Infidelity navigation: Summary * fidelity 101 * fidelity 108 * fidelity 2 * fidelity 3 * fidelity 4 * emotional cost * triangles * how to mend * models of mending * how to forgive * the unforgivable * relationship education * exits from intimacy * ending a relationship in peace * defences * emotional intelligence * re-romancing * on vulnerability
Relationship navigation: * page list * page 1 * page 2 * page 3 * page 4 * page 5 * how to build intimacy * how to mend * models of mending * commitment quiz * toxic patterns * mental maps * tough love * boundaries * turning points * how to end * forgiving * survey of marriage * what is success * marriage research * love styles * marriage quotes * family love like the wind
Meditation navigation: Mind * how to meditate * loving kindness * embodied mind * the Sacred * Yoga Nidra * the resolve * Tonglen meditation * forgiving * Antar Mouna * Tantra * Vedanta psychology * inner smile * reciprocity * spiritual materialism * mental maps * trusting in mind * prayer * zen mind * manifestos
How to mend navigation: 1. How to mend * 2. Models of mending * 3. How to be a grown up * 4. Hold me tight * 5. Becoming vulnerable * 6. Emotional bids * 7. Constructive fights * 8. Exits from intimacy * 9. The answer
Last edit of this page 03/02/2012
Mere thinking will never avail. Thought is a beautiful and proud occupation (where) study is concerned. But you can never think your way (out) of difficult emotional problems. Something else needs to be done. You have to make yourself passive and listen. Get into touch with that little piece of eternity inside of you. Etty Hillesum
To laugh often and much; to win the respect of intelligent people and the affection of children; to earn the appreciation of honest critics and endure the betrayal of false friends; to appreciate beauty; to find the best in others; to leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition; to know even one life has breathed easier because you lived; this is to have succeeded. Ralph Waldo Emerson
1.0 The site
This abundant, labyrinth of a web site is my thinking out loud about the work.
Face to face I am as thoughtful but less talkative.
Reader's response to this site:
1. "Thank you for putting up such a comprehensive and helpful site on the internet. I have spent the last four hours reading it, and have hopefully gained some insight into helping myself, my family and maybe my partner. Thank you again for sharing your knowledge so freely."
2. "I found your site that day.... And your site is the most wonderful, compassionate, complete, real and realistic, hopeful, honest, blunt, detailed website I have ever found!
Your site is a site full of treasures for people like me.... The ones that DO want health but just can't reach it! I have read so many of the pages.... I will read them all.... I do not know what made you decide to create this haven. I cannot imagine the hours, months, years you put into it.... But I want you to know that your words, explanations have become road maps to me.... They are the tie for the loose ends.... I will forever be in your debt and thankful! I think I will make it now and be able to leave and change my life. Take in a sunset or 2... I do." Deidra G.
Please visit my smart phone site couple-therapy.org and check on my facebook site for positive multimedia views of relationships.
1.1 What I do in a session
Only when our hearts are fixed do we find that our hands are truly free. G. K. Chesterton
A session is time to speak and think freely, to feel clearly, to sense truly and reach for all that is best in you and in your life. A session is both playful and earnest; light hearted and at times poignant; confronting and revealing.
I aim for each person to be clear, tender and strong.
For a couple this creates a place to speak the unspoken, untangle the knots, explore a repetitive negative interaction cycle, begin re-kindling the spark, to slowly unfold the unforgiven and to get a glimpse of how the future might be if you work toward it together.
I make a space for robust change, working with head, heart and guts, and without too many theory based pre-conceptions.
I am often an educator disguised as a therapist, and always a process consultant.
My skill derives from on-going training; life experience; the enjoyment of working with people; a natural ability to listen carefully, understand and to communicate clearly, and the evidence of successful work with previous clients. Clinical psychology has taught me how to think about people in context, how to think ahead and to value a thorough enquiry.
Sometimes even one session can kick start a simple life change or a small shift in perception, meaning and values. Though private and subjective, this can nevertheless impact on those significant others, colleagues, friends, children and even pets who are not directly engaged in the process.
This needs to be considered, as others can help and hinder your intentional change process.
1.2 Does it work
Even friends of long standing who know me well ask, 'but does it work?' I used to rely on the glib 'would I spend 40 years of my life doing something that doesn't work' as an answer but they just glaze over.
Often the best answers is to tell a story about someone else a bit like them. There are 6 examples on my intro 1 page and the example section 1.1 on how to mend.
One of the best things that works is to describe the conflict cycle or the stuck interaction patterns of a relationship with the emotions they house - go to this page for more on those patterns.
I posted a longer answer to this question here on my facebook couple therapy site.
1.21 How to get the most from couple's therapy
Here's my couple questionnaire.docx. (or in rich text format). Please fill it out together, then snail mail or email encrypted to me before our first session. I have designed it to deepen your understanding as well as mine.
Follow this link to my office location, hours of operation and fees.
I recommend this article from a veteran therapist if you are planning on working with me. Sometimes I too forget the obvious, for example:
The hardest part of couple's therapy is accepting you will need to improve your response to a problem.
The model of emotionally focused therapy (EFT) is the backbone of my work. I flesh out each session from many other influences. Here is an outline of the EFT, a review and an excerpt from the book by Sue Johnson (highly recommend): 'Hold Me Tight!' and her article in Psychology Today.
1.3 Core values and self-limiting beliefs
Every element of a life is like instruments of an orchestra.
Before a concert begins the oboe sounds an 'A'. There follows a cacophony of instrument sounds until all come into alignment with that first note. Then the conductor walks on and the concert begins.
Life is never that orderly.
We all struggle to hear our own unique 'A', our core values, and to bring all of our life into alignment with them. In not hearing our signal sound, some of our life has not even begun - as if some instruments are absent, hushed or busy playing someone else's tune.
That is as true of the individual and of the couple.
1.4 Selection criteria
I have increased my success rate and lifted my job satisfaction by evolving a straightforward selection process - if you are coupled, come as a couple or not at all. This is the case even if you have been referred by your GP for a specific mental disorder.
Most treatments (e.g. CBT, Interpersonal Therapy) of most mental disorders (e.g. depression, anxiety and trauma) are enhanced by the presence of the primary support person in the treatment program. There is now a substantial body of research in support of that.
I can may be able to refer you to therapists whose preference is working with individuals.
Here is my how to choose a therapist on site.
Contraindications: Involving your partner in couple's therapy is not viable where there is ongoing violence, ongoing affair, uncontrolled drug use or where the partners have incompatible goals for therapy. Clients who present themselves as rigid and consistently externalize their difficulties, insist on keeping secrets that are relationally significant and do not express commitment to a relationship are unlikely to find couple therapy useful. (Quote from Sue Johnson 2002).
If you are partnered and either straight or LGBTI, and want to come for individual or couple work without your partner, I will ask you to explain. Some people call me thinking their situation is the exception.
For example, one guy, withdrawn in his relationship for some years said, 'I want individual sessions first to put the past behind me before I ask my partner if she'll attend.' Another engaged in criticizing her withdrawn partner ('he never talks to me') and pursuing him said, 'he won't come unless it's an ultimatum. So I want to come by myself to work out some strategies to deal with him.'
Another, that 'he is depressed and abusive but denies he's part of the problem' or 'there are some things I need to get off my chest, which will only make matters worse if I say them with my partner present.'
Anything in the past or something controversial in the present is better discovered slowly and dealt with as a couple, especially if the alternative is me keeping it a secret.
Most partners do want to know about their loved one's unfinished business as it is usually material to the problems in the current relationship.
Whatever you might think makes your situation an exception I am likely to insist you bring your partner along, and decline to offer a service if they will not attend, referring you to another practitioner.
When attachment security is uncertain, a partner will pursue, fight, and even bully a spouse into responding to attachment cues, even if this has a negative general impact on the relationship. (Sue Johnson in 'EFT for Trauma Survivors' 2002)
1.4.1 Inclusion
It is almost impossible to undertake an effective individual psychotherapy or behavior change process without implicating an intimate partner in some way.
I think most partners would like to be included in and consent to the effects of your changes in their lives.
It is my duty to provide that opportunity.
To not do so would risk both my professional competence and your integrity by stealing their choice in the matter.
There are few problems individuals bring to therapy/counseling whose resolution would not be enhanced by involving the client's significant other in the change process. Marital distress is a powerful predictor of relapse from almost any kind of medical or psychological treatment.
Over the years I have worked with numbers of couples where one of the partners is undergoing an individual psychotherapy. I have heard how the exclusively individual therapist has sometimes become a significant point of reference for their client in at-home marital discussions. For example, 'my therapist says I shouldn't have to put up with this crap from your mother'.
It is not okay for a couple to be in further anguish from interventions an individual therapist has recommended for a marriage in trouble, sight unseen. Read my how to choose a therapist pages.
The most common and well meaning psychotherapy interventions are practicing active listening in individual sessions with the therapist who role plays the absent partner.
You could argue that active listening is a good thing in marriage. In fact, there is precious little research showing active listening solves marriage problems. Visit Gottman's web site and read this interview with Gottman for the evidence.
1.4.2 Relationship history
The influence of your family of origin on how you think and perceive the world is not without significance in the growth of personal and relationship problems. Both partners share equally in that process.
If I were to see you in your partner's absence, anything I might say or not say about your relationship, could later be conveyed to them in the framework of your family history rather than in theirs. This could then feed into the negative interaction cycle that characterizes marriages in trouble and cause further wounding and withdrawal.
This would be a potential source of harm to your relationship in my name. At the very least it would put me on the back foot were I later to see you and your partner together and found that they had been given a judgment of their behavior, spoken in my name.
It is also possible that were I to see you without including them in your change process, and that change process led you to a later and acrimonious divorce that harmed the kids, those children (third parties to the therapy) could some years later, make a health complaint that I failed to protect them from that harm by not including the other parent in your change process.
This is the regulatory framework in which ALL counselors, psychologists and therapists work in Australia, ignored at their own peril.
If your partner refuses to attend at least for the initial session, I will decline to offer my services if, in my professional opinion, to provide it might harm your primary intimate relationship.
1.5 What are my tasks
I teach, show and coach you in how to:
- hear, see, feel and understand what the other means by what they say and do
- stand in each other's shoes, even if just for a jaw dropping moment
- not react to the first emotion that comes up
- give help in self-managing reactivity when it overwhelms
- keep moving the relationship out of the adversarial or withdrawn fall back positions to the collaborative approach
- communicate empathy and build a map of each other's world realizing that
- each has a subjective experience of the relationship different from the other with
- a coherent internal logic that makes the world sensible to them because of
- a set of values not always well expressed or understood by self or other
- accept that happy couples struggle to love as well; struggle to manage their anger and disappointments in love and struggle to protect their partner from knowledge of the inner work they do in order to achieve a harmonious, cooperative and enduring connection.
- describe the negative interactional cycle that absorbs much of your time
- weaken the effect of that and of habitual stereotyping and family labeling
- soothe emotional arousal when it's appropriate or get upset when that's important
- catch and manage the monsters that cruel intimacy - criticism, defensiveness, contempt and stonewalling.
- remind you of the difference between what you think you do and what you actually do in relationship
- help you reach down to the layer of emotion beneath your first reactions and from that place slowly begin to ask directly for what you need from your partner
- often this is a straightforward 'make "us" our safe harbor'; 'hold me tight even when we disagree', 'let me comfort you', 'will you catch me if I fall?'.
- For men we often think this need for connection is just about sex. It is not. Men, both gay and straight, struggle with their socialization (and against labeling by others) that says for guys sex is the only appropriate place to ask for holding; to show vulnerability; to ask for acknowledgement, for touch and to be known; to reveal their dreams and fears, and their need for a secure attachment.
- That is what we all want in one place in our lives no matter how we were gender socialized. Sometimes a pet will provide it, and when that pet is lost the loss is as inherently traumatic as any other loss of a deep, wide connection.
- I work as a gender trap catcher; a traffic cop when you talk over each other, or don't hear the internal logic of the other's request, and
- as a fire officer to cool things down so that we can get back to work and at the same time
- advise you on fuel management.
- I will usually give homework tasks and follow them up in our next session that requires a commitment to quality time each week.
1.6 How many sessions does it take
I am very happy to chat with you for 10 minutes over the phone before you make a first appointment. In that time I can usually give an estimate of how many sessions it could take to deal with the issues you disclose.
Depending on the duration and intensity of the problems, between 3 and 24 sessions will usually be enough to move a couple into a more satisfying and a self-renewing pattern.
De-escalating a negative interaction cycle can take as few as 3 sessions, but getting beneath the reactive emotions to the underlying attachment needs and creating new ways for those to be clearly asked for and finally met, can take between 6 and 24 sessions.
1.7 If one or both of you have been traumatized
If there is a trauma history in one or both of you, then the session count may increase up to 37. In this situation it is vitally important to ensure safety and containment around the volatile issues; to use adjunctive and evidence based individual therapies including from the curative arts (music and art therapies for example); somatic psychotherapies; energy therapies (such as TFT and the Body Talk system); trauma therapies (such as EMD*R), and to ensure that diet, exercise and sleep are supporting the healing process in both members of the couple.
Here is a link to an excellent resource on trauma is.
The article "Creating healing relationships for couples dealing with trauma: The use of emotionally focused marital therapy" by Sue Johnson and Lyn Williams-Keeler is available here, from which this quote:
The marital relationship can be considered one of the most important elements of the recovery environment. The research of van der Kolk and his colleagues suggests that the ability to derive comfort from another human being predicts more powerfully than trauma history itself whether symptoms improve and whether self-destructive behavior can be regulated. Sue Johnson
2.0 What are your tasks
Different people seek different outcomes from a consultation. Because of this, it is important to talk to me about what you are expecting, or hoping. I can give you an estimate of the number of sessions required to achieve the results you want and a guide to some observable indicators of progress toward your goals. But I can't help if you're a therapy tourist, come under external duress or withhold information vital to our work together.
To get the best out of sessions the following guidelines may be useful:
1. Aim to attend every scheduled appointment
2. Keep a therapy diary or journal for yourself and reflect on it. If the client is a relationship, this does not mean record your surveillance of the between session couple behavior It means keep a diary of your personal journey. I will revisit the between session couple transactions when and how I think it would be most effective.
3. If you wish, make an audio and/or video record of each session or take notes during it, or ask me to write you a summary on the day. All these suggestions are also useful for couple sessions.
4. Develop healthy support networks and draw on them to grow your inner and your relationship process. If the client is a couple, this may mean negotiating boundaries with people that hinder your growth. Or accessing friends and family who can give you breaks from family duties to spend quality time together.
5. At the next session, be prepared to share your observations, thoughts, feelings and your between session experiences openly with me. Read widely and think critically about the ideas that come up.
6. Complete any homework tasks negotiated with me. When unsure, ask for clarification, information or for further reading about any of the activities being recommended or undertaken.
7. Ask any question, discuss any doubts, and raise any concerns you have at any time
8. This is a process that is also governed by your learning and my teaching styles
2.1 Can the benefits be guaranteed
It is an interactive process, which relies heavily upon you or your relationship. For example, your responses and openness; the particular issues and the personal resources available, and the timing of and readiness for change.
No one can guarantee that a therapeutic process will meet the expectations of the person being treated. Many people experience positive and constructive outcomes but not everybody does. [Also see 'Risks' item 4.0 below]
Because we are all unique human beings and all have different perceptions and expectations of what we are seeking, the outcomes can vary as widely as the individual expectations and personal meanings of those who seek my services. I cannot promise any particular outcome, benefit or result from or time frame for the process.
3.0 FACTS ABOUT MY ROLE
Qualifications and expertise
I am an endorsed Clinical Psychologist with 40 years experience of applied clinical psychology, working with individuals, couples, families and community groups. I attend regular, applied training in my fields of interest and undertake monthly peer supervision of my own process and fortnightly clinical supervision of videos of my couples' work.
I am a member of the Australian Clinical Psychologists Association. My expertise is in Clinical and Relationship Psychologies.
I am subject to a wide range of professional and ethical requirements, imposed both by the statutory body AHPRA; National Privacy Principles and the national professional association ACPA.
The effect of these dictates include that my duty to you will remain that of client and psychologist in perpetuity; that I cannot engage in dual business or social relationships with either you or your family, and neither can I accept gifts from you. I will always have more knowledge about you than you will have about me. I am bound to guard those confidences and the consequent imbalance of power in our relationship.
Methodology and approach
I use recognized and evidence based methods in our work together but they are not without risk.
The outcome of psychological treatment is not good for everyone - at the very least not all individuals benefit to the same degree. And some individuals are worse off following a treatment program than they were before.
Consequently, if you have any questions or concerns about the approach that I am taking at any time, please do not hesitate to raise these with me and only proceed after you are completely satisfied with my explanation and your reading of the material I may refer you to.
4.0 The risks of psychological treatment
While people seek and derive many positive benefits from clinical psychology there are also risks. These arise from the effectiveness of the process as well as from a less than adequate fit of the process with the particular client or couple.
Even in the context of a University research trial to test the effectiveness of a treatment process, conducted with world's best practice and safeguards, some people may be worse off after the treatment trial, even when the majority experience significant improvement.
From a scientific viewpoint it is not possible to determine whether the individual who did not improve in the intended way was actually harmed by the psychological treatment. But from a legal point of view it matters not.
If a psychologist does not engage their client proactively in a frank discussion about treatment risks, and warn of the possibility of deterioration during treatment s/he might be held to have caused the deterioration even where there is no scientific or logical evidence of a causal link. Read: 'Tell your clients you might hurt them.' O'Brien-Maloney & Diamond - Australian Psychologist Vol. 41 No 3 November 2006 page 164.
It's the very nature of a therapy to work and to work with issues and areas of people's lives that may expose, or be a catalyst for exposing those involved to a wide range of healing, joyful and challenging thoughts; of clarifying attitude changes that demand a re-think of long established patterns; of strong emotions, reactions and interactions; of mood and life changes.
Sometimes people have both positive and negative mood swings within and between therapy sessions. These may last a moment or hours and even days. These include experiences of joy and sorrow; of grief and anger; willfulness; despair; spaciousness and kindness; guilt and fear; love and hope; isolation and confusion; connection or temporary disorientation.
Others discover a loss or change of direction and/or a loss or change of motivation that has been bubbling under the surface for a long time. Some find old issues with spouses, family or friends re-surface, despite their best intentions to avoid the issue or move on.
There can also be physical signs and symptoms, including alteration in sleep patterns and in appetites; lack of or excess of energy; unusual or confronting sensations, thoughts or feelings. Sometimes headaches, rashes, dizziness, nausea, breathlessness and gastrointestinal upset can also occur. Mind and body are isomorphic.
When the client is a relationship or a family, its dysfunctional equilibrium, chronic adverse patterns and reciprocal interactions (e.g. blaming) can be disturbed or interrupted both for good and for ill. This might be experienced at times, as the relationship getting worse before there are sure signs of it getting better or of it being too hopeless to repair. Whilst these occurrences are hard to predict and to prepare for, the my job is to maintain a robust, well-contained and resourceful anchorage during these transitional phases of the process.
Sometimes these feelings, reactions and experiences can be very severe - to the point that they are quite debilitating in terms of the clients' daily life, their personal and professional commitments and their intimate relationships. Consequently, it is important that you let me know at the beginning and at any time thereafter, whether you have any current personal or professional issues pending, which could be seriously affected if any of the above risks arose. Likewise if you are likely to be facing any such issues during the period of your treatment and beyond, which could be seriously affected if any of the above risks arose. For example, do you have any job interviews, significant business or financial transactions, legal matters, family engagements, surgery, training or examinations or important employment related issues which, if you are seriously affected by a therapy process, could mean that you face unacceptable outcomes, including financial loss?
While relatively rare, it is also possible for the process to be a catalyst for reactions and feelings that lead to the desire for self-harm and/or for harm to others and/or to damage significant relationships. Therefore, it is very important that you share with me if you have ever experienced those feelings before and that you immediately raise those thoughts and feelings with me should they ever arise.Each person is different, so it is impossible to exhaustively list every possible adverse effect. If you're at all concerned about the potential risks and impact of a change process at this junction in your life, then you should consider whether now is the right time and place to proceed. You can always come back after that important personal or professional issue has been dealt with.
New clients are required to fill out my new client agreement form.
5.0 Terms, conditions, hours of operation and fees
Hours of practice
I am available from 10.00 am to 6.30 pm on Monday and Wednesday from February to mid December. I am not available in June or July.
I can be reached by telephone or by email to which you can expect a response within 24 hours.
I do not provide an emergency service outside the ordinary hours of practice or the limited after hours service. The ACT mental health emergency team is on (+61) 6205 1065 or (+61)1800 629 354 and Lifeline is on (+61) 13 1114. I am not in a position to provide any warranties or recommendations in relation to the above or any alternative service providers.
As my resources are limited I may not be available at short notice even within ordinary business hours or within the limited after hours sessions.
5.1 Fees
In person: $220 per hour and $270 for first consultation. You get $20 discount per session if you require no more paper work from me than a receipt. Some private health insurance cover my services.
Cancellation policy: missed appointments/sessions may be charged at the following rate:
48 hours or More Notice - No Charge
24 to 48 Hours Notice - 50% of Minimum charge
Less than 24 hours Notice - 100% of Minimum Charge
The Minimum Charge for a missed appointment or session is for one hour.
The terms of payment are either on the day of the session or, within fourteen days of the issue of an invoice. I reserve the right to charge an invoice fee of $20 per invoice per week on overdue accounts and to cease providing services unless payment is made promptly.
Top cover of a number of Private Health Funds rebate both individual and relationship sessions.
5.2 Referrals
I will not attempt to assist you in areas beyond my expertise or outside my current area of interest. In such cases I will, if appropriate, refer you to another professional with the relevant skills. In that case, by signing the agreement, you will be authorizing me to contact another practitioner on your behalf and provide that practitioner with any information he/she reasonably needs to assist you. You can review this authority with me at any time.
5.3 Records
The records created by me in relation to you are for me to be able to responsibly assist you and in order to reflect reasonably what has occurred in the client relationship. They are encrypted and securely stored. I am the only person who has access to them. The National Privacy Principles contain special provisions applying to such sensitive information see www.privacy.gov.au or call the Office of the Federal Privacy Commissioner on(+61) 1300 363 992 or visit the NH&MRC web site.
At all times the records and their contents remain my intellectual property. A copy will normally be available upon request by you and a small fee is payable. Subject to any statutory requirements and Privacy Principles, I reserve the right to provide you with a summary of your client record. Generally, I retain the records for 7 years but also I reserve the right to responsibly dispose of records at any time after the termination of our client relationship.
5.4 Confidentiality
Subject to the Agreement you may sign and the terms of the consent contained within it, all information in relation to you will be treated as confidential. However, it is not privileged information in the legal sense and can be subpoenaed. Here is an ABC law report discussion of doctor-patient confidentiality.
5.5 Complaints
It is the nature of any service provider that clients may, from time to time, have concerns about some aspect of the service being provided. Should you have a concern about any aspect of my services, please raise it with me in the first instance.
If, after raising it, you are still not satisfied with the outcome, I will recommend the Conflict Resolution Service [(+61) 02 6295 5998] as the next step for us both to take.
5.6 Third party complaint
If a member of your family is a client of this or another service, and you are concerned about the service being provided to your family member, there is an avenue of complaint open to you when you have exhausted the direct avenues.
Section 39(1)(vi) and sections 48(2) and (3) of the Human Rights Commission ACT 2004 does not prevent the Commission from investigating a complaint by a person who has not received a health service from a practitioner but has reason to complain about a service they have provided to another.
This hypothetical case explores those risks.
© ZPJ Fox 2010, 2011 All Rights Reserved www.peterfox.com.au
Source for the idea of this page: "Risky Practices - a counselors guide to risk management in private practice" by Nigel McBride and Michael Tunnecliffe, Bayside Books 2001.
