The Blame Game

blame1Blame always causes damage, either to oneself or to others.  To blame others is to defend oneself from uncomfortable feelings and to avoid taking responsibility for one’s actions; blaming oneself reinforces one’s lack of self worth.  Blame breeds resentment and prevents resolution of conflict.

Blame is a defensive response to pain – instead of allowing us to express hurt, it prompts us to act out and attack.  It is always tinged with anger and produces no result.  Blame alienates and pushes away.  Over time, blame destroys relationships.

In my work with couples I have seen blame exacerbate the rupture that brought the couple into treatment in the first place.  Unless both people in a relationship take responsibility in a conflict, they will express their feelings through blame.  This prevents understanding and enflames problems in communication.

Even if the blamed person takes responsibility for her/his partner’s hurt and apologizes, it may seem like the problem is being addressed when, in fact, resentment and guilt are simply buried and end up being acted out in other areas of the relationship.  While blame and subsequent apology may create the impression that the rupture has been dealt with, it in fact has simply been camouflaged until it presents itself in other problematic areas that the couple may or may not be dealing with.  While not always apparent, in any conflict there is shared responsibility in preventing understanding and healing.

Suspicion or discovery of infidelity is one of the most volatile areas that come between couples, leaving the psyche gripped with feelings of insecurity and rejection.  What drives a partner to explode in rage when experiencing the pain of betrayal?  What role does each partner play in a rupture precipitated by infidelity, either real or imagined?  And does responding with rage when infidelity strikes address the problem?

When both people in a couple discover their own responsibility in a rupture, including infidelity, it does not illustrate “blaming the victim”.  In every dyad, there is action and reaction, and I have found that even in the most blatant breaking of trust, the injured party can look at her/his contribution to the breakdown in the relationship.  If blame is the only response to being hurt, after time the blamed member of the couple will start to resent her/his partner.

A couple who had been together for 11 years came to see me after discovery of a workplace flirtation.  The wife had found a romantic-tinged text from her husband’s co-worker and confronted her husband.  He admitted the flirtation had gotten out of hand and, while confused, he said that he did not want to leave the marriage, loved his wife and the life that they had, and wanted to work on the marriage.  The wife was devastated and enraged.  She acted out her pain and devastation with attack and accusation and, as she attacked, her anger only deepened.  As we worked together, many past problems in the relationship came up that had never been addressed.  But the blame and attack from the wife continued unabated until the husband was distraught and resentful.  I tried to focus on the wife’s pain, the husband’s confusion and on working on the past unaddressed problems that contributed to the flirtation and fantasy.  After a couple of months, the wife’s constant blame and accusation and the husband’s growing resentment ruptured the relationship in a more substantial way than the initial out-of-hand flirtation.  The wife refused to look at her role in the ruptures and continued to blame her husband in total for the problems in the relationship.  The conflict deepened and healing was elusive.

A married man I have worked with for many years struggles with tremendous guilt and self-recrimination over his pornography addiction and for his occasional hiring of escorts.  Although his addiction has been a life-long struggle, during his marriage and until recently he has refrained from pornography and sexually acting out.  During his 10 years of marriage, he has had two children.  For a long period of time he has felt neglected by his wife, who has been focusing on the children and has neglected intimacy with him.  When he brings up the lack of sex and suggests working on it, she avoids the topic and lets it drop.  Lately my patient has succumbed to his porn addiction and is worried that he may act out further.  My patient is filled with self-blame about his addiction.  He thinks of his addiction as a weakness and moral failing.  While he has enormous empathy for his wife, and understands why the intimacy has left their relationship, he has no empathy for himself.  Instead of confronting the issue of sex with his wife and not letting the subject drop when he brings it up, he blames himself for needing to fulfill his need for sex though porn.  Because I fear that his self-blame will further isolate him and may develop into resentment towards his wife, I encourage him to persist in bringing up the subject to his wife and to develop empathy towards his addiction disease.

When one is hurt and responds with blame, she/he is unconsciously motivated to hurt the other.  That way, she/he is not suffering alone.  This only further alienates the person causing the pain and breeds resentment and isolation.  To express hurt brings the other towards the one hurting; blame pushes the other away.

Anger: Repression, Suppression, Expression

anger images

Unexpressed anger destroys relationships and when acted out, rarely produces the desirable result.  When turned against oneself, it causes depression and anxiety.

Most people think of anger as a negative emotion and try to expel or suppress it. The result can be disastrous.  Because anger results from a rupture of one’s sense of self and security, efforts to exorcise it only cause chaotic relationships and produce self-inflicted psychic wounds.

We often forget that as people we are profoundly different.  We interpret behavior in terms of our own belief system and in the context of our own definitions of language and expression.  When we “listen”, we tend to interpret and filter the other’s experience as though it were our own.  Instead of conscious listening and inquiry, we assume we are aware of the other’s experience.  We forget that our perspective is ours and ours alone.  We can’t assume we understand what others are saying without careful questioning.  Since we assume our perspectives represent “the truth”, any evidence to the contrary leaves us unsteady and defensive. Depending on our personalities, we may lash out and place blame or we may turn our feelings against the self, leaving us feeling rejected and insecure.

When I work with couples, I often see acted out the dynamics of blame, hurt, insecurity, and misunderstanding.  This invariably destroys trust and reduces mutual empathy.  Each misunderstanding exacerbates the damage such that the slightest wound leads to accusations, blame, and anger.  A button is pushed, the partner reacts, more buttons are pushed, until this pattern defines the way a couple communicates.  As this unconscious reactivity is played out and becomes ingrained in the relationship, it becomes progressively more difficult to reframe; healing the wounds requires greater and greater effort and attention.  We associate this kind of breakdown with couples, but it can come to play in virtually any kind of relationships.

When hurt and angry, we are often compelled to blame and lash out or to internalize and feel insecure and rejected.  Being human, we attribute our feelings to another when in fact they are our own.  Would it not be illuminating to examine these feelings in light of one’s own past? ?  Often we assume the hurt is coming from the others’ insensitivity or lack of caring.  Although this may be in fact the case, most often what hurts us is a rupture from our past that gets activated and leads to misinterpreting the other’s meaning and intent.

Walking down the street, we may simmer with hostility at the perceived obliviousness or self-serving behavior of others.  But if we examine this anger, it is most often the result of feeling helpless to control our own environment.  Impatience is often misplaced anger that, in fact, would be better directed at another object, the actual cause of the frustration.

People become depressed or anxious when they have unexpressed rage that’s turned in on themselves.  All of this provokes feelings of hopelessness and leaves the individual without motivation and control.  While it’s human to be angry and human to try to deny anger, it is also possible to acknowledge anger and explore its origins through the exploration of the self and the understanding of others.

Sex, or especially the lack of it, is often a source of blame and recrimination in couple relationships.  For the therapist, breaking this cycle of mutual blame may feel herculean.  When couples can no longer communicate needs and hurts, sexual intimacy suffers and they lose the ability to empathize with their partner.  One partner may feel rejected and not capable of empathizing with their partner’s problems with intimacy.  As feelings of rejection slowly build, they express themselves as blame, either outwardly or kept to one’s self and expressed passive-aggressively.  It is less threatening to be angry at what one doesn’t get than to express feelings of vulnerability, rejection and need.

I worked with a couple who have had only sporadic sex for many years.  One partner felt rejected and expressed his hurt by verbally attacking his partner and accusing him of not being physical enough.  The anger alienated the partner, who grew increasingly resentful  – the anger expressed directly and passive-aggressively in tern exacerbating the the lack of intimacy.  The angry rejected partner’s incessant blaming pushed the other away, whereas had he expressed his hurt and described his feelings of rejection, he would have drawn his partner towards him.  In session, I had to continually reframe the “blaming partner’s” anger as an expression of deep insecurity and of feelings of rejection and of hurt.  As the couple was able to access their underlying feelings — fear of intimacy in one partner and fear of rejection in the other — both were able to work through their resentment.  As resentment waned, each member of the couple began to be present for the other and to gradually empathize with the other’s feelings and needs.

I once spent four years working with a patient who continually railed against the world and everyone in it.  In session, he raged constantly and complained bitterly about the stupidity and insensitivity that surrounded him.  He had very painful memories of continual childhood emotional abuse.  I encouraged him to express his anger but as I began to explore the origins of his rage, he would turn it toward me.  He wanted to express his anger but was unwilling to probe more deeply to his hurt and feelings of worthlessness.  Whatever interpretation or intervention I put forth, or no matter how much validation and empathy I provided, he just wanted to express his rage and have it heard.  But having it heard over two 2-year periods did nothing to alleviate his existential discomfort and never drew him to examine his pain.  He never got past his anger and left treatment much as he started.

While we need to let out our anger, if we don’t explore its source, it will continue to feed itself and inhibit growth and deeper understanding.  Blame inhibits understanding and repressing anger causes misdirected rage and depression.  Anger is an emotion that must be acknowledged but whose acknowledgment must also lead to understanding and empathy.

Feelings, Thoughts and Behavior

feeling and thinking picFeelings are internal emotions that have both conscious and unconscious origins. They are neither right nor wrong, good or bad, necessary or unnecessary. We have no control over how and when they present themselves. We may try vainly to suppress them.

We do, however, have control over how and when we express emotion.  Some emotions – jealousy and anger come to mind – are commonly thought of as bad or undesirable. This judging of the feelings exacerbates their painful aspects and can lead to self-recrimination.  To deal with feelings and to be able to choose when to act upon them, it’s essential to respect them and empathize with them.

I often hear patients filled with self-loathing because they judge their feelings as useless or unhealthy.  When working with such patients, I emphasize the value of allowing feelings to simply be, without judgment or editorializing whether they have a point, are unfair or invalid, or should not be felt.  As we explore how to empathize with feelings – especially unwanted ones – we learn how, when, and to whom to express them.

Because shame, embarrassment and inhibition often interfere with the expression of feelings in therapy, it’s essential that the therapist provide a safe and nonjudgmental space to facilitate the necessary freedom that allows the feelings to emerge.

I encourage my patients to discuss their darkest, most hidden and shameful feelings even though as an analyst and human being, such feelings can run counter to my passionate commitment to remain nonjudgmental.  In these situation, I separate my patients’ feelings from how they affect the patients’ behavior.  I help the patient wrestle with how these feelings developed and consequently how they affect functioning and happiness.

Most difficult for patients to express are negative feelings about me, their therapist, whom they often perceive as an authority figure.  Whether these feelings stem from a negative transference or a disagreement with an interpretation, I encourage my patients to talk about these feelings and I help them work through them, especially if they are negative.  Most typically, patients (and people in general) don’t like to express negative feelings to the person concerned because they are afraid of damaging the relationship.  By providing a safe environment and with gentle encouragement, I allow patients to discover that they can express negative feelings about me and have our relationship survive intact.  If all goes well, patients eventually learn to empathize with whatever they are feeling, be it negative or positive.

I once had a patient whom I only saw for a brief time but whose actions illuminated how acting out feelings can be less threatening than expressing them with words.  After only a handful of sessions, the patient started asking personal questions about me, his anger only rising as I set boundaries and refrained from most self-disclosure.  As his anger increased, the questions about me became more intimate and hostile.  I worked on exploring the feelings underlying his insistence, but to no avail.  Finally, in what was to be our last session, the patient became so enraged that he stood up and threw the check for the session in my face and stormed out of the office.  One can only wonder what narcissistic wounds made it easier for him to act on his rage rather than express to me the underlying feelings that motivated such intense anger.

Because people so often think of negative feelings as destructive, they often find it easier to express them through action rather than words, often unconsciously.  While I tell my patients that I want to hear everything – the bad, the good, and the ugly – such direct permission is rarely enough to break through the fear.  Only after a prolonged period, in the therapist’s safe and holding environment, do patients feel comfortable enough to bring up upsetting or threatening feelings into the therapy space.  At this point, the treatment can deepen and progress towards understanding and change.

Infidelity, Guilt and Honesty: Should I Tell?

When cheating ruptures a relationship, sexually and/or emotionally, any semblance of trust is shattered. There is a breakdown of trust, intimacy, and security accompanied by rage, guilt, dishonesty and paranoia. It takes a long time down a very difficult road to reestablish this trust.

Perhaps the most difficult question a cheating partner must ask him/herself is “Should I tell my partner?” While on the surface the answer to this dilemma may seem obvious, it is vital to asses what motivates the impulse to make this disclosure.

A cheating partner is assaulted with guilt, dishonesty and anxiety while his/her partner will feel rejected, insecure, and paranoid. Someone who seeks intimacy outside his/her relationship will immediately be confronted with the decision of whether to disclose the breech. Rationalization is almost always present: “My partner has let him/herself go” or “My partner doesn’t want to have as much sex as I do.” While such justifications may indeed represent the truth, acting out by cheating is, of course, dishonest and ethically unsound. In a monogamous relationship, cheating only exacerbates the original problems that motivated the cheating in the first place.

To keep communication open and healthy, each partner must be honest. However, I disagree with the assumption, often made, that secrets between partners constitutes dishonesty. It’s essential to respect and understand that everyone has private thoughts that they want to keep to themselves. This is not inherently dishonest. But when the essential structure of a monogamous relationship is breeched and the breech hidden, the intimacy so vial to a healthy relationship is poisoned.

To admit infidelity is to be fraught with guilt, fear, and regret. Congruent with these feelings is the desire to be honest and ethical. It’s important to explore the motivation behind admitting an infidelity and to examine what such condor will accomplish. Is such honest intended to assuage guilt? Is it to ensure that such infidelity won’t happen again? Or is it a passive-aggressive attack on the partner, designed to elicit certain feelings?

When I work with individuals struggling with this decision, I find that most want to tell their partner because “it’s the right thing to do.” On further exploration, however, it often turns out that the real reason motivating such an admission is to assuage one’s own guilt. This may help the individual who cheats but it does nothing to help the relationship. In fact, admitting infidelity under these circumstances can be fatal.

For many years I have been working with a man who has struggled with pornography and sex addiction throughout his adult life. As he acts out his addictions, he is wracked with guilt and shame. His sense of self-worth is shattered. Fortunately, as he has been in treatment with me, he has been able to address his addictions and avoid falling prey to his compulsions. During our work together, my patient has gotten married and has had a child. His wife knew nothing of his past struggle as he feared she wouldn’t understand and would feel rejected. As his treatment progressed, he was able to forgive himself for his behavior and resist his impulses; his level of shame diminished remarkably. We successfully terminated treatment after a decade.

Two years later, my patient contacted me and told me he wanted to come back into therapy. During this period he had succumbed again to his addictions and, while away on business trips, spent hours on the computer looking at pornography or in chat rooms looking for women to hook up with and had a number of brief affairs. When he returned to treatment, he was overwhelmed with shame and desperate to stop. After recommencing treatment, he did manage to stop and in the last year has had another child.

My patient and I have often explored whether he should avow his addiction to his wife. After much work, he was able to see through his shame and guilt and realize that it was best for his relationship not to disclose his addiction and past infidelities. His marriage is now strong and his family sound. We continue our work to avoid future triggers to his addiction.

I’m working with a couple who have a child and have been together many years. One partner discovered e-mails and text messages revealing that her partner had been having an affair. We continue to work together to understand what happened and to heal the broken trust.

When I see a couple for the first time, I recommend having individual sessions with each partner before our second session as a couple. When I met with the partner who was cheating, she revealed a history of another affair. While this history of infidelity was not something she wanted to admit to her partner, she was committed to working on her relationship and to reestablishing trust. I was willing to allow to keep this past from her partner as long as she honored her commitment and remained monogamous. Had I insisted she reveal all to her partner, the relationship would probably not have survived.

If a couple wants to stay together and work on their relationship, complete honesty may not always be helpful. It is often clear that sharing an infidelity can cause irrevocable damage to a relationship and that disclosing the behavior may not be in a couple’s best interests. If, however, a couple does manage to address such a rupture and build trust and honesty, admitting such lapses may strengthen the couple’s bond with a new-found intimacy based on understanding and respect.

Getting High and Sexual Intimacy

Alcohol and drugs are often used to relieve anxiety during sex. However, in addition to leading to dependency, they can also lead to psychic and physiological dysfunction. While getting high may ease the discomfort involved in “hooking up,” it can also become a prerequisite to sex and damage one’s ability to create authentic intimacy.

Even though having sex while high may create the impression of deep connection, this experience is largely illusory. Because this depth of experience is mistaken for reality, the need to be high becomes an integral part of sexual relatedness. In addition, those whose anxiety is relieved by drugs are even more likely to become addicted to being high when physically intimate.

The establishment of healthy sexual functioning is a virtual minefield. For adolescents, coupling sex with getting high can abort the normal learning process that occurs during experimentation. Getting high then becomes a prerequisite for sex early in life.

Many substances heighten sensation and create a sense of the profound. This heightened physical and psychic experience leads to an intensity that is, of course, purely chemical. While alcohol may cause a dulling effect and even lead to blackouts in which memory becomes blocked, other substances create a false sense of connection. When two people have taken substances that blunt anxiety around sex, we have a couple coming together in a hazy and unreal way. Some substances even create the sense of intimacy while actually blocking one’s ability to relate to another person. When the substance is removed, one’s partner may suddenly seem like a stranger or become, all at once, dull and boring. The end result is that sex without substances may seem uninspiring at best.

I worked with a gay man who was addicted to crystal meth. He claimed that the drug allowed him to feel uninhibited around and during sex. We worked on the addiction and my patient started going to 12-step Narcotics Anonymous meetings. Because of our work and the support of the program, he was able to stay clean and get his life together. Being able to relate sexually with others, however, was proving to be a more difficult endeavor. Because he had used meth for his whole adult life—he was now near 40—the prospect of having sex without being high was unimaginable. Because of his frustration, he avoided sex, never having learned how to relate sexually while sober. Eventually over time he began to engage sexually, while being clean, and entered into a long-term relationship. It had been a difficult road.

By no means is this phenomenon limited to crystal meth; I had an almost identical problem with someone who used marijuana.

Many people go to bars to look for a date or to hook up for sex. This, of course, leads often to drinking. While alcohol indeed reduces anxiety, it can impede relating in a realistic way. I’ve often been told tales of people hooking up in bars only to realize in the morning that they brought someone home whom they can barely relate to or to whom they’re not even attracted. And while the result of such experiences is typically embarrassment and regret, these are rarely enough incentive to stop the behavior.

Sex is most meaningful and intimacy most real when the mind is sharpest. When sexually stimulated by another human being, and not a chemical, authentic intimacy can flower and profound connection can be established. Instead of a chemically induced fantasy, the groundwork is laid down for genuine relatedness.

Sex and Medication

Medications provide enormous relief from acute or chronic pain, dysthymia and depression. When physical or psychic pain interrupts optimal functioning, opiates and anti-depressants can relieve suffering and help debilitated people lead normal lives. But even when taken as directed to address pain, side effects from these medications can cause serious sexual dysfunction. In addition, opiates are rife with the danger of addiction and abuse.

Many people taking these medications end up choosing between relief from pain and an active sex life. When those taking medication are in a relationship, both partners can contribute to the decline of physical intimacy.

Medications can cause lust to dissipate and sex drive to plummet. For men, failing to achieve or maintain an erection can cause frustration and leave the partner feeling rejected. Healthy communication can alleviate some of the discomfort, but because sexual issues within a couple are so difficult to talk about, communication easily breaks down, leaving each partner in the couple isolated and distressed. If this issue festers long enough, a couple’s sexual dysfunction becomes the norm such that even after discontinuing medication, sexual dysfunction can be very difficult to reverse. Both partners must be willing to risk discomfort talking about sexual issues and establish open dialogue to repair what has been lost.

Since discontinuing needed pain medication is not a beneficial option — pain itself inhibits sexual performance – couples must learn to override a lack of lustful feelings with sensitivity and empathy. If one partner is experiencing feelings of rejection because of the other partner’s lack of interest in sex, it’s helpful for both partners to establish an open dialogue. Such a dialogue permits the couple to distinguish between drug-induced rejection and rejection that might arise from other causes. Above all, it’s important to remember that pressure inhibits sexual feelings. By expressing hurt and rejection, caused by insecurity, one partner can exacerbate the problem by pressuring the other to continually reassure sexual interest and attraction.

Penetrating the wall of drug-induced frigidity takes diligence and work. Sensitive touch and physical openness without pressure to perform can help the medication-taking partner relax and enjoy non-genital physical intimacy for its own sake. Relaxation can open up sexual intimacy and break through a partner’s medication-induced disinterest in sex.

I worked with a couple who for many years had a healthy sex life. However, when the husband was put on Oxycontin, a time-released opiate, for chronic pain, their sex life broke down. The medication managed the pain so the husband could function normally but it left him with no interest in sex. Because Oxycontin was by far the most effective medication for his pain, he became resigned about his disinterest with sex and his wife felt shut out and undesirable. While the couple was able to address and work through most of the problems in their relationship, when it came to sex, the issue was fraught with discomfort. Instead of being able to talk through the problem, the wife would try and seduce her husband or ask for sex, only to be rejected. This left the wife feeling hurt and isolated. Both were aware of their loss of physical intimacy but were not able to help each other reestablish a physical connection. Finally, through suggestion and exploration, I helped the couple establish a reawakening of their physical intimacy. Beginning with non-sexual touch, without sexual pressure, and slowly adding sensuality, the couple learned new ways to be physically intimate. The slow progression took the sting out of hurt feelings and helped the couple communicate physically without needing to have lust drive the physical encounter. Both the husband and wife were able to relax around this issue and build a satisfying sex life. It was not the same sex life as before, when it was driven by lust, but one equally rich, deep and connected.

Our society teaches us that sex is driven by lust; if people are attracted to each other, sex is unproblematic and easy. If and when sexual problems arise, people rush to the conclusion that the relationship is dysfunctional and needs to be reassessed. Any sexual problem in a relationship needs to be addressed with compassion and empathy. When medication is deemed appropriate for physical or psychic pain, the solution should not be a choice between pain and sex. When a couple learns to incorporate changes within their sexual relationship, there comes about a new and satisfying sexual intimacy.