Therapy and the Face of Real Change – Part 2

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.

B:  Okay.

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.

You can find other therapy vignettes in Character Disturbance, and a complete description of the most common responsibility-avoidance and manipulation tactics in In Sheep’s Clothing.

24 thoughts on “Therapy and the Face of Real Change – Part 2

  1. I’m curious to hear more about the methodology aspect – how you use ‘CBT’. I certainly see the ‘B’ in your many fascinating vignettes; in focusing on behavior. I suppose I still have a question about some of the nostrums of Cognitive Therapy being applied to CDs. So much of the distorted thinking patterns that are the mainstay of CBT (or just ‘CT’) seem so much more applicable to neurotics, especially those that tend to fuel depression or anxiety. Which as far as I understand from you (or observe in the ones I’ve ‘studied’ in real life) is not the usual symptom of disturbed characters! Meanwhile, you stress so often that disturbed characters are very much aware of themselves and what they’re doing, as well as their stuff being ego-syntonic…
    They clearly have some distorted ‘beliefs’ in one respect – but I’m tempted to say, these are ‘beliefs’ in a moral/ethical sense, or a world-view sense – rather than the distorted thinking patterns, in an epistemological or cognitive sense that afflict depressed neurotics. I realize moral or ethical discussions are not popular amongst many (most?) contemporary Western psychotherapists.
    But where would you say the ‘faulty thinking’ of the CD really lies? Is it not in their views of – as one friend said – ‘the map of the world, and where they are on it’? It’s not a problem of illogical thinking but of self-assessment, entitlement, and the moral weight of their acts.
    Look forward to your thoughts on this, if you want to share them.

    1. Thanks for asking. While I don’t have the time just now to be specific, here are the general rules: In contrast to traditional therapy where you gladly allow the client to take the lead, you have to be willing to set all the terms of engagement in the here-and-now moment with the disturbed character. Why? Because they simply can’t be trusted to set the rules. And when they engage and display their problem behaviors (both their tactics as well as other behaviors that bespeak their unhealthy thinking patterns and attitudes), you respond in a manner that suggests “we’re not going there because it’s unhealthy, destructive to relationships, and keeps you from being a better person. Whenever you catch yourself doing that again and re-direct yourself to what you know is more appropriate behavior and thinking, you’ll get lots of encouragement and reinforcement from me. When you fail to do so, I’ll call you on it.

      In short, it’s a dance, but you must take the lead or your toes will get stepped on like everyone else’s in the disturbed character’s life and they’ll only be more reinforced for getting better at the bad dance.

      When I have a bit more time, I’ll give you some more specific details of the process. And you can find therapy vignettes in my book Character Disturbance. Feel free also to use the contact feature and email me and I’ll write back with more details.

  2. Thanks so much for responding. And I wouldn’t want to put you to the trouble of too detailed a response, I know how many important things you must be attending to!
    It does confirm my sense that your method is not ‘cognitive therapy as many know it’ — or put it this way, if you *are* as is traditional specifically dealing with distorted thinking patterns, it’s not the usual list of thinking errors that lead to depression and anxiety. (Catastrophising, all-or-nothing thinking, and so on. At least not in the usual way.)

    These people have a list of their own thinking distortions – which I suppose is what your books outline. They have the grammatical form of:
    ‘It’s acceptable for ME to…’
    ‘I am entitled to…’
    ‘No one has the right to make me…’
    and so on!

    But it does sound like the most fundamental technique is essentially behavioral.

    I suppose the reason for my question is that I take very seriously your points about ‘don’t judge the intention, judge the action’; beware of struggling to ‘understand’, and so on. And I was just trying to square that with the usual aims and approaches of ‘cognitive’ therapy; which almost seem to run counter to your very welcome warnings about the dangers of trying to ‘get into these people’s heads’!

    Thanks so much for your response.

  3. OMG this is describes almost exactly our situation. When I found out what my husband was doing I was devastated and my world fell apart, but at first he was surprised and confused about my reaction and overtime he became at one time sorry and the next ambivilant, it took months and months for him to admit what he did was wrong. He believed if he didn’t actually have sex with the woman then it wasn’t cheating and he saw nothing wrong with keeping their relationship secret from me, even setting up a separate email account to correspond and telling her things about us. We have been on a rollercoaster for 18 months now and he has now agreed to go to a psychologist (I’ve been seeing one too) and go back to marriage guidance but now I’m wondering if all of this will get him to understand that his behaviour is wrong and he has to start being honest and taking responsibility for his actions and stop blaming me. I really think he thinks I’m the problem. I’m having a real problem with trusting him again because he works in the oil & gas industry and has worked away on and off for 20 years and has sworn to me that he has never so much as flirted with another woman when he’s away from me, but when I find stuff out that he’s done and confronted him he at first denies it, then admits it, but then say’s either there’s nothing wrong with, or it’s because we weren’t getting along, or if he told me I would have been upset and it is always ‘the first time anything like that has ever happened’. He has proven to me that he can look me in the eyes and tell me a blatant lie, but when I find out he’s lied he’ll come up with the same excuse. I want our marriage to survive and I love him but I want an honest husband and I never know if he’s being honest or lying. He has agreed to go to see a psychologist but I’m concerned that he’s not really wanting to change, he is very charming and the classical ‘nice guy’ to everyone else. What are the chances of him changing and is there anything I can do or say to help him change?

    1. Now that you’ve gotten some good feedback from the readers, let me emphasize a few points: First, define for yourself what you mean by the word “help.” I define it as when someone through no fault of their own has experienced an unfortunate circumstance from which they can’t possibly wrest him/herself alone and is asking for assistance. You’re then morally obligated to “help.” But I find when most people talk about “helping” impaired characters change, they’re usually talking about a “rescue” or a “push,” both of which are destined to have disastrous consequences. Also, when someone “agrees” to go to a psychologist or other professional, that usually means they didn’t really see the need for it themselves or if they did, they didn’t have sufficient motivation to take action. That’s why it’s so important for YOU to completely define the “terms of engagement” (I discuss this in both books) and to establish the minimum expectations you have for anyone who would have a relationship with you. Lastly, the best predictor of behavior is prior behavior. And the only thing you know for sure is that there’s probably a lot you don’t know. Besides, the “technicality” of whether some contact with another woman, though admittedly inappropriate, was not “physical” is totally irrelevant (if in fact it’s actually true – and the only thing you know for sure is that he can look you in the eye and lie). It’s just another tactic in the arsenal of responsibility-avoidance and throwing you on the defensive. Read and learn all the tactics and respond to them appropriately. Then establish the terms and the expectations and hold fast to them. And whether he sees a therapist that can be bamboozled (this frequently happens, unfortunately) is less important than whether he demonstrates real and lasting change and a firm commitment to make of himself a better person. YOU have to be the judge of his success in that, not the therapist, anyway.

      1. Thankyou Dr Simon, this makes so much sense. I feel like I’ve been in a fog for the past 25 years, certainly the past 18 months have been an absolute train wreck. I would like to work on the marriage and stay together if we can but if he isn’t honest then I can’t live with that, it’s hurting me like hell to have to face what he’s been doing. But I feel I am finally starting to see the light so to speak, he’s hurting me and I have to look after myself, I guess I come from a generation (I’m 56) who tends to put others first and to put yourself first was considered self centred. But not now. I’ll certainly keep following you posts and will add comments to let you know how I’m going. Thankyou so much for your time to answer my somewhat lengthy posts, it is very much appreciated.

        1. Awreck, you are not alone in “the fog”. If he is a disordered person, that is a very common feeling and a result of many dynamics at play. Just stay objective and listen to your instincts while you do your reading and research.

          1. Thankyou Puddle, I feel I do have very strong instincts or gut feelings but I’ve been confused by them and I have kept revisiting what happened with him and telling him about my suspicions because this feeling in my gut won’t go away, but he just keeps saying he’s told me everything and he’s not hiding anything. But the only stuff I know about what he’s been up to is the stuff I’ve found hard evidence on and then challenged him on it, he at first denies, the will say ‘I thought I told you about that’ and then ‘well I didn’t tell you because I knew you’d be upset’, when I point out to him that he has just admitted to lying he appears to not understand the context of what he just said. I think I now understand that the knot in my guts is that I know on some level that I’m being deceived but because I love him so much I maybe haven’t been strong enough to face it. This is painful, but I’ve been getting help (and this forum is helping me so much too) that I can feel myself getting stronger and I know that I shouldn’t have to put up with this and if it doesn’t change I’m going to have to make a choice. Thankyou all so much for taking the time to respond to my posts, I really d appreciate it.

      Print it out and give it to him and tell him this is what he needs to work on in therapy.
      I personally will have a one strike and you are out policy in regards to lying in the future with any man, period. It’s SUCH a red flag.
      Read, read, read. I recommend you educate your self as much as possible. Dr. Simon’s books are great as are many others. You can start by reading as many of Dr. Simon’s on line articles as you can. Pay attention and trust yourself and your instincts.

      1. Thankyou for these replies, it is helping me so much to be able to talk about it. I have download two of Dr Simons books onto my Kindle and will start reading them. I’m currently reading The Verbally abusive relationship & I’ve downloaded Should I Stay or Should I go, which I was planning on reading next. It is so hard, I just want him to come clean and tell me the truth about whats gone on in the past so we can work through it and hopefully have a better decent marriage, but he just denies anything has happened and declares he has told me everything, but knowing what i know about what he did, seeing how he acts around women and women around him my gut tells me he’s still lying, I’ve had that feeling in my gut the whole time and it’s not going away. I’m going to give the counselling a go, but if he can’t change I can’t keep living like this, it’s not fair.
        Thankyou guys, I will keep reading and keep going. I had a dream last night about being in a tunnel, it was very long, and there was daylight way in the distance at the end, but I remember feeling very, very, tired. Not sure what this is telling me but I think I have some idea, I just don’t know how much more I can do.

        1. Awreck, Once you really start reading (and do it in an open objective way if possible), if he IS someone you need to get away from…..the light bulb will come on. I have found that all the reading I have done basically validated my gut feelings but until I did the research and reading, I didn’t KNOW know so I stayed. I was very much in love, deeply emotionally invested in the relationship so I did not want it to end….ever. I really thought it would/ could turn around. I thought he wanted it to turn around. I believed that he loved me…….but at the same time, I didn’t trust that he loved me. I doubt that makes sense… barely makes sense to me. Anyhow, I really did see a LOT of red flags and I wouldn’t say that I ignored them exactly but I didn’t know how bad it really was/ would be. I’ve been with other impaired men in my past but this was different and I’d never encountered someone this disturbed romantically before. I hope I never do again. What a looser! I have other words I could use for him as well but I’m sure that blank is easily filled in with just about anyone’s imagination!
          Good luck to you Awreck!
          Dr. Simon is the best and a wonderful man and human so I would highly recommend you read his books and articles.

          1. Thankyou Puddle, I’m reading everything I can and unfortunately (or fortunately) I’m recognising myself and his behaviour in so much of it. Thankyou for the words of support and encouragement

        2. Awreck, I recommend too, not to take anything away from Dr. Simon but there is a lot of support there too.

  4. Dr Simon, I find these blow by blow accounts of therapy sessions very helpful.

    thank you.

    I’ve started reading the ‘character disorder’ book now. I realise one of my adult sons fits the ‘asocial’ category. As a teenager, he was diagnosed with some autistic traits but not enough to really get a ‘label’ or any support. the asocail category and it’s definition is helpful to know. it changes my expectations. I wonder if there are books/articles to help me know how best to support him or for him to read?


    1. Thanks, Rose. There are no books specific to the topic, but you might find some of the more popular books based in Jungian psychology on extremely introverted personality types to be helpful. I think what Jung considered “introversion” in the extreme is really the trait we now ascribe to asocial types. And although not all of the material you find will fit, some will probably fit quite nicely. There’s a plethora of them out there. I’d put “Jung” and “introversion” as keywords along with “book” into the Google search bar and peruse what comes up.

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