Couples with unhealthy bid for connection

I often see couples who are so disconnected but fail to reconnect in healthy ways. Their “bid for connection” often comes in the form of fight, flight, freeze which often makes things worse. Unfortunately, it’s a recurring pattern for them. It may have stemmed from past hurts which they or others are unable to change.

Same pattern will tend to give the same result isn’t it?

So the key aim is to assist these folks to defuse from the old patterns in order to create new healthier ones for their context.

And defusion is often the key rate limiting step.

How to prevent relationship failure

In couple counseling work, there are 4 key red flags pointing towards the failure of that relationship as per Gottman’s research.

1. Criticism
2. Defensiveness
3. Contemptuous
4. Stonewalling

Like managing the risk factors for heart disease namely diabetes, hypertension, hypercholesterolaemia, and smoking, we manage the 4 red flag signs of the above.

Helping couples to work better as a team

I often see couples who fight with one another and are unable to resolve their differences.

There are common patterns I see.

When solving problems, and both take the perceiving, “zoom out” or defused approach, then no action. Lots of brainstorming perhaps, but not enough action so this can be frustrating for both parties.

When one takes a “zoom out bigger picture” approach and the other takes a “zoom in focused obsessive/passionate” approach, then this can complement really well.  Think resus code blue in the hospital.  At least one person “zoom out” with the broader picture, hands behind their back and direct, while the rest can “zoom in” with various tasks. 

The problem is, when both are “zoomed in” and are super focused on an issue but in different ways, then it’s really hard to reconcile that isn’t it?

The issue may be around parenting, finance, where to live, who to include in the invitation list, big and small stuff around the house, to name a few.

The key is to know who to predominantly “zoom in”, and who to predominant “zoom out” in a given context. It’s a hard dance to get right for sure so holding space for each other’s failures is critical. Doing multiple takes are often required.

I wonder if you can relate…

Helping patients to resolve conflict for better mental health

I often see folks who have great difficulties around conflict resolution.

In conflict, which is inevitable in any meaningful relationship, instead of defusing, re-aligning goals, reconnect and reconcile, they tend to fight, flight or freeze.

This will of course tend to make things worse.

Fear of conflict will then be inevitable.

These experiences will then reinforce the fight, flight or freeze for the next set of conflict.

Conflict resolution skills are therefore a critical part of any counseling work isn’t it?

Helping couples overcome the four horsemen as described by Gottman

I’ve seen a few patients in the last week fallen trap to the ”Four Horsemen” in their relationship as described by Gottman. This is common for many couples. 

1. Being overly critical of one another

2. Being overly defensive with one another

3. Being contemptuous with one another

4. Stonewalling each other

This is like the “high cholesterol, diabetes, hypertension, and smoking” for heart disease. 

The good news is, one can change these factors to improve one’s relationship and one’s psychosocial health.

Helping couples in Family Medicine

I’ve seen many couples who struggle with the emotional space in their relationship.

It’s very common. 

There’s an emotional space and there’s the more logical/practical space of running a “family” big or small. Zooming out and rating these out of 10 may give one more clarity.

If the logical/practical space is great, but the emotional space is empty, it will likely to fail.

If the emotional space is great but the more logical/practical space is lacking, then it may also fail.

Couples who have a blindspot in any one of these will eventually run into trouble.

But there’s always hope once insight or clarity is gained.

Helping our patients who are “extreme thinkers” or “extreme feelers”

Fundamentally speaking, at a transdiagnostic level, in counseling, we often see the “extreme thinking mind folks”, and the “extreme feeling mind folks” who struggle to adapt to their context or environment. In DSM, these folks may get labeled with different things but in essence, it’s an adjustment issue with fight, flight or freeze responses leading to anxious or depressed moods.

If we use this framework in order to help these folks to adapt and thrive better, the ”extreme thinking mind folks” have to learn more about the “feeling mind” and/or find someone who can scaffold for their “blindspot”, and the “extreme feeling mind folks” have to learn more about the “thinking mind” and/or find someone who can scaffold for their “blindspot”.

It’s not uncommon for these two “extremes” to get together and cover for each other’s blindspots.

As Family Doctors, I am sure you have observed those.

Helping couples to move from compromise to consensus

I often see couples who use the word “compromise”.

They feel that they have to compromise on many different things. Although they believe that compromise is important, it has lead to much resentments over the years.

We explored a shift in mindset to “reach for consensus” rather than compromise.

So what is the difference?

I often see “compromising” is something “external compass” folks tend to do at the cost of their “inner compass” i.e. their principles, values and beliefs.

“External compass” folks tend to make decisions based on the feelings, rules, or principles of others in order for workability and external harmony, and so they “compromise” their own internal principles or values in order to make it work.

In the right doses, it’s workable, but with over reliance, it may lead to a lot of inner disharmony and resentment.

Reaching consensus is the other way.

It’s more about following our own values and beliefs, COUPLED with understanding, appreciating, and allowing others to have their own values and beliefs, AND through that deeper understanding, we try to reach consensus. It’s not about imposing on each other, but each is empowered to reach “consensus”.

A lot of “holding space” with critical thinking and critical feeling is required and so it’s not easy.

The key difference is, compromise has emotional resistance. Consensus has more emotional acceptance.

Compromise is a “logical, practical and intellectual agreement” in order to make something work.

Consensus is a deeper “emotional agreement”. It requires a deeper dive into the values and beliefs of both parties, and holding space for opposing ideas without judgement before judging to make it work i.e. reaching consensus.

Compromise tries to achieve outer harmony but often at the cost of inner harmony.

Consensus tries to achieve both inner and outer harmony.

In business, one can usually get away with “compromise” because it’s more emotionally detached.

In long term personal relationships, compromise tends to end up in emotional problems eventually.

It’s hard but it’s more emotionally sustainable.

Helping our patients who struggle with emotional literacy

When assessing language and literacy, we try to assess whether the problem is in the receptive comprehension, in the expressive, or both.

When we try to assess emotion literacy, same thing. 

Is the problem in the “receptive” or the “expressive” domain?

How well does this person interpret and decode feelings and emotions?

And…

How well does this person use the appropriate feelings or values to take congruent action in a particular context?

Not easy for many of the folks that we see. There may be problems in both domains leading to relational and mood difficulties.

Helping our patients learn how to repair a disconnection in relationships is critical

Maintaining good healthy and stable relationships is important for our sociopsychobio health. The 75yr Harvard study have shown this. But it’s not easy is it?

When the feeling mind takes over, it often can work in unconscious, subconscious or reactive ways. This will inevitably lead to misunderstanding, miscommunication and conflict.  

So knowing how to repair a “disconnection” in our relationships is critical right?

Making decisions together rather than going solo

When we make important decisions at the practice, we have 4 people with different personalities and different biases. We try to reach consensus through our different perspectives.

Each of us have different biases based on the following.  

1. One of us is biased towards workability and practicality.

2. One of us is biased towards the social harmony and public relations.

3. One of us is biased towards following certain sets of logical principles and what makes logical sense.

4. One of us is biased towards what feels right and what is in line with our values. What is authentic to us.

Making decisions together can be better than going solo. It can be more “balanced” when done with the acknowledgement and appreciation of each other’s differences.

I wonder if you have one of the above biases. 

Social prescribing and helping patients to better manage “drama” may need to go hand in hand

The key problem I see for folks when being more “social” or “connected”, is that it will inevitably create some associated “drama”.

With drama or disconnection, the rational thing is to reconnect in a healthy way.

But many will instinctively fight or flight which then makes the disconnection worse.

The cycle continues.

How to manage drama or relational conflict is an important skill that MAY need to go hand in hand with social prescribing.

How to call out “bad or inappropriate behaviours” in the consult room without the escalation

It’s tricky in communication because at times, it’s not just the exchange of words but also the exchange of feelings or “vibes” around those words.  It’s part of the “non verbals”.  

When we call people out with frustration or disapproval, their feeling minds may get defensive and counter attack.  Their feeling mind may say, I am not a bad person. You are. This may escalate into a non productive lose lose situation. 

When we are able to acknowledge their position with “holding space” for their thoughts and feelings, then we are more able to explore with them an alternative position, and a shift may occur or at least, a seed is planted.  

Helping our patients to live a life that is more in line with their values

I regularly see conflicts, both outer and inner conflicts. I suspect we all do. The trouble is, at times, we don’t really understand ourselves or each other.

One of the commonest sources of conflict is in our differences around making decisions. We all make decisions differently.

1. Some of us rely heavily on practicality. What works? What’s effective? What’s practical? What are the rules? Let’s take the “feelings” out of the equation. What are the logical steps to our goals and let’s take action?

2. Some of us rely heavily on making decisions based on the feelings and values of others in order to achieve our goals, and at the same time, maintain social harmony.

3. Some of us are more reliant on “critical thinking”. Everything we do has to make sense to us and follow a set of internal logical rules, “truths”, and principles. We apply a “scientific approach” to our decision making.

4. Some of us are more about authenticity. Everything we do has to “feel right”, and stay true to who we are and our values. Take action, and at the same time, not at the cost of our inner harmony.

Schools, society, and even our families are often better at teaching us the top 3 methods, and may neglect the last one with negative consequences to our mental health.

In counseling, we often need to assist folks to focus and move towards their values again in order to find more balance.

Helping our patients with connection and empowerment for better mental health

I love reminiscing about the past.  Lots to reflect and learn.

This evening, I went through some of old photos with my parents. We spent some time in the refugee camps back in 1980. 

So what have we learnt?

1. When we don’t have much BUT connected and have autonomy=happy

2. Having much BUT not connected and lack autonomy=unhappy and lots of worry

3. Not having much, not connected, and lack of autonomy=really bad news 

The latter describes many of the patients we see doesn’t it?

Helping them with connection and empowerment is a good start. 

Helping our patients with their social health including healthy relationships with their families

As a Family Doctor, we see familial conflicts all the time.  Couples fight. Siblings, children, parents, and relatives fight. When we care, we get upset. When we get upset, we fight. 

I think the key to a wonderful relationship is not in making no mistakes or having “no fighting”, but knowing how to genuinely repair it when it inevitably happens.  

And there’s no real “statute of limitations” on when to repair that.  

Helping couples to stay together and be happy

I often see couples who have fallen into the “fight or flight” trap. I am sure that you have too. 

Often they have opposing personality styles.

Over time, they have fallen into the trap of blaming each other for their personality. The problem is, one can’t really change one’s personality. We are, simply who we are.

When explored further, it became more apparent what the real issues are. 

1. They failed to align goals over time as their lives changed including the complexity of having kids. When opposing personalities have the same goals, they make a great team. When not, conflict is inevitable.

2. When feeling disconnected, instead of reconnecting, they blame, demand, lash out, or withdraw. They “fight or flight”. This will of course lead to more disconnection.

3. When in conflict, instead of listening to understand, they listen to respond with “fight or flight”. Each want to be right to make the other one wrong. They have great difficulties holding space for each other’s opposing views, acknowledging those, be assertive with their own needs without blame, and reconciling each other’s needs.  

Without change to the above patterns, the outcome will often repeat itself until there is a change.

Helping our patients to embrace their “opposites” in their “life team”

Have you ever read my posts and wonder, what is this guy talking about?

If yes, then it’s normal. No offence taken. Chances are, you may be my “opposite”.

Although we may speak the same language i.e. English or something else, we perceive and process information differently.

So despite our best efforts to communicate more effectively, there’s always going to be a group of folks who don’t quite speak “our language”. But that is not necessarily a bad thing is it?

Interacting with our “opposites” can definitely be draining and frustrating at times.

But I suspect that it’s necessary to include our “opposites” in our “life team”. Our “opposites” will cover for our blindspots and help us with our own personal development. They give us contrast for our own self understanding.

I am always surrounded by my trusted “opposites” in my personal and work life. They help to cover for my blindspots, and I cover for theirs. They give me insights into their “language”, and I give them insights into mine. We do become more “multilingual” over time.

Do you have trusted “opposites”?

If they annoy or frustrate you, reflect and reframe with the above perspective in mind perhaps.

Helping our patients hold thoughts and feelings more lightly in order to resolve conflict

Do you see a vase or two faces?

Either way can be “right” isn’t it?

Having the ability to hold onto thoughts and feelings more lightly is a very important skill in conflict resolution and life in general.

Unfortunately, when we are under excessive stress, we tend to hold onto thoughts and feelings way too tightly. It manifests as psychological rigidity.

Practicing mindfulness is to hold onto these more lightly for better psychological flexibility.

Helping our patients resolve conflicts in their lives for better biopsychosocial health

In counseling, we often see folks who seem to “attract” conflicts and at the same time, also fear conflicts. With conflicts, they often fight, flight, or freeze. There may be of course a number of reasons for this, including traumas and adverse childhood events (ACEs).

Even without traumas and ACEs, it’s extremely hard to resolve conflicts as we all perceive and use objective information and “feelings” differently.

We don’t really get each other really, and often make the mistake of judging each other based on our own frameworks, values, beliefs, and ways of processing information. This will inevitably lead to misunderstandings.

Part of counseling is to help folks understand, appreciate and accept both self and others, in order to reconcile conflicts more effectively.

Without good understanding and conflict resolution skills, these folks may have more struggles in their “social health” domain, which then leads to other “psychobio” health issues.

I am sure as Family Doctors, you will have seen many of those.