Dr Heather MacIntosh what worries you most
You said your blog post was inspired by news stories warning of a rise in domestic violence while people were being encouraged to stay home, and you said this worried you a great deal. What worries you most?
One of the things that happens a lot – if you’re a couples therapist this will resonate with you – is that couples will come in well down the road in their distress. So they don’t often come in at the point where we’re doing preventative health, they come in at the point where they’re very distressed. And one of the things that a couple will often say at the beginning of a session will be something like “I held onto this to discuss it here, because I was afraid that it would explode if I tried to talk about it at home”.
Often couples who are in a lot of distress are dealing with what we call ‘emotional disregulation’, so difficulty handling the emotions they’re having about the distress that they have with their partner. Because of course we know that while partners can be the people who help us feel better, when things aren’t going well they can also be the person who makes us feel worse. So one of my real concerns is that putting couples into isolation together, adding children without childcare, animals, financial difficulties, we’re raising the level of stress and reducing the level of support.
Depending on the context for this couple or family, this could be something that brings them together, and helps them build a sense of closeness and an identity as a family unit. But it can also, in the context where there might be a history of trauma, or a history of distress in this couple relationship, it can also be the thing that pushes them over the edge in terms of their ability to cope with the distress they’re having.
Sometimes even just going for a walk can help us blow off a little steam, for lack of a better word. And what we’re being told is that unless it’s that once-a-week trip for groceries, we shouldn’t be leaving the house.
So my concern was that for many – and I’ll speak for myself – I work ongoingly with couples who have a history of trauma, and we had sessions the week before the world basically locked down, and that was that. So even couples who have been in therapy for various reasons some of them have not been able to continue therapy virtually. Now all of a sudden there they are at home alone, in their distress, with more financial pressures, more things to worry about, and none of the supports they had before.
I imagine that even for those who are able to do long-distance therapy, it’s a difficult thing for them because they’re doing it from their home, where their partner lives.
Yes, that’s part of it. But there’s a debate – should people learn how to do individual therapy first, or should they learn how to do couples therapy and group therapy first? There are people who say that if you learn how to do individual therapy first, couples therapy is going to be overwhelming. Others say learn how to do couples therapy first because then individual therapy will be less stressful.
The reality is, when you’re doing individual therapy, even on Zoom or one of these platforms, the relationship that you’re working on is the relationship between you and your therapist. And if you have a conflict with that person, part of the therapy is trying to figure out how to work that through. It’s part of what makes the therapy helpful, having what we call a ‘rupture’ or something that doesn’t go so well, and figuring it out.
But that person, the therapist, is not your wife. It’s not your child. It’s not, for lack of a better term, the “real attachment relationship” with the person you’re connected with. And you also get to go home after your therapy session. Imagine then, when we put partners together in therapy, especially when there’s a history of trauma, either between the couple or in their past, the emotional intensity of those sessions goes way way up.
Part of what we’re doing is helping the couple manage that emotional intensity but still trying to resolve the difficulties that brought them in in the first place. So it’s a more complicated juggling of emotional arousal. Doing that over the internet where the two people are together – and maybe they’ve got kids around and the dogs are barking – is going to be a higher octane experience than going off into the bedroom, shutting the door, and talking to your individual therapist.
I’m also a little worried about how we’re going to manage that piece of things. Because while we want to continue to offer support, it’s really essential that we don’t make things worse.