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.

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.

Love and Substance Use

Drugs and alcohol provide an illusion, an illusion that ranges from love to despair. Many substances evoke both positive and negative feelings, euphoria and anxiety, side by side, with the negative emotions typically following the positive. This affects the user’s emotions and perception of reality, and subsequently the stability and wellbeing of a couple.

The affect of drugs and alcohol on a couple will vary with the frequency, the social context, the kind of dependence and the kind of substance. A relationship is also affected by whether one or both partners partake. When feelings experienced while “high” are confused with “real” feelings, serious ruptures and rampant misunderstandings are likely to adversely affect healthy romantic interactions. While this phenomenon can occur in any kind of relationship, the intimacy of romantic relationships exacerbates this dysfunction.

Keep in mind there is a difference between use and abuse. When individuals choose to put a substance into their body, they aren’t necessarily affecting their relationships or their ability to function. However, addictive use and, at times, periodic recreational use, may cause a serious rupture within a couple. This may be followed by recrimination, dishonesty, misunderstanding, and a breakdown of empathy.

Many substances foster feelings of omnipotence that lead to narcissistic behavior. This clouds empathy and sensitivity and makes it easy to disregard others’ feelings and needs. When feelings of euphoria are prominent, one can seem to be highly empathic to others when, in fact, the feelings are originating from the user’s own narcissistic needs. Although being high may seem to heighten connection between people, it ultimately separates people in a haze of unreality. This can be most acute and damaging within a couple – particularly when such feelings and behavior exacerbate dysfunctional communication already problematic in the relationship.

I am working with a gay male couple who have been together for 6 years. The partners have different cultural histories which causes some friction in the relationship. They both use drugs and alcohol recreationally, mostly when going out together to socialize. When they are home alone together, they claim to be content and argue little. They do, however, have issues of trust and when they go out and take club drugs, the trust issues explode and feelings of insecurity, paranoia, and heightened sexuality come to the forefront, exacerbating the milder mistrust that already exists. While this couple uses drugs relatively infrequently (they say 5 times a year), they will binge for days at a time, leaving them rife with drug-induced depression. This occasional drug use has caused havoc in the relationship and has led the couple to seek treatment. Most of my work has involved separating the issues caused by the substance use from those occurring in the couple’s everyday lives. It is not an easy task since the conflict provoked by the drug use bleeds so easily into the pre-existent mistrust.

Another couple I worked with had been together over two decades. They had a loving healthy relationship and had come into treatment, not because there were major problems, but rather to keep and maintain open lines of communication. They both enjoyed a nightly glass of wine before dinner. One of the partners started drinking a strong margarita instead of wine during their pre-dinner ritual. While a glass of wine didn’t affect either’s ability to relate, the margarita drinker became very high and lost his ability to communicate in any realistic way. Because of this, his partner felt shut out and asked that his partner refrain from drinking hard liquor at those times and go back to a glass of wine. Because both in the relationship were sensitive to each others’ needs, and listened to and respected each other, the margarita drinker, not wanting his inebriation to cause conflict in the relationship, went back to wine. If the couple hadn’t already had good communication skills, the drinking could have created a major rupture.

Substance use often creates volatility and unpredictability in couple relationships. Unless monitored with honesty, understanding, and open communication, drugs and alcohol can cause serious ruptures between partners. Left unaddressed, these ruptures can develop into a breakdown of the relationship. Unreality and erratic mood overtake any ability for healthy communication.

My Analytic Dilemma

While analytic training emphasizes the need for caution when interpreting or intervening, certain conditions require or at least strongly suggest, immediate intervention.

Few issues stir up more emotion than those revolving around HIV/AIDS.  While the face of the disease has changed radically in the U.S., sero-conversion to HIV+ is not as rare as it should be.  While my own views are no doubt colored by 3 decades of working with people with HIV/AIDS, I can be particularly blunt when confronted with a patient who is practicing unsafe sex.

Even though I always express thoughts with care and concern, my directness runs countercurrent to much of what I’ve been taught — that the expression of opinion should be kept out of the treatment.  However, when dealing with HIV and AIDS, my concern for my patients’ physical wellbeing trumps my training.

An HIV+ patient was frequenting sex clubs and not always practicing safe sex.  He justified this by assuming everyone else who didn’t practice safe sex was HIV+ or didn’t care.  When I probed a little deeper, it became clear that he mostly feared stigma and rejection.  My patient claimed that it was the equal responsibility of the other person to inquire about or divulge HIV status.  He stated that his partners bear the ultimate responsibility for their own actions.  After continuing to press the subject, I let go of my reservations and made clear the importance of self-disclosure for keeping both my patient safe from further infection and any of his partners safe.  Clearly this was my own agenda, not my patient’s, and trumped any of my analytic training.

 Another patient, who for many years had been desperately seeking a romantic relationship, was finally falling in love with a man with similar feelings.  My patient also periodically went though strong hypocondrical fears around minor health issues.  Two months into the relationship, my patient and his new boyfriend went to get tested for HIV.  Delighted when the tests both came back negative, my patient made it clear upon inquiry that they were now going to have unprotected sex.  After exploring the issue in session, I asked my patient if I could give my thoughts on the subject.  He readily agreed.  I expressed my concern that after two months of dating he barely knew his new boyfriend and was making a potentially devastating decision of trust extremely early in the relationship.  He listened attentively and showed appreciation, but at the same time pointed out that my point of view was colored by my own experiences with AIDS during the ‘80s and 90s.  Despite my feeling strongly that my history was not relevant to my concern, I refrained from pressing the issue.

Some therapists might view such patient behavior in an even more dismal light, and equate it with inflicting inward or outward violence.  While this is a common attitude, the issues involved are much more nuanced and complicated and while I’m certain that my interventions were appropriate, I must remain vigilante in avoiding the simple expression of opinion instead of vital and necessary intervention.

Men, Sex, and Society

Generally, men and women relate to sex differently. Men tend to think of sex in external ways, women in internal ways. This difference leads men and women to approach sex in a manner that can lead to misunderstanding and conflict.

Because men tend to think of sex in physical terms, initial attraction is based on physical appearance. Men’s lust is aroused visually; emotional intimacy and connection are not the primary motivations. In fact, because visual arousal is so immediate and two-dimensional for men, most pornography is made for and by men. An addition consequence is that men are far more likely to become addicted to porn and sex than are women.

As discussed in my last post “Gay Men, Sexual Addiction, & Society”, the lack of socialization for gay children and adolescents contributes greatly to how gay men learn to relate to each other. In addition to society’s role in the development of gay male sexuality, gay men, like heterosexual men, are first motivated by sexual arousal in their search for romantic partners. Because both partners are men, sex plays a different role in homosexual mating than it does for heterosexuals.

There are many theories about what contributes to the male’s sexual habits. As we’ve seen before, socialization is one factor that plays a significant role in sexual development. It is more difficult to assess how much gender informs male sexuality. Clearly, when coupling involves two men, sexual expression is going to be different than between men and women.

Society has judged harshly the sexual habits of gay men and has relied on prejudice and stereotyping to make unfair comparisons to the mating habits of heterosexuals. Comparing heterosexual and homosexual sex disregards the impact of gender and ignores the fact that two gay men are both males. Many heterosexual men claim that their sexual behavior would be similar to that of gay men if women themselves responded sexually like they did. But women’s sexuality is different such that this isn’t an option. Here we can see the impact that gender plays on how men experience and act on arousal. While gay sex is greatly influenced by societal factors, the simple fact that both partners are male also contributes to the way gay men function sexually.

Because the mating of gay men involves partners that are both male, they’re going to approach sex differently than mating between men and women. Understanding the role gender plays in sexuality will enable society to empathize rather than criticize gay male sexual habits.