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Posts Tagged ‘psychotherapy’

At Affordable Relationship Counseling, licensed marriage and family therapist, Dr. Barbara Cunningham, specializes in issues of grief and loss. Death, divorce, breakups, pet loss, homicide, suicide, career transitions, moves and many other changes all may herald in a period that the client may experience grief and loss. Dr. Cunningham emphasizes that all people belong to an emotional system. Emotional systems are made up of individuals, all of whom are interdependent upon one another to a greater or lesser degree. Thus, exits from the family system may create a kind of “emotional shock wave effect,” wherein relationships shift among members upon the death of an important family member.

As Dr. Cunningham experiences just such a change…the serious illness of her own mother…she is observant of the emotional process swirling about her and within her. She often advises clients not to make major decisions or changes for a year following the death of an important family member or after a divorce. This is a cautious way to insure that the brain calms down enough to make a rational decision. Homo sapiens are a social species. When we lose a profound attachment, it is an automatic impulse to grieve and even to look for a replacement love object to comfort us in our loss. The idea of doing so is normal…letting the passage of time occur to insure the decision is made with reflection is good insurance. To learn more about Dr. Cunningham’s model of practice, visit her website at http://www.cunninghamtherapy.com or call 619 9906203 for a complimentary telephone consultation.

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In my practice in San Diego, I specialize in relationship counseling, couples counseling, and marriage counseling. I do counseling with straight, gay, lesbian and transgendered couples in my practice.

Presently, I see a couple with two grown children. They have remained stuck for years in the repetitiveness of a distancer-pursuer cycle. The more he puts up walls, goes into his “cave.” or just gets too busy to make time for them, the more she pursues him by asking to “talk,” and even getting critical and blaming, just to get some reaction-any reaction- out of him. Both partners appear for treatment with a resigned look on their faces and seem to be frustrated and hopeless about their relationship. This cycle has gone on for years, and no matter how many times the woman complains about their lack of connection or no matter how many times the man pleads with his wife to stop nagging and just let him be, the battle continues. Sometimes the battle takes place underground-for example, in his resentment, he knows that it will make his wife angry whenever he is late. So he’s habitually late. His wife knows that it will make him mad if she buys too many new shoes at Nordstrom, so she splurges on multiple pairs of Jimmy Choo’s. Other times, the batttle takes place above ground, and they just go over and over what is stopping them from moving forward until one of them tires of the blaming behavior and withdraws. And so it goes.

When this couple finally appears in my office, early in the assessment phase of treatment, I assign them each two books : The 8 Concepts of Bowen Theory and Extraordinary Relationships, both by Roberta Gilbert, M.D. I explain a bit about my model of practice. I emphasize that when two people are anxious, it is common to blame the other for all the problems. Our brains are hardwired to do this. The work is to use that tiny part of our brain that has evolved above other forms of life and, on a good day, allows us to think about our thinking. Reading the books is an example of using that cognitive capacity to calm down the emotional while at the same time learning a new kind of causality about relationship functioning. Blaming behaviors reflect a linear causality. My model looks at problems from the perspective of a circular causality. This means no one is blame! Instead, problems are co-created, or tri-created and,in some cases, may be rooted in each partner’s multigenerational story as well as unfinished personal business from past relationships that ended poorly.

In order to find out context (with the idea that nothing ever happens in a vacuum anyway), in the second and third sessions, I take a family diagram of three or four generations. I look for patterns of strength as well as  problematic patterns that may repeat over generations. I look at levels of functioning and variation in each generations’s sibling group. I look at patterns of closeness and distance. Some partners come from families who are emotionally expressive and, in the extreme, “into each other’s business.” Oftentimes, the other partner comes from a family that is the polar opposite: family members are distant and isolated from one another, emotionally, and, at times, this can be reflected in family members being flung all over the globe or just not communicative despite living in the same town. I look for levels of functioning academically and professionally. I look for how well members can “hold” intimacy over the long haul through each members’ number of marriages. I look for patterns of loyalty and infidelity. I like to think of this effort as being akin to climbing to the top of the bleachers to see the football game rather than sitting on the fifty yardline. Past is, indeed, prologue.

The assumptions I hold are myriad. Four key assumptions involve the following: 1.) We are all more alike than we are different; 2.) we are interconnected; 3.) the human being has a need for both connection and separateness; and 4.) functioning is reciprocal (for example, the more one overfunctions in relation to another, it may, in part, determine the level of underfunctioning in another).

An example of interconnectivity can be seen in emotional shock wave effects after the death of an important family member. It is common to watch dramatic changes among the relationships of those who were closest to the deceased family member. We all can think of someone, for example, who has been married for many years and one partner dies. Within a year, the other partner passes. It may reflect how profoundly connected the partners may have been, so that even their mortality is affected by the distance of death.

In my view, change is about going outside your comfort zone. It is in a frustrated partner’s comfort zone to blame and criticize the other person to justify why he/she is right. Paradoxically, this blaming effort merely serves to solidy the other partner’s opposing position. There is gridlock. The therapy effort is to work toward being able to visualize your own part in a problematic relationship dynamic. This involves getting some separateness from all the togetherness in order to see how you are impacting the dynamic yourself.

Learning and then applying family systems principles to one’s own life is an ongoing challenge and lifelong process. My model of therapy sets people on the road to making this shift in their thinking. To be able to transform ones thinking from individual (blame) to systemic (cocreated) is a continuing effort. Keeping one’s eye on oneself instead of on other can change a couple’s dynamic in a dramatic way.

Dr. Cunningham has her doctorate with a specialty in marriage and family therapy. She is licensed in the state of California as a marriage and family therapist. Dr. Cunningham has published an academic book chapter on her family systems treatment and has been an adjunct professor at a COAMFT accredited graduate school of marriage and family therapy. She has long life experience and has enjoyed seeing thousands of couples in her career. For more information about Dr. Cunningham’s model of practice, visit her website at http://www.cunninghamtherapy.com or call 619 990-6203 for a complimentary telephone consultation.

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At times, the pain of separation seems more than we can bear; but love and understanding can help us pass through the darkness toward the light. And in truth, grief is a great teacher, when it sends us back to serve and bless the living. . . . Thus, even when they are gone, the departed are with us, moving us to live as, in their higher moments, they themselves wished to live. We remember them now; they live in our hearts; they are an abiding blessing. ~Jewish mourners’ Kaddish (Central Conference of Rabbis, 1992)

Dr. Barbara Cunningham offers insightful counseling to survivors of homicide, specializing in helping sibling survivors move through their grief and their loss (read about her model of practice at http://www.Cunninghamtherapy.com).

According to the U. S. Department of Commerce (1991), almost 2 million children from birth through 18 years of age become bereaved siblings each year. Although homicide is the least frequent form of violent dying, it may have the most profound and lasting impact on surviving family members (Rynearson, 2001). Since the mid-1980s, the rate of murder committed by youth has doubled, increasing by 102% (State Legislative Responses to Violent Juvenile Crime, 1996-1997). Homicide survivors are defined as significant others who are left behind to mourn victims of homicide. While society recognizes that the violent loss of a child is one of the most devastating experiences a parent can confront, there is little societal recognition of the impact of such a loss upon surviving siblings (Fanos, 1996). Despite the large number of adolescents and young adults who are faced with this catastrophic personal and family crisis, there is a lack of theoretical constructs and systemic treatments from which to generate a theory of sibling bereavement (Walsh & McGoldrick, 2004).

The loss of a brother or sister has a lasting effect on the overall development of the surviving sibling and the family system, and it is extraordinary that so little attention has been directed at understanding the impact of loss in young adulthood upon both individual and family life cycles (Carter & McGoldrick, 1999). The role and function sibling relationships play in identity formation is becoming recognized as a powerful force in personality development (Provence & Solnit, 1983).

Complicated grief is often part of the clinical picture with sibling survivors of homicide (Rando, 1993). In this blog, complicated grief is defined as involving an intensity of symptoms that affect people over an extended length of time or as barriers to daily living caused by grief (Weiss, 2000). Green, Lindy, Grace, and Gleser (1989) found that the experience of surviving the homicide of a loved one frequently led to complicated grief reactions. Rynearson (1984) pointed out that “the manner of dying rather than the event of death determines the meaning of death, which in turn influences the form and cause of bereavement” (p. 1452).

Allen (1991) noted that surviving the homicide of a family member was detrimental to the survivors’ psychological well being because homicide is “stigmatizing, unnatural, especially burdensome, and unexpected” (p. 18). Parkes and Weiss (1983) empirically supported their belief that the mental health effects of homicide on survivors were more pronounced than those experienced by individuals who lose a loved one because of an anticipated death. Furthermore, Allen (1991) noted that “the closer the survivor and the victim were, the more difficult the bereavement” (p. 20). Raphael’s (1983) summary seems the most appropriate to conceptualize the severity of the grief experienced by relatives of a homicide victim: “First degree family members are the ones who are the most impacted by the death, and the greater a family member is involved with the deceased, the more deeply the loss is felt” (p. 67). Kubler-Ross’s (1969) stage model of grieving has not been useful in helping these forgotten grievers to feel validated in their need to remain spiritually and emotionally connected to their deceased loved ones and to surviving family members (Walsh & McGoldrick, 2004). Instead, a model of treatment that has a deeper perspective and that examines multigenerational and emotionally interdependent functioning is needed (Bowen, 1976; Walsh & McGoldrick, 2004).

In addition to therapy focused upon issues of grief and loss, especially in the context of violent crimes, Dr. Cunningham also specializes in couples counseling, marriage counseling, and individual counseling/psychotherapy. To learn more information about Dr. Cunningham and her systemic model of practice, visit her website at http://www.cunninghamtherapy.com/ or call her at 619 9906203 for a complimentary telephone consultation.

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