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Do no harm: A reminder to therapists

For over 35 years I have treated thousands of men and women of all ages and stages in life. They have come from different socioeconomic, religious and cultural backgrounds, seeking help for problems including depression, anxiety, early child sexual abuse, domestic abuse, substance abuse of various kinds and sexual and relationship issues.

The majority of my patients typically contact me asking for individual therapy. Since we don’t live in a bubble, people’s relationships, beginning with their own families of origin and significant others – including friends, lovers, colleagues and spouses, need to be fully explored. This step is critical in understanding the possible ‘root causes’ of the underlying problem(s).

People can naturally only describe their own ‘truths’ and experiences. That’s why it is important for the therapist to encourage the patient to have various family members participate in the therapy (as long as the patient feels safe to do so)— particularly when a patient’s presenting problem and chief complaint is specifically about these very important people in their life.

Although it is not always possible to do this in every situation, experience has taught me that we, as therapists, can do enormous harm to the very people that we are committed to helping, when we are unable or unwilling to obtain as complete a picture as possible. I have seen too may families and relationships destroyed, suffering irrevocable damage and pain as a result of therapists not willing to do their do diligence and be open to hearing ‘the rest of the story’.

I recently received a phone call from Robert, 38, a very successful and well-known Southampton attorney. He told me that he and his new wife, Amanda, had been married for just one year and that the marriage was in serious trouble. His wife was initially reluctant to accompany him to an appointment. A few weeks later he called and said that they were finally both ready to come in and see me.

Robert and Amanda (both never previously married), met on Tinder just prior to the pandemic. As a result, they had not been able to spend very much in person, face to face time together. They emailed, texted and sexted for over a year and became engaged within a few months after things began to open up. They shared a love of tennis, running, and travel, and both talked about their desire to have a child some day. We spent most of the initial session talking about how Robert’s family did not care for Amanda and were opposed to the marriage. Amanda’s feelings of rejection, disappointment and anger dominated our session. She felt that Robert did not support her and was simply too enmeshed with his family. Robert said very little, but made it very clear that Amanda was over-reacting, invalidating her feelings about how badly his family treated her. The fact that Robert did not protect his wife from his family’s hurtful and disrespectful behavior was one issue that we would definitely be tackling in our couples sessions.

After the initial couples evaluation, (oftentimes lasting several hours), I always meet with the individuals alone. This enables me to really get to know who the people are as individuals, including finding out about their own family histories, dating relationships, abuse of any kind, psychiatric histories, affairs, etc. I often learn things in these individual sessions that may never be disclosed in a couples session.

Robert told me that Amanda regularly throws temper tantrums when she is upset, including hitting him, destroying property and threatening to commit suicide. These ‘scenes’ are followed by a period of calm – including apologies and promises to ‘never do it again’. Robert told me that there were several recent episodes where he felt that he should contact the police and have Amanda admitted to a psychiatric hospital. He acknowledged that he really didn’t know her when they decided to get married and that his own individual therapist had been deeply concerned that she had major unresolved psychiatric problems. He now realizes that their love of the outdoors and travel were not sufficient reasons to have gotten married. He has discussed all of this with his family. I now understand why his family had been so worried about Robert and why they have not embraced Amanda.

Robert also confided that since being with Amanda, he regularly suffers from erectile dysfunction, despite the fact the his urologist assured him that there is no physical reason to explain his problem. In discussing this further, he was able to see that even though Amanda was desperate to have a child, that under the circumstance he was not. His penis was telling him something very important!

I may never have known about the reality of Robert’s experiences with Amanda had I not met with him individually. At the end of our session Robert told me that he was thinking of going to a hotel for the night, since he hadn’t been able to sleep in several days. He planned on calling Amanda to let her know of his plans as soon as he left my office.

Robert called to tell me that Amanda threatened suicide and that the police were on their was to their New York City apartment to take her to a hospital.

I spoke with both Robert and Amanda after Amanda was discharged. She told me that she threatened suicide because she didn’t want Robert to go to a hotel, fearing that he was going to leave her. Amanda and I scheduled an individual appointment to meet the following day..followed by another couples session. Effective treatment (both individual and couples therapy) would now be possible, now that I had an accurate picture of the reality of Robert and Amanda’s life together.

*The names and some of the details have been change to protect the confidentiality of my patients.

Beatty Cohan, MSW, LCSW, AASECT is a nationally recognized psychotherapist, sex therapist, author of For Better for Worse Forever: Discover the Path to Lasting Love, national speaker, national radio and television expert guest and host of the weekly ASK BEATTY SHOW on the Progressive Radio Network. She has a private practice in New York City and East Hampton.

Beatty would love to hear from you. You can send your comments and questions to BeattyCohan.msw@gmail.com. For more information go to BeattyCohan.com.

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