Communication
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Propaganda was a big part of pre-World War II and WWII itself and was major ammunition in the Cold War between the Western allies and the Soviet Union block. Advertising took off, care of Edward Bernays who exploited his knowledge of subconscious processes, thanks to his Uncle Sigmund Freud (his mother was Freud’s sister). ↩︎
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I use “marriage” as shorthand for any category of intimate couples. ↩︎
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Despite the myth, the Polish Calvary did not attack the tanks with swords, but they might as well have. ↩︎
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While that may be true, it doesn’t mean that a marital rift will be healed from dealing with individual issues. ↩︎
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My comfort zone is one-on-one. Marriage and family therapy is conducting and refereeing. I don’t like conducting or refereeing. ↩︎
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I’m not referring to troubled couples who don’t come to counseling. For various reasons, usually trust-related from their history, many individuals have one foot out the door during the entire relationship. ↩︎
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The main clues for one or both not being interested in making the marriage work are either petty arguments (with me or their partner) about the details of homework I assign or failing to do the homework at all. “When we were about to start the homework, the phone range.” ↩︎
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Asperger’s Syndrome is out of use in favor of Autism, which is a category too broad without going into clinical detail. ↩︎
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I wrote my version of what should have happened. Nevertheless, the failure of the counseling was necessary for the plot. ↩︎
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How the harmony is maintained depends on the approach of each therapist. I’m not teaching couple counseling here. ↩︎
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There are similar books, but I invented that one.# Communication and Its Discontents, Part 1, Coupling ↩︎
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Well, yeah, it is. ↩︎
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A counselor friend guessed I was modeling the old professor after myself. She was right. ↩︎
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↩︎I'm making this up. The specifics of Timoney's research were never brought up in the TV show. -
Reminds me of the old joke: the operation was a success, but the patient died. ↩︎
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In early episodes, Martin comes off as a fish out of water, like Dr. Joel Fleischman from Northern Exposure. In later seasons, he comes off as a fish swimming in the Aspergers tank. ↩︎
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This change in point of view is a cornerstone of approaches influenced by the famous hypnotherapist, Milton Erickson, and in various cognitive-behavior approaches. ↩︎
You Can't Change Just the One Part You Don't Like
A marriage counseling session is improv: the plot is developed by the characters in real time. Note that the only skill the therapist needs is curiosity.
Chris: We think our lack of communication is ruining our marriage.
T: {to Stacy} You agree? Does Chris speak for both of you?
Stacy: Um, I guess so.
T: Why are you guessing?
Stacy: Well, Chris thinks so.
T: And Chris may be right but maybe not?
Stacy: Sorta
T: {to Chris} Can you be more specific how a lack of communication is ruining your marriage?
Chris: We don’t talk enough.
T: Is there something specific you think you should be talking about that you don’t talk about?
Chris: Lots of stuff.
T: Can you give me an example?
Chris: Stacy gets taken advantage of at work!
T: How so?
Chris: Everyone at work likes Stacy so much, and why not? Stacy helps others when they run into problems and never asks for anything in return. But Stacy gets passed over for promotions.
T: So everyone likes Stacy so much, but Stacy’s boss doesn’t or doesn’t think Stacy’s work rates promotions?
Chris: Stacy doesn’t even apply for promotions!
T: Oh. Not applying is different from being passed over, isn’t it?
Chris: So, why doesn’t Stacy apply?
T: You’re asking me?
Chris: I’m just exasperated. I’m asking the universe.
T: Why are you asking the universe? Stacy is right here.
Chris: {to Stacy} Why don’t you apply?
Stacy: We’ve been over this a million times. You know why.
T: {raises hand} Do I get to know?
Stacy: {exasperated} Because I don’t want to. I love my job. I love the people I work with. I don’t want that to change.
T: {to Chris} Oooh, you want Stacy to get a promotion because it would bring in more money to your household?
Chris: That’s one reason, but it’s not so much about the money. We don’t really need it. I make three times what Stacy makes, and we’re definitely not hurting. Maybe, after a tax hike, it wouldn’t make much difference.
T: {to both} Then what’s this all about?
Chris: I think Stacy should get fair value for Stacy’s work. If nothing else, it would be good for Stacy’s self esteem.
T: {thinking}
T: Let’s hold off on that for now.
T: {to both} You’ve been married for… {checks the intake form}
Chris and Stacy: Seven years.
T: Who wants to tell me how you met?
Stacy: A friend of a friend introduced us.
T: And how did the budding romance happen?
Chris: I had been doing the dating apps thing and was tired of it. I was getting to the point where I wanted to settle down, but with only the right person.
T: What was wrong with the dating apps thing?
Chris: The dating apps matched interests and preferences, but that didn’t translate to I want to be with this person. It was more, this could be a good friend, if that’s what I was looking for. I had enough friends. I was discouraged, I guess.
Stacy: I had just gone a long time between having more than a date or two with the same person. Just didn’t find anyone who I clicked with, until Chris, that is.
T: You clicked because?
Stacy: It was just comfortable. I could be myself.
Chris: Yeah, same.
T: When did you learn that Stacy made a third of what you made?
Chris: It became obvious, early on. Stacy didn’t want to go to fancy restaurants and lived a more modest lifestyle than I did, in general.
T: Did that bother you then?
Chris: I was so happy to be with someone like Stacy, I didn’t give it a thought. And, as I said, if we were going to be together, I make plenty of money.
T: You hadn’t met anyone before who you thought a lot of and also made a lot of money?
Chris: Yeah, but there were other issues. They weren’t interested in a life mate at the time, or maybe I didn’t find them attractive. It’s not easy to find a life partner fit.
T: {joking} Some find it easy enough that they find a life partner multiple times. {no one laughs} I was joking in my way of agreeing with you.
{as the joke hits them, both Chris and Stacy smile}
So, if I understand you, Stacy was your first or best potential life partner. Do you see that differently, now?
Chris: God no!
T: How would you explain your current dissatisfaction of what brought you to see a marraige counselor?
Chris: I don’t want Stacy to change. I just want Stacy to value what Stacy contributes at work and be promoted.
T: And you don’t see that as Stacy changing?
{quiet}
T: Can you explain in more detail what you fell for in Stacy?
Chris: Stacy was … is just kinder, more thoughtful, and more fun, than anyone else I’ve met. Stacy’s got a bunch of friends who adore Stacy, and I can see why. Stacy is good with kids—I hope we’ll have kids eventually—and is just a great person.
T: Why do you think Stacy doesn’t apply for promotions?
Chris: I think Stacy’s afraid of being turned down—doesn’t want to put Stacy’s accomplishments on the line for potential criticism.
T: And you’ve asked Stacy, and this is what Stacy tells you?
Chris: Stacy just shrugs and says, “I dunno, I guess I like my job.”
T: And you don’t believe Stacy? Why don’t you ask Stacy right now.
Chris: Why don’t you apply for promotions?
Stacy: {quiet for a couple of minutes}
T: What’s keeping you from answering?
Stacy: Chris will think it’s dumb.
T: What makes you think that?
Stacy: Because maybe it is. I dunno. I tell Chris, I like my job, and that doesn’t seem to mean anything to Chris.
T: Maybe if you elaborated.
Stacy: I like the work I do. I like the people I work with. I like my boss, who gives me complete latitude. I like the office building, the coffee vendor down below, the exercise club next door. If I was promoted, I have no idea where I’d have to work, who my boss would be, who my co-workers would be. I would have more responsibility, but not the kind of responsibility that I’d like, which is working independently. I don’t want to supervise subordinates. I’d bring in a little more money, but after the effect on our taxes, it wouldn’t be much more, and as Chris says, we don’t really need it. So if I applied for a promotion merely to satisfy my ego, and got a position I liked a whole lot less, how would that better my life. And if I made my life worse to satisfy Chris, I’d probably be resentful, and how would that make our marriage better?
{quiet}
Chris: I don’t know what I was thinking. I assumed that what I would like for my career would be what you would like for yours. Obviously, that’s not true.
T: And Stacy would be a different person if Stacy got a job Stacy didn’t want. And you may not like that new version as much as the old version.
Chris: {thoughtful} Probably not.
People aren’t fixer-uppers. Be wary of going into a relationship that you believe will be just one change away in your mate that will make the relationship work. You probably won’t be successful in facilitating that change, or if you are, your mate won’t be the same in all the ways you liked beforehand.
Recursion in Therapy
(For the sole purpose of amusing myself, I gave my website a title.)
The unexamined life is not worth living.
—Socrates
Get over yourself.
—Thousands of people who aren’t Socrates
Because my wife keeps asking me to define recursion, which is tricky because it’s originally a mathematical concept, then borrowed by computer programmers, and eventually, by scientists.
Recursion is a different way of looking at the feedback loop. An abundance of carbon monoxide is feedback that the body needs to take a fresh breath. A recursive explanation considers that the whole body has been updated to its present state that includes the abundance of carbon monoxide in the lungs. The effect is the same but it’s a description of how the whole body updates rather than just looking at a change in a part of the body. A focus on a single change ignores the changes that are conditioned on taking that breath, in this case the other bodily functions and changes in the consequences that are dependent on oxygen (such as remaining alive). Change in a living being is not a single change while the rest remains exactly as before.
Below, I describe each change in the client as the whole of the client being the feedback for the therapist. The following is a caricature, that is, not based on a particular client and I attempt to give only the flavor of sessions. Think of the collection as an interview with all the “ums” and “you knows" deleted.
T: What brings you here?
C: I’m afraid to go outside.
T: How did you get to my office?
C: I drove.
T: You have a garage where you have your car, and can enter your car without going outside?
C: No, my car is at the curb.
T: So you walked to your car on the street and got in and drove?
C: Yes.
T: So you do go outside on occasion.
C: I guess so.
T: On what other recent occasions have you gone outside?
C: I needed groceries, so I went to the store.
T: There’s no one at home to get the groceries?
C: I live alone.
T: So you go outside when you absolutely have to?
C: I guess so.
T: On what other recent occasions have you had to go outside?
C: I work. I have to go to an office.
T: Like five days a week?
C: Yeah.
T: So, you’re afraid to go outside, but you do go outside?
C: I guess so.
T: You go outside regularly, in fact.
C: Yeah.
T: So you’re afraid, but you face your fears by necessity.
C: Yeah.
The client entered the office as someone who identified as afraid to go outside, but now identifies as afraid to go outside but does so when necessary. He is a slightly different person than when he entered.
T: You live alone. Do you have friends or family who visit you?
C: I don’t have friends. I have a sister who visits about once a month and brings her toddler.
T: You work in an office as what?
C: I’m an accountant.
T: How many people work in your office?
C: Maybe 20 or so. Six CPAs, the rest support staff.
T: Half are men, half are women or…?
C: Umm… probably about right; I don’t count them, offhand.
T: I assume you talk to your fellow workers, as needed.
C: Of course.
T: How about, besides as needed? Like, in the break room where you might say, “Did you watch that comedy about accountants?”
C: Not much [shrug].
T: Because you’re shy?
C: Yeah.
[Quiet for a couple of minutes…]
T: Do you have neighbors?
C: Yeah.
T: You talk to them ever?
C: We nod.
T: They’re shy too, or not friendly?
C: No they’re friendly. Guess they gave up.
T: Trying to strike up a conversation?
C: [shrug]
T: When you say you’re afraid of going outside, is it outside or worried about running into people?
C: Little of both, I guess.
The client now identifies as someone who is afraid of running into other people, perhaps more than being afraid of going outside. He is a slightly different person than when he entered.
T: You say you don’t have friends. Did you have friends when you were younger? In college? Or before that, in school?
C: I had one friend. He moved away when I was eleven.
T: How long was he your friend?
C: About five years.
T: And no friends since. What was it about him that you could be friends with and no one since?
C: Well, I guess we met before being cool was a thing and just liked doing stuff together.
T: Such as?
C: At first, just playing with toys together; mostly just hanging out at each other’s house, having snacks, and playing video games.
T: Before being cool; you didn’t have to pretend to be different from how you felt.
C: Yeah.
Session 2:
T: Anything different for you this week?
C: I waved to my neighbor.
T: Did the neighbor respond?
C: Yeah; took him a few seconds, then he waved back.
C: {laughs} Guess he was surprised.
T: Could be. That’s cool; anything else different this week?
C: I sat in the break room for a few minutes while drinking my coffee.
T: Did anyone come in?
C: Yeah, a couple of people. They said, “Hey.” I said, “Hey.”
Unlike, many therapists I don’t respond to these answers with, “How did that make you feel?” My bent is not to make explicit commentary on feelings because it reinforces focus on oneself, which shy people have more than a sufficient supply. An abundance of focus on oneself is a remnant of adolescence and its accompanying anxiety. Developing a habit of outward focus, curiosity about others, is a better strategy for shy people (and for most people).
Yet, again, the client is a slightly different person from who he was when he first came to see me and after the initial session. He’s no longer someone who’s afraid to go outside. He’s now someone who is experimenting with social interaction.
Session 3:
T: Anything different for you this week?
C: I walked around the block, as you suggested
T: [waiting]
C: I waived at someone mowing the lawn.
T: [waiting]
C: He just looked at me, then went back to his mowing.
T: [waiting]
C: I felt like an idiot.
T: You have a theory about why he didn’t respond to your wave?
C: Only idiots wave to a stranger.
T: Your one theory was he thought you were an idiot for waving at him? Did you have any other theories?
C: What do you mean?
T: Did you have any other theories why he might not have returned your wave with a wave or some such?
C: No.
T: Can you think of any now?
C: Um…
T: Can you think of any theories why he might not have returned your wave with a wave or some such that had nothing to do with you?
C: Oh…um… argument with his wife?
T: Or?
C: Guess there can be a lot of reasons…
T: …that had nothing to do with you.
C: Yeah.
The client entered the office as someone who identified as afraid to go outside, then identified as afraid to go outside but does so when necessary. He entered the latest session, miffed that my suggestion that he walk around the block resulted in him feeling like an idiot when his greeting gesture was ignored. (When you have few interactions with others, each interaction takes on great significance.) However, he’s now a person who is slightly less self conscious. He is a slightly different person than when he entered the first, second, and third sessions. This presentation of a slightly different person is recursive feedback for the therapist.
Session 4:
T: Anything different for you this last week?
C: You always ask me the same thing.
T: I guess I do.
T: [waiting]
T: Is there something you’d like me to ask you instead?
C: I dunno, seems you could be more creative.
T: Maybe I’m not that creative, but I’m open to suggestions.
C: I’ll think about it and let you know.
T: Ok. Does that mean you don’t want to answer my question—“Anything different for you this last week?"—today?
C:
T: Care to explain, or rather not?
C: I don’t want to, at least, not now.
I don’t know why the client wasn’t in the mood to answer my regular opening gambit. Anything I can come up with is an inference that has less of a chance of being accurate and more of a chance of creating something that wasn’t there until I suggested it into existence.
Session 5:
T: [I’m quiet.]
C: [Snickers] You’re not going to ask me what you always ask me? Did I hurt your feelings?
T: [I chuckle] Maybe a little. Mostly, I’m just trying something different.
I think it’s good he knows he can affect me, that he knows he can affect anyone at all. It’s the opposite of realizing the guy who was mowing his lawn was not personally snubbing the client; that the mower has his own life and is not a character in the client’s life. The client is learning he can affect other people, including me.
Session 6:
C: I thought of something different you could ask me.
T: Cool. [waiting]
C: You could ask me whether I did anything new this week.
T: I see, more specific. Did you do anything new this week?
C: I talked to three people in the break room.
T: How was that for you?
C: It was ok.
T: Anything in particular that was ok?
C: Not really, I guess because nothing bad happened.
T: Nothing that made you regret it like with the guy in the yard.
C: Yeah.
Since my early years as a therapist, I’ve had a theory that the client will nudge the therapist in some way, as needed, in the same spirit that the therapist nudges the client. This is mutual recursion. The therapist is also changing in relationship to the client over the sessions. In other words, the relationship between the therapist and client is the same as any other. The one difference is it’s the therapist’s role to be the change agent. Except, because of the mutually recursive feedback, they become each other’s change agent. The client’s change is specific in that he’s becoming someone who can change the therapist to change him.
Session 7:
T: Did you do anything new this week?
C: [Chuckles] You learn fast.
T: I know, right?
C: Not really, new, I would say. More talking to people in the break room.
T: Anyone in particular?
C: Just whoever came in.
T: Tell me about someone who came into the break room who you talked to. What is the person like?
C: [Puzzled] I dunno know. She’s ok, I guess.
T: Is there anyone who you talked to that you know more about? Are they with someone? Have kids, maybe? Do they like music; any particular kind of music? Or sports? Or whatever? Good dressers or causal?
C: Not really; I don’t know those things.
I’m putting out a couple of suggestions: (1) the way to overcome shyness is to show interest in others (as opposed to focus on oneself), and tips how to specifically show interest in others.
I liked that he had the confidence to tease me at the top of the session. We’re not friends; I get paid to talk to him, to help him in how he wants to be helped. However, a relationship is a relationship. It’s not as different from other relationships as many therapists believe. Yes, there’s “projection” in that a therapist may remind you of a significant figure in your life, for example, a mother, father, sibling, etc., and respond at some level as if you were that figure, but that’s true in all relationships. Therapists needn’t make a big fucking deal out of it by bringing up transference.
To reiterate: unless the therapist lacks the behavioral repertoire to respond to the behavior of another, we are mutually responding to each other. Therapy is recursive in that we are constant changing each other and those changes are feedback to each other.
Session 8:
T: Did you do anything new this week?
C: I learned a couple of things about a co-worker.
T: Did you ask a co-worker questions?
C: No; I just listened to when the person was talking to someone else in the break room.
T: Another way of learning about others. You can observe them.
C: Yeah.
Two ways the client is a different person from when he started therapy: he realized he could learn about others without feeling invasive, and he is less attentive to himself and more attentive to others.
Communication and Its Discontents, Coupling
Despite how unappealing it would be to the average person, there’s an advantage to earning your living doing colonoscopies: other than in politics and social media, assholes don’t talk. Another choice for healthcare professionals who wish to avoid conversation is dentistry. It’s hard to talk with instruments camping in your oral opinion factory. But once in a while, bedside manner and all that, your dentist will ask a question, and they’ll pretend to listen for moments before they cram another instrument in your mouth. My new Portland dentist had that moment and asked the classic, “What do you do?”
“I’m retired; I was a marriage counselor.”
“What’s the secret to a lasting marriage?”
“Most marriage counselors will say, ‘communication and understanding,’ but that’s bullshit. It’s acceptance.”
The dentist shoves an instrument into my mouth.
The dentist’s assistant seems to like my answer (but he’s about twelve years old and unmarried): “Yeah, compassion.”
Good try, but by acceptance, I mean neither compassion nor how it may sound, resignation. I mean, it’s the only way long-term relationships—any long-term relationship—can sustain.
As I’ve stated previously, communication, as most understand it, is either biologically impossible (as professed by neuroscientist Humberto Maturana and those influenced by his work) or psychologically and cognitively unreliable (as supported by numerous theories in psychology and cognition). In either case, this means it’s the receiver, not the sender who determines the meaning of a message. Yet, since the sixties, better communication has been the Holy Grail of reducing conflict between spouses, parents and their children, business associates, and more currently, the polarized extremes in modern domestic politics.
How communication became the solution to conflict
In the first half of the twentieth century, pioneering psychotherapist Sigmund Freud and his followers focused on treating emotional problems that (he believed) stemmed from cultural sexual repression during the Victorian era. In Freud’s psychoanalytic theory, neuroses developed from internal conflicts—animal instincts (the id) versus culture (the super-ego) in an intra-psychic cage match, with the ego as the referee.
Several cultural changes shrunk Freud’s influence: the birth control pill and subsequent relaxation of cultural sexual repression; the leap in both propaganda used in war, and in advertising, that led to the study of communication to deceive;1 the evolution of marriage; and psychotherapy moving from a focus on individuals in internal conflict to individuals in relational conflict.
If the fifties in America was the “silent generation,” the sixties was the generation that would not stop expressing itself. Articles about psychology and relationships escaped from magazines targeted at women to newspapers and magazines meant for all. A new magazine, Psychology Today, dispensed relationships research in popular language.
Interest in communication began to generate scientific research. The social scientist Gregory Bateson attended the 40s–50s Macy conferences on cybernetics (“control and communication in the animal and machine”) and related fields—subjects previously tied to either the interests of war or to basic brain research.
After the conferences, Bateson received a grant to study communication. A trained anthropologist, Bateson hired researchers for his team to study the utterances of schizophrenics in the Veterans Hospital of Palo Alto. When Bateson’s grant ended after ten years, he went on to study communication elsewhere, but his team and consultants stayed in Palo Alto to found the Mental Research Institute (MRI), and MRI became the most influential and prestigious center to train therapists to deal with relationship issues. With books, conferences, and trainings, their ideas spread internationally, and the problem of communication among family members became the central theme of psychotherapy. In retrospect, this change in emphasis in psychotherapy was inevitable. In Western cultures, marriage had evolved from practical alliances of tribal, national, or household to romantic, and eventually, to best friend. Marriages, once dictatorships, became partnerships, and partnerships need agreements, (largely implicit in marriage), and agreements need communication.
As if marriage didn’t have enough cultural responsibility—its stated and unstated rules and regulations for the right kind of coupling—in modern Western culture, marriage has become a prototype for all types of relationships, even business. We’re supposed to relate to everyone as if we’re raising children together.
If not communication, what?
My articles have laid down my belief that because all realities are local to individuals, all incoming signals to our mind must get past border crossing agents so suspicious that little intended meaning is allowed through. Even your most devoted listener isn’t going to understand you. The good news is, regardless, some of us get along well enough to be friends, relatives on good terms, and intimate companions. The bad news is we believe we should get the good stuff in relationships without the conflicts, and that if we only communicated better, we’d understand each other better, and the conflicts could be tossed into the recycling bin and remanufactured into fluffy stuffed animals and Disney animated movies.
Marriage counseling2
It’s common wisdom that generals are always fighting the last war. Nowhere was this better illustrated than when the Polish Calvary—that’s right, soldiers riding horses—attempted to beat back Hitler’s tanks in 1939.3 Not many years after the end of World War II, pioneering marriage and family therapists were still riding their theories designed to treat individuals into the mire of marriage and family therapy. Previously, because adult relationship problems were viewed as the manifestation of neuroses based in childhood,4 a couple asking for marital help would have been referred to separate individual psychotherapists. Marriage counseling was primarily the domain of the church minister. That era was not far in the rearview mirror when I began my graduate internship in family therapy. I was at best on my own, or worse, doing battle with my supervisors.
My first experience in private practice (that is, working under my own license) was with a man and a woman, unmarried but living together. I don’t recall much about the counseling other than the sessions were directionless. My lack of training in marriage counseling meant I had no agenda. The three of us talked and after several months, the members of the couple felt resolved, set a wedding date, and we ended the sessions.
The expression goes, fish don’t know they live in water. They also don’t know when their water is polluted and that their health is deteriorating. To couples living in discontent, the discontent pollutes everything in their relationship, conscious or not. By talking together, it’s not hard to remind those who love each other but are going through a bad patch that they still love each other. Any reasonably competent counselor can tip the conversation towards bringing out what got them together in the first place. Eventually, they’re swimming in the reminder of what they like in each other.
Gettin’ some education
Over the next few years, I read nearly every book that came out about marriage and family therapy. I experimented with the ideas, implemented some well and some badly, retained the ones that worked and discarded the ones that didn’t. You’d think after my book knowledge and later experience, I’d speak with authority on how couple counseling works and doesn’t work. Limited authority, anyway. But I don’t. I do, however, have some ideas about how couples work, or don’t, and who benefits from couple counseling and who doesn’t (at least with an unexceptional marriage counselor as I am)5.
The following is likely to be disbelieved by many if not most marriage counselors. They can write their own articles.
I note three types of couples who make it to counseling. 6 The first two come with one or both of them immunized against success in marriage counseling. First, when one of the members has already left the marriage but is coming to sessions to demonstrate that he or she tried. I find it cruel to extend these sessions beyond when the soon-to-be-left partner realizes that he or she is the only one trying to better their relationship. Second, when the members of the couple don’t like each other (let alone love each other) but don’t want to be alone. They are the type of couple most likely to end the sessions, quickly. If they stayed, they’d have to face that they don’t want to be together. Last, the couple who love each other but encounter problems when they must adapt to change, typically around job, money, children, and their living situation.
I believe it is nearly impossible for a counselor to have success extending a marriage with the first two types of couples, and the futility of the process is quickly discovered.7 On the other hand, it takes practiced incompetence to not help the third type of couple.
Whether consciously or subconsciously, experts can’t observe behavior in their domain of expertise without getting drawn in. What I observe is that couples who’ve managed to stay together for decades are not particularly good at listening to or understanding each other, and I can’t assign the success I had in marriage counseling to improvement in what we refer to as communication.
Doc Martin
(Spoiler alerts ahead) What I believe creates a lasting coupling is best illustrated by the TV series, Doc Martin. Martin Ellingham is a noted London surgeon who moves to a small fishing village to work as a general practitioner. During the series' ten seasons, his personality ranges from brusque and aloof to Asberger’s8. (Either the show’s writers don’t know the difference or I don’t.) On the other hand, he’s a brilliant physician who becomes full-on heroic and caring during medical emergencies.
Into the seasons, despite Martin’s best efforts to subvert his happiness and his romance with his wife-to-be, Louisa, marriage and child come to the couple, but not for long as Martin continues to be Martin. His insensitivities grate on Louisa, and she becomes fed up and leaves him. Martin and Louisa make a final attempt to rescue their marriage with sessions with a so-called expert psychotherapist, but the counseling fails miserably.9
(Spoiler alerts ahead, really!) The last episode of the seventh Doc Martin season has the most illustrative moment of what defines a successful coupling. Martin and Louisa, are currently separated. Martin is held under gunpoint on a rural farm because a patient’s wife demands Martin come up with a miraculous cure for her terminally ill husband. After the bumbling sheriff fails, Louisa rescues Martin. In the final scene, they’re sitting and talking on a hilltop on the farm. Louisa realizes she wants to be with Martin regardless of his insensitivities.
Acceptance
You don’t know what you’ve got ‘till it’s gone. —Joni Mitchell
Louisa apparently concludes that (in my words) coupling is not about communication and understanding; it’s about acceptance, acceptance of differences, and even differences in how love and caring are expressed. Because our cognitive system can’t grasp another’s version of reality, no matter how much we care for that person, we can’t communicate; we can’t understand. What we can do is accept the differences between ourselves and others.
In sessions with couples, I believe the counselor’s main role is to maintain harmony but leave the lyrics to the couple.10 In the case of the marriage counseling described above, I did not observe increased communication or increased understanding between the partners. I observed a process—being together in words and body language that created acceptance.
(Groom’s name), do you take (Bride’s name) to be your wedded wife, to live together in marriage? Do you promise to love her, comfort her, honor and keep her for better or worse, for richer or poorer, in sickness and health, and forsaking all others, be faithful only to her, for as long as you both shall live?
Do you take this person you found on the Tinder dating app to be your wedded spouse, to live together in marriage (in a four-bedroom house and three-car garage)? Do you promise to love this person, comfort this person, honor and keep this person for better or worse, for richer or poorer, (but define “poorer”) in sickness and health (as long as we meditate together), and forsaking all others, be faithful only to each other (except we each get a free one), until you realize you don’t get just the parts you like about your spouse?
The first version is the traditional marriage vow from the groom side’s from the Book of Common Prayer. The second version is from the book How to Do Your Own Divorce or Find the Right Lawyer.11 The second version is because those Disney movies you watched as a kid never show the after-the-wedding Prince throwing his dirty underwear on the floor and spending the weekend drinking beer and watching TV.
The difference between the two vows: in the second one, you’re unhappy that you don’t get just the parts you like about your spouse. In the first, you’re making a vow of acceptance. Five centuries ago, someone had coupling right.
The Psychotherapy of Doc Martin, by Dr. Rachel Timoney
(This is a form of fan fiction, intended solely for educational purposes, that combines events from the Doc Martin TV show, Season 7, with stuff I make up.)
Dr. Rachel Timoney was looking forward to her first session with the eminent Dr. Martin Ellingham. She didn’t know much about him, apart from he was rumored to have abruptly resigned his prestigious position as head of vascular medicine at Imperial College, London. Chance would bring them together for an initial psychotherapy session. Dr. Ellingham (Doc Martin, to the locals) had taken a position in Portwenn, an isolated fishing village on the Celtic Sea. And she was spending a few months in Portwenn, writing and seeing a few patients.
Rachel Timoney was once considered a prodigy in her field. Nine years ago, at age 23, she was granted a doctorate in psychotherapeutic theory. Her research had gained a moderate bit of fame, even getting into a few newspapers at the time. Even she knew that being highly regarded as a psychotherapy expert at age 23 would be beyond stupid. Mathematicians do breakthrough work at 23. Physicists do breakthrough work at 23. Even those in the arts do breakthrough work at 23. Counselors do not do breakthrough work at 23. There are certain things you can learn through experience, only, and if anything, those gifted in academia have typically sacrificed life experiences to excel in studies. There’s an age between infancy and senility that someone can become a good therapist, and it ain’t 23.
In the years following receiving her doctorate, Timoney has worked on living up to her reputation. She’s done well, but from what she knew of him, she believed that having Dr. Martin Ellingham in therapy would be a novel challenge. It proved to be that.
Doc Martin
Seconds after he sits for their initial session, Martin informs Timoney that he expects she’d diagnose him as having attachment disorder. (Timoney notes silently that Martin describes himself as if he were a third party.) Martin explains that he was “an unwanted, unloved child” and gives a brief account of his upbringing by his cold and self-centered parents. (Later, Timoney would recount to her mentor that if Harry Potter had Doc Martin’s parents, rather than sacrifice their lives for his, they would have swapped him to Voldemort for a MacDonald’s breakfast coupon.)
Martin makes it clear that he is aware of his interpersonal shortcomings. In discussing his marital difficulties, he accepts the entire blame. Responding to Martin’s depiction of his life, Timoney comments that he is as blunt with himself as he is with others. Martin had never considered that and feels his body relax into the thought.
At the close of the session, Timoney suggests that it’s rare that one member of a couple is the sole source of conflict and asks that his wife Louisa come for an appointment.
Louisa
Dr. Timoney learns from their session that Louisa is an accomplished, articulate Portwenn schoolteacher. What Louisa is not, is eager to be in the session. She makes cracks about Timoney’s youth, implying that Timoney is inexperienced and naïve. Louisa contends that her marital problems are entirely due to Martin’s deficits in sensitivity, and that he should (as the English say) get them sorted without her involvement.
Responding to Dr. Timoney’s questions, Louisa states that her parents were “fine, normal as you like,” moments later adding that her mother abandoned the family when she was 12, but “I didn’t really need a mother by then.” And, by the way, her father “spent some time in prison” when she was a young child. After listening to herself describe her childhood as normal as you like, with reluctance, Louisa agrees to attend couple counseling.
Initial sessions
In Martin and Louisa’s first couples session, Louisa begins with an account of their relationship. Louisa describes their awkward courtship: boy gets girl, boy loses girl, boy marries girl, girl has baby, boy loses girl. If it were a TV show, Louisa explains, it’d be the usual get-them-to-watch-the-next-season stuff. But it’s not a TV show.1 Martin and Louisa don’t stay apart because of contrivances. They don’t miss a reconciliation because one of them is seen hugging an attractive stranger who turns out to be a sibling, while viewers yell explanations at the TV screen. Their problem is straightforward and never-changing. As much as Louisa wants to be with Martin, she’s constantly frustrated by his interpersonal limitations.
Experiments
As Timoney has learned through her training, struggling couples often have repetitive interactional patterns that result in seemingly irresolvable conflicts. Commonly used interventions or experiments (as she prefers to think of them) can be used successfully with many couples. For example, have them experiment with a small (but designed to interrupt) behavioral change in the middle of a pattern of conflict. Or, if one or both members of the couple believes that conflict is bad, and have no way to deal with anger and resentment other than to withdraw (after all, avoiding conflict worked for their parents, right up to the divorce), the therapist can design a practice for successful conflict resolution.
As we shall see, commonly used interventions don’t work for everyone. And they do not for Martin and Louisa. Their pasts have left Martin with a limited repertoire of behavior and Louisa with small boundaries of trust. Their situation calls for a specialist, not a general practitioner. Timoney attempts three homework experiments that fail:
(1) Homework: Timoney has figured that Martin and Louisa have problems with physical intimacy, they are told to hug three times a day, while stating something nice about each other.
Failure: While it’s true that Martin is not a toucher, he does like holding Louisa. In this case, the not touching was an effect, not a cause of their psychological distance, and the homework just creates additional awkwardness. To add to the awkwardness, Louisa never thinks of anything positive to say to Martin.
(2) Homework: Because Martin is a control freak (affirmed by both Martin and Louisa), they are told to have an outing in which Louisa is in total charge. In theory, this will help balance their relationship.
Failure: Louisa decides on a picnic to the beach, where Martin is uncomfortable with the random elements of a beach and a picnic, but sets out to give Louisa a normal family outing. The outing is eventually interrupted by a medical emergency that Martin must attend to.
(3) Homework: Martin and Louisa did not have a typical courtship, that is, they didn’t date. Timoney suggests some conventional courtship outings. Martin and Louisa plan a restaurant date.
Failure: In just minutes spent at the restaurant (because of yet another medical emergency that requires Martin), Martin and Louisa experience the whole of their relationship awkwardness.
There’s a smorgasbord of reasons why these homework assignments were doomed. Leave room for dessert:
First, two of the assignments were exercises to get Martin and Louisa to engage more. That’s more, not better. More, not different. There wasn’t anything in these exercises that would help them engage better.
Second, each assignment was bound to make Martin feel even more awkward and more vulnerable. Martin’s increased awkwardness exacerbated the very things that Louisa finds unattractive in her husband. That is not a recipe to increase intimacy.
Third, characterizing Martin as a control freak is simplistic. He’s compulsive — habitual and tidy, beyond what most consider practical. But he’s not trying to control the behavior of others; he’s trying to control his environment in which other humans happen to be present. Being habitual and tidy is a common adaptation for those who have dealt with psychologically chaotic circumstances, especially in childhood. Even more significant, as Martin desperately wants to be with Louisa, she has the most meaningful control, control over his happiness. Martin is in control of nothing beyond his medical practice; he’s the most psychologically fragile person in Portwenn.
Fourth, Timoney misses an opportunity (which I’ll explain below) to cast Martin in a more positive light, which could have contributed to a major improvement in their relationship.
In Timoney’s mind, if her tried-and-true conflict-resolution schemes don’t work, it can’t be her fault. She salves her shrinking-ego (pun intended) through the time-tested technique of blaming her clients. After Martin and Louisa inform Timoney that they won’t be returning, she tells them that they’re “one of the most challenging cases I have ever come across.”
Dr. Timoney gets a Mulligan (in golf, a do-over)
(Up to this point, I was following the TV script. The rest is my contribution.) After Martin and Louisa decide to end counseling, Rachel Timoney feels relief, guilt, and regret — relief that she won’t have to watch herself struggle with her work, guilt that she feels that way, and regret that she did not help her clients. Timoney decides to confer with her old professor. Sure, he’s past his prime. He babbles too much, repeats himself, but now and then, he still conjures some inventive advice.2 But before she calls him, Timoney has a WTF moment. She knows what he’d say. Instead of calling her professor, Timoney contacts Martin and Louisa, apologizes for her last remarks, and states that she has some fresh ideas. Surprised by the apology, they agree to give counseling another try.
Anticipating the call to her professor, the conversation Timoney had with herself exposed that her interventions reeked of this worked in the past, so why be creative? She was being lazy: the experiments were designed with the relationship in mind, but not with the people in the relationship in mind. While couple counseling can counter interactional patterns that lead to relationship problems, that doesn’t mean you can ignore the distinctiveness that individuals bring to relationships.
Couples Therapy: it’s not just for couples anymore
Timoney notes that Louisa was right; she should have started with Martin. But not because he’s the one who needs to get his problems sorted. Despite the notoriety that Timoney got for her research, she forgot to implement her own hard-won knowledge. What her research yielded3 is that, when engaging in couple counseling, confronting a resistant client is rowing upstream.
Due to the influences of substance-abuse treatment and early family therapy, confronting clients became fashionable in the 1970s. When parents brought a child for treatment, they were told that the child’s behavior was usually a symptom of a dysfunctional marriage and poor parenting. A child client became labeled as the identified patient; the real patient, the parents were told, was the dysfunctional family, with the unspoken (and sometimes spoken) message that the parents were at fault. While confrontation made for dramatic teaching videos — therapist as action hero — the approach too often chased away the clients.4 After all, if the clients were willing to face their own problems, there wouldn’t have been all those identified-patient children in the first place.
Given the above, Timoney decides that the best course is to hold off on working directly with the relationship. As both Martin and Louisa feel that the major relationship problems lie with Martin, to avoid needless friction, Timoney opts for one-person couple therapy, the other leg of Timoney’s research.
Timoney (as have many before her) found that a change in one member of a couple can have a profound and positive effect on the relationship. Timoney knew that therapists have been practicing one-person couples therapy for decades, but have been intimidated against stating so by the family therapy mafia, who define family therapy by who comes to the session. That’s silly and never should have happened. Many family therapists apparently never moved past Piaget’s concrete-operational stage of development: once family therapy moved from the psychodynamic model to systems theory, it should have been obvious that if the client lives in a family, all therapy is family therapy.
Therapy with Martin
In discussing goals with Martin, he agrees that he would like to become more comfortable — fluid is the word agreed on — in his interactions with Louisa and with his infant son. He wants to make sure that he doesn’t recreate the relationships his parents had with him and with each other.
The experiments with Martin commence:
If you live in a cosmopolitan area where men commonly wear business suits, or you have watched episodes of Mad Men, you’ll notice that the men always unbutton their jackets when they sit and button them when they stand. A well-tailored suit jacket has no give, so a buttoned jacket pulls at the waist when the wearer is seated. Timoney jots this in her memory because it provides an inroad into a subtle experiment.
From the time he rises to when he retires for the night, Martin dresses precisely the same, in a suit with the top two buttons fastened on his three-button jacket. And you’ll observe that he never unfastens his suit jacket buttons, even when building a sandcastle with his son on the beach. A change in dress will give Martin the experience that nothing catastrophic will happen if he changes one habit.
In order, over several weeks:
To help Martin have the experience of overcoming a compulsive habit: (1) Timoney asks Martin to unbutton his jacket whenever he sits. (2) Next, she has him leave his jacket unbuttoned all day. (3) Last, she asks Martin to buy and wear casual clothes on his non-office days (presumably, the weekend). While change in one habit may seem trivial, the experience of that change can be a dramatic confidence builder.
To help Martin expand his repertoire of interpersonal responses and range of affect, Timoney exploits Martin’s desire for an enhanced relationship with his son: As stated, above, it’s obvious that Martin wishes to be involved with his son’s upbringing in a manner that sharply contrasts with how he (Martin) was raised. But he needs instruction and encouragement. While Martin gladly holds and bathes James, he does not exchange facial or noise expressions. We can assume that Martin’s deficit is a result of being neglected in infancy, that no facial expression mirroring took place between Martin and his parents.
(1) Timoney asks Martin to exchange facial and noise expressions with James. As James has learned to smile from his mother, Martin has the opportunity to both initiate and respond. (2) Rather than exchange hugs (as above), Timoney asks that Martin and Louisa trade smiles. (3) Timoney asks Martin to progressively expand his gestures of relationship beyond his son and wife. First, smile at his aunt (the one other person for whom he has affection), then his receptionist, then patients. This mildest demonstration of affect can teach him to better interact with others.
Marital grad school
After the above experiments, Timoney asks Martin and Louisa to come in together, once more. The experiments yielded a larger shift in their relationship than expected. To Timoney’s surprise, Louisa discloses that when she first met Martin, he was more outgoing and considerate. While never the life of the party, he was sensitive and generous to many in Portwenn and is acting that way again.5 Timoney realizes that she had made an assumption that Martin had always been this inhibited in his mood, sensitivity, and affect. Not learning otherwise was a rookie mistake.
Many couples have trouble in their relationship because they had no models of a good marriage. As both Martin and Louisa had parents with poor marriages, this could describe the experiences of both. However, some react the opposite of what you’d expect. Rather than stay away from marriage because they experienced poor models, they idealize what a good marriage would be like. Timoney asks each of them what a normal marriage is like. After some discussion, both admit that, while they have fantasies of a normal marriage, they guess that no such thing exists. Timoney states that fantasies of the extreme, positive or negative, usually get in the way.
Wrapping up: In their solo session, Timoney had suggested to Louisa that, given her background of abandonment by her parents, she (purposely) married someone who would leave her. As we find out, Louisa believes the exact opposite, that Martin is the most dependable and loyal man she’d ever meet. Given her background of abandonment, it’s easy to see that she picked Martin, not because he would leave her, but because he wouldn’t. If in early sessions, Timoney had made a better effort to bring this to light, it could have changed the context of their marital relationship. If every time Louisa glances at Martin and sees not someone who has a limited range of sensitivity and affect, but someone who loves her without reservation and will always be there for her and their children, Louisa’s entire attitude towards their marriage could shift.6
In the final session, Dr. Timoney, Louisa, and Martin discuss the wide variety of successful marriages. They conclude that Louisa chose Martin for his loyalty, and Martin chose Louisa because he saw in her that he could get the warmth and connection he desired.