PACT Level 2
It’s inevitable. If you see individual clients, you will work with someone who is struggling in their primary partnership. While we’re prepared to support an individual’s healing process, we have a profession-wide blind spot; few of us are trained to ethically and effectively support individuals whose clinical concerns are partnership-related. In fact, our superpowers in treating individuals may end up acting as the couple’s kryptonite.
Relationships Show Up in Individual Therapy
Our training and daily interactions as individual therapists constantly hone our abilities to empathize and validate our clients. We commit to believing that our clients’ experiences are, indeed, their experiences. While we also push our clients to evaluate their experiences toward their own growth and transformation, doing so when the client’s focus is their romantic relationship poses a particular challenge; we can only see what our client experiences, not how they are experienced by the partner who isn’t in the room. We cannot see the system. Recent empirical exploration of this phenomenon demonstrates that even therapists who are trained in systems-thinking couples modalities offer relationship-undermining messages to their individual clients.
Take heart; we don’t need to globally jettison individual therapy as a practice in order to protect our clients’ relationships. The first intervention we can deploy to support both our individual clients and their relationships is to educate our individual clients about the value of seeking couple therapy for relationship challenges. Then, to decrease the likelihood that we will undermine a relationship as we engage in individual therapy, we can focus on five clinician vulnerabilities: pathologizing clients’ relationship needs, diagnosing an absent partner, triangulation, offering advice, and ignoring a conflict of interest. We can then replace these harmful tendencies with interventions based on PACT principles to guide our support of individual clients in alignment with secure functioning.
People Need People
For decades, committed partnership has been culturally understood as binary; unhealthy relationships are codependent and/or enmeshed, while healthy relationships are independent. Instagram and self-help bookshelves overflow with diagnoses of codependency and enmeshment, and independence escapes un-critiqued. This bias ignores our biology. Thankfully, clinical views on relationships are shifting toward more explicitly valuing, cultivating, and celebrating the healthy interdependence that is our birthright.
As a social species, our need for each other has been a factory setting for a long time. We have been hominids for 6 million years, and Homo sapiens for approximately 230,000 years. For all of this time, being kicked out of the group meant certain death. We truly needed each other to survive. The last few hundred years of individualism as an idea can’t change that our need for each other remains a biological imperative.
Western culture allows us to exist further and further from our biological predispositions. Our genotypes haven’t changed. As we’ve moved from tribal groups to multigenerational families to modernity’s prized isolation, we remain governed by an ancient need to belong.
As a social species that also tends toward pair bonding, this pull is as strong as the circadian rhythm that governs our species-wide tendency to be diurnal. We have electric lights, but we don’t pathologize peoples’ need to sleep at night. Why, then, do we diagnose people who crave relationships?
As individual therapists, we can honor our clients’ hard-wired cravings for belonging and pair bonding. We can utilize the PACT value of interdependence to validate the need for – and value of – relationships.
Missing Data Makes Diagnosis Impossible
We know it’s unethical to diagnose someone who isn’t our client. We think we dodge that ethical obligation with disclaimers, like “I’m not diagnosing them, because they aren’t my client, but it sounds like they have traits of (insert diagnosis).” This approach is neither as sneaky nor as helpful as we think. It’s also absurd.
We can oversimplify by pretending that we’re getting half of the picture when we hear about an individual’s experience without their partner present. It’s likely we have far less information than that. Not only are we missing data about the absent partner, we’re also missing critical information about the dynamic between the two partners. Often, dynamics-related data must be observed as a couple interacts in real-time, or even better, via video replay. Accurate diagnosis without observing the system in action is impossible.
PACT prioritizes real-time data and real-time interventions. As individual therapists, we can work with what’s in front of us. We can work with the individual to develop and enact agentic two-person psychology.
Tell the Drama “No”
As clinicians, we want to help. We like to matter. This slippery slope aligns with Stephen Karpman’s Drama Triangle. To build rapport and therapeutic alliance, at least part of us has to love and/or empathize with at least part of our client. This makes us vulnerable to feeling protective of them. We combine a protective impulse with our desire to help, and place ourselves in the rescuer role, consequently deeming our client the victim and their partner the persecutor.
To address triangulation in our clinical practice, we need to reauthor the triangle using the PACT stance “no angels, no devils.” We shift our role from rescuer to coach. Rather than victim, we see our client as a capable actor. Rather than persecutor, we see the partner as a worthy challenger. Better yet, we use PACT-aligned two-person psychology to see our client and their partner both as capable actors, and the process of partnership itself as their worthy challenge.
We Are Not Them
Just like we’re not supposed to diagnose someone who isn’t in the room, we’re also not supposed to give advice. In my own individual therapy, when my partner and I were going through what we now refer to as our “dark time,” I received advice cloaked as therapeutic use of self. Statements like “When I was going through my divorce, I didn’t care if I ever talked to him again…” carry the implicit message that I, as a client, shouldn’t care if I ever spoke to my potential ex again. Just because my therapist’s statements didn’t start with “You should…” didn’t mean it wasn’t intended as advice.
Just as we miss data with only one partner in the room, we also miss data about the client in front of us simply because we are not them. When our suggestions about how they should think, feel, or behave happen to align identically with how we, the clinicians, think, feel, and behave, that’s an indicator that we’re in the fairyland of countertransference. This is dangerous territory for both clinician and client. The only way out is curiosity.
When moved to give advice, the antidote is to ask the cleanest questions possible via the PACT stance of data collection. No leading, only exploring. PACT understands that every relationship is unique and self-constructed. If we support our individual clients to pursue our ideal relationship, we’re setting them up to fail. If we support them to understand themselves more fully, we support them to advocate for the partnership they need.
By Definition, We Profit Off of Pain
Breakups are painful. Our cultural worship of independence can make that pain tough to acknowledge. Clinicians’ offices are among the few places where people can be honest about the depth of agony their breakup has caused. Clinicians offices are also places where clinicians earn livelihoods.
Our ethical commitments as mental health providers implore us to prioritize client well-being. So, too, are we expected to avoid financial conflicts of interest. These two ethical expectations are themselves in conflict. Clients work with us to process pain. We get paid when clients are in our offices. By the transitive property, we profit when our clients are in pain. While this is an unflattering reality to admit, it’s much better to daylight than hide. If we don’t acknowledge this financial conflict of interest, it can persist without examination and therefore less scrupulously. Like all other components of countertransference, the best disinfectant is sunlight.
There isn’t much conversation around how therapists benefit financially by building dependence and extending treatment length however unintentionally. If a clinician wasn’t mindful — and through ignorance did contribute to the dissolution of what could have been a revived relationship by any of the pitfalls described above — that therapist may also profit off of the continued therapy a divorcing individual would understandably require. Every element of our clinical practices deserves and demands well-boundaried clarity and ethical rigor. The fact that we also need to pay bills doesn’t excuse this obligation.
As ethical clinicians, we perpetually strive to work ourselves out of a job. Rather than using techniques that build dependency, our ethical obligation is to build capacity. PACT builds capacity in couples; our support for individual clients must do the same.
We Don’t Know What They Should Do, But We Understand Secure Functioning
It would violate our respect for client autonomy to assume that we know what a client should do in response to relationship conflict.
While we don’t know what they should do, we do know how to help them figure it out for themselves. And we know what we should do. This includes, of course, referring their relationship to a great PACT therapist after being transparent about how individual therapy can and can’t support relationship challenges.