Therapy Has a Relationship Problem ...Middle East

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Years ago, I treated a woman whose husband was deliberately trying to drive her toward suicide while attempting to extract money from her family. What struck me was not only the cruelty of his behavior, but his complete lack of empathy or remorse for the harm he was causing. Leaving him was necessary, and the woman is now happily remarried.

Mental-health professionals have become remarkably good at helping clients identify unhealthy relationships. We have a sophisticated vocabulary for boundaries, trauma, toxicity, narcissism, gaslighting, and emotional safety. But I worry that we are far less effective at helping people navigate difficult but meaningful connections.

Too often, we mistake relational distress for relational dysfunction. Wall Street Journal columnist Elizabeth Bernstein recently highlighted this eloquently. She reported on therapists who encouraged adult children to go “no contact” with their parents, often after surprisingly little effort to mend ruptures. In a survey of roughly 7,000 estranged parents, one-third believed their adult child’s therapist had influenced or even recommended the decision to cut ties. That should give us pause.

In reality, walking away from another person often solves one problem while creating others. Increasingly, my practice sees clients who have ended relationships that took a lifetime to build. The immediate conflict may be gone, but so is the connection. Many become lonelier and less equipped to navigate conflict, disappointment, and repair elsewhere.

I learned this lesson the hard way about 15 years ago.

This reflects something larger about how mental-health care is generally structured. Our system is overwhelmingly individualistic. Diagnostics assign disorders to individuals, and insurance reimbursement follows an identified patient and his or her diagnosis. Even family psychotherapy is typically covered only when it is being used to treat an individual’s mental health. That model may make sense in other areas of medicine, such as orthopedics where a fracture occurs within one body. Mental health is fundamentally different. A great deal of flourishing and suffering happens between people, not just within them, because human beings are relational beings.

Effective treatment does the opposite: it helps people face distress so they become more capable to withstand adversity, not less. Applied to relationships, this becomes especially critical because even the healthiest connections generate some strain. Loving spouses disappoint us, supportive parents fail us, close friends misunderstand us, and even terrific children create enormous stress. If stress itself is taken as evidence that a relationship is unhealthy, the normal difficulties of human interaction begin to look pathological.

These skills matter beyond any single relationship. Learning how to reconnect with a spouse can make us better caregivers. Learning how to accept a parent’s limitations can change how we relate to our friends, work colleagues, and children. Working through difficult interactions can both preserve meaningful connections and strengthen our ability to navigate other ones.

That message matters because a great deal of interpersonal conflict comes from trying to force others to change. We want parents to be more emotionally available, spouses to react differently, siblings to finally understand us, and adult children to make choices we approve of. Sometimes change is possible and can be requested directly upon the foundation of a loving connection. But sometimes the wiser move is to stop demanding that another person change as a condition of staying in contact with them.

Human beings need relationships. Relationships require skills. Therapy should help us build them.

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