As I tried to illustrate in last week’s post (see: Therapy and the Face of Real Change), genuine behavioral change always occurs in the here-and-now moment. And last week’s example depicted an interview conducted with a single individual who had run afoul of the law several times and was facing possible incarceration. In this week’s post, I thought I’d give an example of a married couple who had experienced multiple problems during the course of their marriage and who were (at the wife’s insistence) making another attempt (they had tried counseling twice before) at therapy. Certain details of this case have been deliberately altered to completely ensure anonymity. But the case illustrates so many common problems that arise in a relationship when character disturbance is present that perhaps many of the readers will be able to identify with the situation described. My participation in the dialog will be signified by the letter “T”, and the wife’s (whom we’ll call Vicky) and her husband (whom we’ll call Bill) by the letters “V” and “B”, respectively:
T: “This is the second of our three evaluation visits, and I think we’ve covered about all the background information we need to discuss. So now I think it’s time we clarify just what things need to be worked on. Okay?
V: I think trust is the main issue. I want to trust him again, but I don’t know how. He says the affair with that woman is over and that it will never happen again. But it’s hard for me to get past it. I feel so betrayed.
B: There she goes, dwelling on the past again. I’m trying to put the past behind us. I’ve taken responsibility. I admitted my mistake and said I was sorry. Now, I’m just trying to move on… to get things back the way they used to be. But she just won’t let it go. And we’ve already been to counseling. And I realized then some of the things the therapist said I was in denial about. I’m different now. But she doesn’t want to accept that. And she doesn’t ever want to be affectionate with me.
W: I’m sorry, but it still hurts.
T: Bill, you said you’ve taken responsibility. But what I observed is a lot of blaming Vicky. Not only didn’t it sound like you take responsibility, but you didn’t even hesitate or self-correct when you were doing all that blaming. And Vicky, you mentioned last time that one reason you don’t trust Bill very much is because he doesn’t seem to take responsibility for anything. Yet when he was doing his blaming, you didn’t call him on it. In fact, you apologized.
B: I’m not blaming Vicky.
T: Bill, you did blame her. And you just lied about doing it. Blaming and lying cannot build trust. And those are two aspects of your character we’ve already talked about that you really need to work on more consistently.
B: So what are you saying?
T: I’m saying that to rebuild trust you must really take responsibility for the actions you took that destroyed the trust and the arduous work you have before you to rebuild it.
B: I guess I was still blaming her to a degree. I think I even blamed her at the time I was cheating. I told myself all kinds of things to justify what I was doing. But I want her to forgive me so we can move on.
T: Might I commend you on your willingness to admit your blaming. And it seems like you’re being a bit more honest with yourself, too. But you’ve still got a long way to go. And the bigger question is what effort you’re willing to make and the pain you’re willing to endure to earn back the trust you destroyed.
B: Vicky, I’m sorry. And don’t for a minute think any of this is your fault. I made a mistake ….oh… no,… that’s not right… Dr. Simon always says that making a mistake is like when someone accidentally steps on someone’s foot …. what I did was I betrayed your trust and now I need to earn it back. But I know I’m an impatient man and I tend to expect more of everyone else than I do of myself. I’m going to work on changing that.
T: Now that, sounds much more like taking responsibility. And good self-correcting on the “mistake” thing. But as we all know talk is one thing, and action is quite another. The proof, as they say, is always in the pudding. Why don’t you take some time between now and the next visit to propose some concrete steps you’re willing to take to earn some trust back. Be specific about the behaviors you promise to work on. Then, run them by Vicky.
V: What do I do?”
Now, this case actually proved to be quite a difficult one with many ups and downs. And it was extremely difficult to encourage Vicky not to do too much or to “save” her husband from the weight of the responsibility he bore for repairing the damage he’d done to the trust in their relationship. I didn’t actually work with this couple after the 3 visit evaluation period. I referred Vicky to another therapist for individual work (to address self-esteem and emotional dependency aspects of her personality that made her overly accommodating in relationships) and worked with Bill until they were both ready for joint visits with a marital counselor. But what I wanted to illustrate most is what it looks like when a person is confronted on habitual responsibility-avoidance and manipulative behaviors, shows some willingness to correct them (in the moment!) and is encouraged to keep doing so. In sound cognitive-behavioral therapy (CBT), the focus is always on behavior and in the here-and-now. The client’s job is to self-monitor and correct thinking errors and responsibility-obstructive behaviors, and the therapist’s job is to reinforce efforts toward genuine change. It’s definitely not your traditional counseling format.