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The Relational Field Beyond Home and Family

Stephen Proskauer MD — Fri, 11 May 2012 15:10:22 +0000

The wide availability of self help groups offers a valuable resource for
therapists to engage some patients in a sympathetic and supportive social
network of people who understand from their own experience how difficult
it can be to engage with others. Group therapy provides a more structured
and protective option for patients who respond aversively to leaderless self
help groups. In this protected group setting, patients can begin to resolve
the inner conflict between their need to connect with others and their ingrained fear of contact, engendered by past traumatic experiences.

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Relational Healing

Stephen Proskauer MD — Thu, 10 May 2012 15:10:08 +0000

Beyond couple and family work, promoting involvement in social, occupational and community networks can become a crucial area of Relational healing for abuse trauma. In general, survivors of severe childhood abuse have low tolerance for social interaction. For many, social anxiety of paranoid proportions and extremely low self esteem have crippled them all their lives and confined their contact with others to immediate family, job settings
and occasional church services.

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Treating Relationships Continued

Stephen Proskauer MD — Tue, 08 May 2012 15:10:21 +0000

From what I learn in these sessions, I devise entertaining exercises for couples and families to rehearse in the office and take home, often involving comical role reversals in which family members have a chance to take on attributes of others and exaggerate them to absurdity. This playful way of changing the system dislodges everyone from customary roles and gives the family a chance to lighten up by playing together instead of struggling
to be heard. Everybody looks forward to doing these fun exercises and participates
more wholeheartedly than they would in a dreary and futile effort to change old habits by force of will.
When the couple or family returns for the next visit, I review what has happened and fine tune or change the exercise, depending on what is reported. Within a few sessions the family system begins to function more freely or else it implodes, allowing for other interventions that address previously concealed psychopathology. This approach may sound risky, but in the hands of a skillful clinician it saves a lot of time and keeps the therapist from getting caught up in frustrating efforts to change a chronically stuck
system by working with just one member.

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Treating Relationships Continued

Stephen Proskauer MD — Thu, 03 May 2012 15:10:39 +0000

When one spouse withdraws the projection and reclaims the aspect that has been projected previously, the dissociation is dissolved and the other partner is then forced to take back what has been projected onto the spouse. My intervention strategies combine two approaches that I find to be particularly effective to untie Relational knots. The first involves simple exercises to facilitate better communication within the system, opening up
cut off channels, letting hidden voices within each spouse speak openly, and training couples and families to listen more attentively. This process dissolves projections and replaces them with real intimate contact. The second method focuses on changing self-reinforcing dysfunctional communication loops and breaking up polarized alliances that are constantly at war with each other, sapping everyone’s energy and locking the system into the endless repetition of the same stale struggles.
Both these tactics are based on altering communication patterns, utilizing interventions derived from structural and strategic family therapy and systems theory. Both involve a shift in my role from individual therapist to coach, in which I encourage families to interact spontaneously in my presence and comment on the process I observe in the moment, rather than indulging in repetitive disputes about what has happened in the past. I
suggest trying different ways of speaking, shifts in body posture and eye contact, and even changing positions in the room in order to interrupt dysfunctional patterns of interaction and introduce more effective ones.

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Treating Relationships Continued

Stephen Proskauer MD — Tue, 01 May 2012 15:10:17 +0000

In my experience, this phenomenon occurs most commonly in couples where one spouse displays symptoms of a major mental illness and the other plays the part of the long suffering “normal” partner taking care of a chronically ill spouse. After the “sick” partner begins to stabilize and function more effectively, the caretaker unexpectedly decompensates, revealing previously hidden psychopathology. This dynamic can be regarded as a particular type of codependency wherein initially unstable spouses rely on their caretakers to manifest their own hidden high functioning side while the initially
stable partners choose an obviously unstable person to act out their hidden instability for them. Both partners are functioning as partial people psychologically speaking, each dependent on the other to be a functional whole. The mutual projection process that sustains this split could be described as a dissociative phenomenon in the Relational dimension.

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Treating Relationships Continued

Stephen Proskauer MD — Thu, 26 Apr 2012 15:10:24 +0000

For a patient or a family to break this cycle and make even small changes in the way they treat each other is a tremendous achievement that may require considerable work on a couple or family’s part. Paradoxically, the more chaotic and dysfunctional the family system, the more resistant to change it can be. If the identified patient makes fundamental
shifts as a result of individual therapy and begins to relate in a less dysfunctional way at home, we would expect everybody to benefit and the whole family system to function better. Sometimes this happens, but more often severely dysfunctional couples and families are thrown into crisis by the identified patient’s success in treatment.

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Treating Relationships Continued

Stephen Proskauer MD — Tue, 24 Apr 2012 15:10:50 +0000

In our society, members of a couple have usually chosen each other, so acting out of the abusive patterns fulfills unconscious needs for both parties. Their children are just trying to survive, however, to get whatever attention and care they can, so they are compelled to adjust to whatever skewed role they are cast in by parents for fear of total rejection if they don’t. What other choice do they have while they are small and totally dependent?
Abuse survivors who have no insight into the true source of their own behavior feel completely justified in what they are doing to others. They find reasons to place blame for their own actions on their children or partners.
Anyone who dares to object out loud faces being targeted for blame and punishment. Children must deal somehow with their fear and pain without parental support, developing their own abuse symptoms, escaping somehow from an intolerable family situation, or resorting to manipulative strategies to get their needs met indirectly within the family, preparing them for a future personality disorder in adulthood. In an unconscious fashion,
unhealed abusive patterns are passed down the generations like family heirlooms.

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Treating Relationships Continued

Stephen Proskauer MD — Thu, 19 Apr 2012 15:10:42 +0000

Ongoing relationship patterns often sustain the disabling symptoms that therapy is trying to relieve. Conflicts are no longer just internal but have become embedded in the family system as well. When the symptoms shift, the whole family system shifts. Self-reinforcing interactive systems like families, however, are quite resistant to change. Patients’ symptoms are no longer just their own problem; the family has a stake in the symptoms
too, even if they lead to unhappiness and chaos in the home.
Prior to healing, abuse survivors compulsively and unconsciously in flict what they have suffered at the hands of their abusers on their spouses and children while looking to them to make up for the good parenting they didn’t receive and to act as convenient targets for their pent up rage against abusive parents. Acting out against intimate partners and kids
dumps pain on others, providing only temporary relief to abuse victims without resolving anything.

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Treating Relationships

Stephen Proskauer MD — Tue, 17 Apr 2012 15:10:25 +0000

Distortion of current relationships in the families of patients suffering from severe childhood abuse can complicate the individual healing process. In the absence of therapeutic insight, patients tend to be unaware of the ways in which unresolved issues from childhood have influenced their current family patterns. An experienced therapist will assume that the version of marital or family conflict being presented by an abused patient is at best incomplete and at worst completely misleading. Only by including information obtained from other family members or, better still, by watching actual couple and family interactions can the therapist obtain a more balanced picture and be able to intervene effectively with a dysfunctional couple or family system.

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Research Shows that Hope Correlates with Outcome

Stephen Proskauer MD — Thu, 12 Apr 2012 15:10:24 +0000

Issues discussed become critical in chronic disorders like PTSD symptoms resulting from childhood abuse. Self esteem, already severely damaged by abuse experiences, has been worn down further over many years of dysfunction, often to the point of despair. Hope and purpose are crucial to health, and psychotherapy research has shown that hope correlates highly with outcome. I try to mix in those ingredients from the start by giving my patients a clear and confident explanation of my diagnostic understanding and proposed treatment plan, emphasizing not only recovery from their symptoms but also realization of their highest potential. Finding positive meaning in their troubled lives can accomplish much to restore morale and engender hope for the future.

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Big Heart Healing a Multidimensional Approach to Trauma and Abuse

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