14 Dec Patients and Couples Considering Divorce: What is the Psychotherapists Role?

Posted at 11:04 pm in Couples Therapy by jlbworks

By Philip Chanin, Ed.D., ABPP, CGP

(I would like to thank a number of NPI and Nashville, TN  psychotherapist colleagues and friends who read the first draft of this article and made very helpful suggestions. They include: Mary Arwen, M.A., Zach Bryant, Ph.D., Tom Campbell, M.D., Jim Fuller, Rod Kochtitzky, M.Div., Jamie Kyne, Ph.D., Jordan Lee, Ed.D., Christine Oliver, M.A., Marsha Robertson, LCSW, Warren Thompson, Ph.D., and James Walker, Ph.D.)

“When love dies, it remains dead. Trying to bring back that which is dead is like giving mouth-to-mouth resuscitation to a cadaver…Too many couples who would be infinitely better off apart from one another stay together in an atmosphere of indifference or even hatred. Some are chained together by their religion. Most remain together out of fear. A loveless marriage is a terrible waste of two lives.” (Lazarus, 200l, pp. 98-99)

As psychotherapists in Nashville, TN, we practice in a region of the country whose dominant cultural values are avowedly “pro-marriage and pro-family.” As Tennesseans, we practice in a state in which, in the national election three weeks ago, the presidential ticket that is most identified with these values carried ninety-one of the ninety-five counties in the state.

This cultural reality was evident to me in a recent session in my office with a female patient who has filed for divorce after a 30-year marriage to a narcissistic husband who aggressively forced her to have sex, against her will, for much of the marriage. The minister of the church where she and her family have been very involved for many years insists that she must stay married, despite his knowledge of what amounts essentially to years of marital rape.

My patient states, “The minister is pushing for reconciliation, because my husband has ‘repented.’ The church and the minister will not accept divorce.” If she follows through with her plans to divorce, she will be subject to “church discipline” by the entire congregation. Most likely she will be expelled from church membership.

Many psychotherapists might say that their goal is to help their patients and couples to stay married. For these therapists, divorce may represent failure. My goal with my patients is to help them to lead more fulfilling lives, with equanimity and mental balance. In many cases, this means assisting them with deciding to divorce, or else helping them to get strong enough and to feel entitled enough to a better life, in order to be able to decide to divorce.

In her feedback to me about this article, Dr. Jordan Lee adds a thoughtful comment in this regard: “…a divorce agenda generated by the therapist prematurely without the accompanying ego building work often causes either the therapy relationship and/or the divorce to fail. There is a process and rhythm to this work that is painstaking and some of us don’t have the patience to withstand it.”

Dr. Lee makes another cogent point about the therapist’s role, stating,

“It’s so important to help a couple put divorce on the table precisely because it offers them the possibility of choosing marriage, rather than feeling trapped in it. I tell patients that I don’t have an agenda about what they choose, but that the choice (marriage or divorce) needs to come from a thoughtful and deliberate place rather than reactivity or fear. Usually they come to the same conclusion that I have.”

Mira Kirshenbaum, in her excellent book, Too Good to Leave, Too Bad to Stay (1996), cautions individuals in troubled relationships from using the “balance scale approach,” as it can keep a person caught in long-term “relationship ambivalence.” Instead, she offers decision-making guidelines such as “If there’s something your partner does that makes your relationship too bad to say in, and he acknowledges it, but he’s in fact unwilling to do anything about it, and if his unwillingness has been clear for at least six months, you’ll be happier if you leave. Quick take: If you’re waiting for your partner to want to change, you’re waiting for Godot. (p. 149)

I utilize a Marital Satisfaction Questionnaire in my first session with all new couples, to give me a sense of each partner’s level of satisfaction in a dozen different aspects of their marriage. It also tells me whether there is one partner who is decidedly more unhappy about the relationship than the other. When this is the case, often it is the wife. We know that approximately 70 per cent of divorces are initiated by wives.

As I stated in my NPI luncheon presentation on narcissism, in November, 2010,

“I believe it is incumbent on us as therapists to educate our patients about when what they are enduring constitutes abuse, and about what level of respect they are entitled to in their relationships. Terry Real (2007) writes, “Behaviors are abusive when they violate your psychological self…” When I talk with a patient who is in what I believe to be a toxic marital relationship, I will often encourage him or her to divorce. As Dr. Lazarus (2001) states: When a therapist is consulted by a couple who thoroughly dislike (if not despise) each other, is it professionally appropriate to declare the marriage bankrupt, or is this, as some declare, playing God? In these cases I always state my candid opinion—but stress that it is merely an opinion and recommend that they consult someone else to see what he or she might conclude.

Increasingly, much of my practice involves assisting individuals who 1) have been (or are being) emotionally wounded by narcissistic parents, spouses, children, or bosses, or 2) are struggling in painful marriages or relationships. Very often both of these conditions are present. As I look over my patient schedule for the past twelve months, I see that I have worked in my office with fifteen patients who have divorced this year, are in the divorce process, or have decided to divorce. I’ve seen seventeen couples in crisis who were considering divorce when they came in to see me. In addition, I’ve seen forty-seven individual patients who were struggling with whether to divorce, or whose spouses had asked them to leave.

As psychotherapists, perhaps we should not be surprised that so much of our work involves working with individuals and couples in desperate marital relationships. As Terry Real (2002) writes:

“Is there some natural law of marital entropy? Some ubiquitous centripetal force pulling decent people away from each other? Of the thousands of statistics about marriage churned out by social research each year, the one I find most depressing is that in all couples, rich and poor, happy and unhappy, one of the most reliable predictors of marital dissatisfaction is simple longevity. The longer couples live together, the lower their reported contentment.” (p. 35)

If I see individuals or couples in long-term marriages who report they are happy, I tell them that they are a statistical anomaly!

I believe that toxic marriages make people sick. According to Weissman (1987),

“People in unhappy marriages are at a 25-times greater risk for developing major depression than those in happy marriages.” A female patient who came to see me this year for help in coping with her narcissistic/borderline mother stated to me, “My father died of liver cancer—he internalized all of her rage.” Another female patient with whom I’ve worked recently, who has been married to a grandiose narcissist for many decades, has developed a number of debilitating autoimmune illnesses.

A man whom I’ve seen in weekly therapy for eleven years, who has developed chronic pain in many parts of his body, has been in a toxic marriage with his narcissistic wife for 40 years. I believe that he has often wanted to die, as a way to escape this marriage. Neuropsychologist, James Walker, Ph.D., ABPP, who did a recent evaluation of my patient, stated in his report:

“The psychological test results raise significant concerns about the possibility of a somatoform disorder. He is a man who is very uncomfortable with strongly negative emotions such as rage and dysphoria. Instead of expressing his feelings directly, he is more apt to take on a sick role, searching for sympathy and emotional support by presenting himself as physically debilitated. He is struggling with strong feelings of anger and hostility. In all likelihood, his psychological conflicts are driving much of his pain behavior.”

This patient, when he met with the neuropsychologist, made no mention of his marital unhappiness.

How do I assist patients in troubled marriages? In addition to their work with me, I strongly suggest to them that their partners need to also be in individual therapy, and that they should also seek out therapy as a couple. I say to my patients, “Those I work with whose partners are engaged in their own personal therapy and/or spiritual practice and/or recovery program are generally hopeful about their marriages. My patients whose partners reject such help or involvement are generally despairing.” As Terry Real (2007) states:

“…you owe it to yourself and your family to get—or insist that your partner get—help…Some people hesitate to confront their mate’s emotional difficulties for fear that it will ‘set off’ the person and ‘make things worse.’ …But my advice is to put principle aside and do whatever it takes to get your partner in front of a mental health professional. Even if you need to make the calls, screen the potential therapists, and make the initial appointment, I suggest you do it.” (pp. 95-96)

Also, I will educate my patients about the fundamental building blocks of successful relationships. Ethel Spector Person (1988) suggests that a good marriage involves three basic characteristics. These are: 1) idealization; 2) mutuality; and 3) romantic passion. By idealization she means, “Do I think my partner is special and unique and that I’m lucky to be with this person?” By mutuality she means, “Do my partner and I have shared values, interests, life dreams, and activities we enjoy together?” The issue with romantic passion is whether this has been sustained through the course of the marriage, which is a big challenge for most couples. I frequently recommend Esther Perel’s wonderful book on this subject, Mating in Captivity (2006), for patients and couples who struggle to maintain romantic passion in long-term marriages.

Dr. Lazarus has a slightly different but related set of necessary building blocks for a good marriage. He writes:

“…truly happy marriages involve couples who (1) see eye-to-eye on the practical details of life, (2) are on the same wavelength, and (3) have similar sexual needs and preferences…One of the most significant problems on the practical dimension involves money. Different views on the importance of money, on spending habits, and on saving money always spell trouble. Likewise, neatness (or the lack thereof) also often plays a major role. The wavelength dimension involves values, aspirations, ambitions, spiritual orientations, and political leanings. These are a few of the main factors, and any discords will undermine the quality of the relationship. In every marriage, differences are bound to arise and thus it will be necessary to expend effort to deal with various issues. If this effort amounts to hard labor, it signifies a basic incompatibility…”

As psychotherapists, we work with many individuals and couples whose marriages constitute “hard labor.” When I assist a patient or a couple in getting divorced, I then usually have the privilege of working with them as their new life or lives take shape. Almost always their depression lifts, and often they begin the process of dating and building a new future. Certainly the divorce process is almost always frustrating and painful, and there is often hard work still to do in experiencing anger, sadness and grief at the loss of the marriage. There is also the crucial work of prioritizing the children’s emotional needs as they also adjust to the loss of their intact family and cope with new custody and visitation arrangements. As a former divorcing patient once said to me, “A divorce is the death of a dream.”

Typically the decision to divorce is made after years of agonizing struggle. Rarely ever is this an easy decision. I like the guideline that Mira Kirshenbaum (1996) recommends:

“If your experience with the (couples) therapist is, ‘Gee, she’s really good” and yet there’s no change after nine months in whatever it is that makes your relationship too bad to stay in, then you can feel confident in your sense that it’s most likely unchangeable. You’ll know you’ve done everything you could do. And that will make it easier to accept that you’ll be happier leaving the relationship.” (p. 52)

A recent session with a new male patient, aged 42, highlighted for me the poignant losses, of a lifetime of opportunities for happiness, that can result from the decision to remain in an unhappy marriage. He was talking about his parents, who separated for 3 months when he was 7 years old, and then got back together and didn’t divorce until eight years ago, after a 40-year marriage.

My patient stated further:

“She was so committed to the external ‘no problems.’…She sacrificed her own happiness…She tried to date after she broke up with my father. She had a lot of dates, for two years, with 75 to 80-year-olds. She realized ‘Prince Charming’ isn’t out there. She gave up, saying, ‘It’s not worth it.’ A lot of ‘Frogs.’”

I will conclude this article with a very different story. A young couple came to see me last year for pre-marital therapy. They met with me regularly for nine months (remember Mira Kirshenbaum’s advice). They worked hard in therapy and learned communication skills and developed a lot of awareness of their difficult dynamics as a couple, rooted for each of them in their families of origin. They planned an elaborate wedding. Then, five weeks before the wedding, I received this email:

“We wanted to let you know that we will not be coming to our appointment this week. We have decided to cancel the wedding ceremony and we are no longer a couple. Our fights have continued to be excessive in number and intensity and we just cannot continue. We appreciate everything you have tried to do for us. We wish it had been a different outcome.”

While I was sad about the ending of this relationship, there was also a sense in which I saw our work together as successful. In addition to both of them learning
a great deal about communication and their own psychological dynamics that they can apply to future relationships, I believe that they are spared a potential lifetime of heartache with each other, as illustrated by the case which just precedes them in this article. Reiterating Dr. Lazarus statement which opens this article, “A loveless marriage is a terrible waste of two lives.”

Arwen, Mary. Personal correspondence. (November, 2012)

Kirshenbaum, Mira. Too Good to Leave, Too Bad to Stay. New York: Penguin Books, 1996.

Kochtitzky, Rod. Personal correspondence. (November, 2012)

Kyne, Jamie. Personal correspondence. (November, 2012)

Lazarus, Arnold A. Marital Myths Revisited: A Fresh Look at Two Dozen Mistaken Beliefs About Marriage. Atascadero, CA: Impact Publishers, 2001.

Lee, Jordan. Personal correspondence. (November, 2012)

Oliver, Christina. Personal correspondence. (November, 2012)

Perel, Esther. Mating in Captivity: Unlocking Erotic Intelligence. New York: HarperCollins, 2006.

Person, Ethel Spector. Dreams of Love and Fateful Encounters: The Power of Romantic Passion. New York: W.W. Norton and Company, 1988.

Real, Terrence. How Can I Get Through to You?: Reconnecting Men and Women. New York: Scribners, 2002.

Real, Terrence, The New Rules of Marriage. New York: Ballantine Books, 2007.

Walker, James. “Psychological Evaluation Report.” (October 11, 2011)

Weissman, M.M. “Advances in Psychiatric Epidemiology: Rates and risks for major depression.” American Journal of Public Health, 77, 445-451.