clients with similar issues. However, this book provides a useful source for any therapist or client and gives important insights and mind provoking ideas how to come to terms with your relationship with your mother and how to move on from it, also without the help of prince charming.

And back to the question why her father didn’t support Snow White? Well, he was so busy looking after the needs of the queen that he had no energy left to also look after the princess (and he would also have had to pay the price for putting the princess before the queen).

Karyl McBride, Ph.D. (2009): Will I ever be good enough? Free Press, New York.
ęCarmen von Haenisch


TRIANGULATION (OR: I FEEL LIKE THE SPARE WHEEL)

TRIANGULATION, a concept coined by Dr. Murray Bowen and used widely in therapy, is the “process whereby a two-party relationship that is experiencing great intensity will naturally involve a third party to reduce anxiety” (Bobes & Rothman, 2002). So instead of keeping the focus on the two individuals and face the potential conflict, the attention and energy is shifted to a third party - person or object. This third party doesn’t have to be another person like e.g. a lover in an affair, it can also be an issue like the next holiday destination, or a substance like alcohol; anything really that shifts the focus away from the relationship thus reducing the tension. It can also serve as protection “against excessive intimacy by removing opportunities for one-on-one encounters” (Solomon, 1992) because intimacy brings up anxieties around abandonment versus autonomy. Depending on attachment style and narcissistic injuries human beings are more or less comfortable in close relationships. Triangulation can also serve as a way to bring back excitement into a relationship - in affairs one partner often looks for the excitement that has left the relationship - or in order to avoid separation from the family of origin. A typical example would be a relationship in which the mother of one of the partners would be encouraged to constantly be present either in person or on the phone and thus drawn into the couple’s life.

  • The triangle would often draw in the most vulnerable other person available in the environment. “Many couples are aware of the discomfort triangular situations may cause their relationship, but are uncertain as to what, if anything, can be done” (Crowe & Ridley 2000). Some of the problems triangulation can cause are loss of sleep, appetite, concentration and the sense of self worth (particularly when the other partner is having an affair), jealousy, guilt, depression, rivalry and the urge for revenge.

  • Detriangulation can be used in Transpersonal Therapy to facilitate differentiation. Initially the therapist might be welcomed as the third point of the triangle and her/his job is to raise awareness of the process and explain the function of the triangulation to the partners. By encouraging both clients to approach their presenting issue from the “I” perspective (e.g. I feel left out when... or I feel hurt when...) rather than blaming (“you always...or...your mother always...) individuals can be provided with “experiences of self worth, clarity and compassion, personal responsibility and unity consciousness” (Andrande, 1988). Another intervention might be to draw clearer boundaries around the couple’s relationship. This can be supported by exploring what the two members of the couple have in common and what drew them together at the beginning of their relationship. Once the couple has explored what their relationship used to be based on, they can continue to look at the changes that have occurred over time and what might have gone missing (e.g. a sense of closeness or intimacy). When the focus has been brought back to the relationship it might be possible to explore the positive function of the triangle for the relationship, e.g. highlighting what is missing in the relationship or indeed how the triangle might be protecting the couple from facing difficult feelings (e.g. discord or disappointment). This can lead to an exploration how the positive elements of the triangle can be brought back into the couple’s relationship, e.g. how the support one partner gets from his mother might be substituted by support from the partner.

  • If the triangle can’t (e.g. if children are involved) or won’t be given up, the partners can explore in the safety of the therapeutic relationship what needs to change in the relationship to enable distance to the third party and to find an agreement what constitutes for both parties an “acceptable relationship with the third Party” (Crowe & Ridley 2000).

  • Last but not least, it might be necessary for the therapist to facilitate a grieving process if the change of the triangle is experienced as a loss (e.g. giving up an affair or “losing” the wife to the new born baby). In all this therapeutic work it is very important that the therapist is aware of her own values in order to be able to facilitate the couple to focus on the needs of the relationship rather than putting the blame on each other or claiming moral superiority.

  • Andrade, P.Y. (1988). Family of origin: A land of opportunity for Transpersonal Therapy, [Online]. Psychosynthesis Resources. Available from http://www.psychosynthesisresources.com/NieuweBestanden/familyoforigin.pdf [Accessed: 6 May 2010].
    Bobes, T. and Rothman, B. (2002). Doing couple therapy. W.E. Norton & Company, New York, London.
    Crowe, M. and Ridley, J. (2000). Therapy with couples. 2nd ed. Blackwell Science: Oxford.
    Solomon, M.F. (1992). Narcissism and intimacy. W.W. Norton & Co, Inc., New York.

    Further article by Carmen von Haenisch:
    How did compulsory personal therapy during counselling training influence personal and professional development? To visit informaworld just CLICK HERE.

    Carmen von Haenisch | phone: 07900 194549 | Email: [email protected]