Couples Therapy that Goes Deeper than Dirty Dishes Ari Tuckman, PsyD, MBA West Chester, PA [email protected] adultADHDbook.com A good relationship pushes you to become a better person Deeper Couples Therapy 2 ADHD Inconsistency Impacts Relationships . ADHD, especially unmanaged, can impact: . One’s ability to be the partner one wants to be . A partner’s ability to be the partner they want to be . Every couple needs to negotiate different desires and ways of doing things . ADHD exacerbates these universal struggles Deeper Couples Therapy 3 ADHD Unreliability Impacts Security . We hope for reliable actions from our partner in order to trust what they say . And from ourselves. ADHD inconsistency makes it harder for: . ADHD partner to feel effective . Non-ADHD partner to feel secure . The easy trap . ADHD becomes the scapegoat for the non-ADHD partner’s anxiety Deeper Couples Therapy 4 It Takes Two To Tango Deeper Couples Therapy 5 The Classic Dynamic . It’s easy to fall into the stereotypical dynamic of the under- and over-functioner . Will all the accompanying anger, nagging, avoidance, and general frustration . Casualties mount on the battlefield of daily demands . ADHD is an obvious contributor, but the other partner is still half of the relationship Deeper Couples Therapy 6 It’s a Trap . Nobody is winning when stuck in this chase dynamic . And doing more of the same won’t tip the balance . Nobody is bringing their best to the relationship . And we can’t expect our partners to behave better than we do . Medication and good systems can help a lot . But won’t resolve the deeper dynamics that all couples must address . ADHD puts more pressure on partners to be diligent Deeper Couples Therapy 7 Preferences vs. Limits . We all have preferences based on our personality and experience . These are not factual, no matter how moralistic we get about them . We can choose to be flexible about both the means and the ends . Limits are preferences that we cannot flex on without selling out our integrity . Which would inevitably spill out somewhere else . We choose to hold these lines Deeper Couples Therapy 8 Find the Balance . Two easy slides . Too much rounds down to what the ADHD partner would do . Too much rounds up to what the non-ADHD partner would do . Clients may ask you to decide what is reasonable . Therapists can have an opinion (sometimes), but not a vote . Inform clients’ choices . How ADHD might impact their agreements . How the couple’s dynamic plays out Deeper Couples Therapy 9 You Gotta Choose . We don’t get everything we want, so we have to be clear about what preferences are most important to us . And therefore which ones we can more easily let go . A truly negotiated agreement is more fulfilling for both . Helps clients clarify what is most important to them—and therefore also least Deeper Couples Therapy 10 Vulnerability on Both Sides . There is vulnerability in all of this . To put your real request (and deeper reasons) out there, since you may be judged or denied . To try your best to please your partner, since you may fall short . To maintain good feelings for each other even when frustrated . To admit one’s own part in problems . To be optimistic that progress will be sustained, since it may not be . To accept what won’t change . Dig below the surface of what is most obvious Deeper Couples Therapy 11 Right or Happy? . Two parallel truths . You can’t have something done by someone else and also done your way . You can’t have something done by someone else and also have them be happy about it . What’s more important to you—and what price are you willing to pay for it? . Help clients to actively think this through Deeper Couples Therapy 12 With Knowledge Comes Responsibility . Understanding ADHD’s many impacts on daily functioning can help couples create better systems and expectations . This carries the responsibility to use that information well . For both partners . Drop the shoulds, morality, and comparisons and focus on what will meet your needs Deeper Couples Therapy 13 A Friendly Reminder . Given ADHD’s executive function challenges and partners’ different preferences, reminders/structure may be necessary to maintain agreements . But need to be both given and taken respectfully . Don’t let resentment build so reminders are given angrily . And then don’t forget to show some appreciation . Don’t cop out so you feel defensive . Make an active choice to do it because you agreed to Deeper Couples Therapy 14 Emotional Regulation . ADHD can involve emotional impulsivity—by both partners . The non-ADHD partner needs to take responsibility by speaking before the emotions are overwhelming . And not taking ADHD personally . ADHD partner needs to manage emotions and take requests well . Positive interactions now can vindicate past failures Deeper Couples Therapy 15 The Superficial Goes Deeper . Addressing practical matters of daily life reduces stress and improves emotional regulation—for both partners . Medication creates better symptom control and emotion regulation . Coaching and organizing create better systems . Therapy creates a stronger mindset, addresses comorbidities, and helps partners work better together . This makes it easier to do the deeper work Deeper Couples Therapy 16 Go Deeper Deeper Couples Therapy 17 The Choice to Change or Accept We don’t get everything we want So we need to accept sometimes not getting our way But if we get too little, the relationship is unsatisfying So we need to fight for what we want It’s a judgment call—and an active choice Is it too important to let go? Is it not worth the fight, at least right now? Agency matters—and the client is the one who decides Deeper Couples Therapy 18 How to Dodge a Difficult Conversation Couples have lots of ways to avoid growth-promoting honesty: Choosing to not learn about ADHD Guilting/shaming/moralizing ADHD or anxiety Letting anger rule the day Shutting down, ending the conversation Creating vague, unenforceable agreements Unilateral decisions And each evokes the others, so we need to address these Deeper Couples Therapy 19 False Agreements Guarantee Trouble . Agreeing to something without thinking it through . Take the necessary time to think through a sustainable solution . Agreeing to something you know you won’t/can’t maintain or be happy with . Speak honestly and accept discomfort in the moment . Forcing an agreement . Calm your frustration, perhaps explore more, and wait for a sustainable solution Deeper Couples Therapy 20 Better Agreements . Sustainable agreements require: . Understanding ADHD’s impact on the individual and dynamic . Self-knowledge of one’s abilities and preferences . Knowledge of partner’s abilities and preferences . Emotional self-regulation—in the discussion and implementation . Willingness to be honest with oneself and partner . Willingness to recognize intentions, effort, and progress . Integrity to be accountable to self and partner . Lots of therapeutic intervention points. Deeper Couples Therapy 21 We Are Responsible for Our Own Happiness ADHD can create feelings of powerlessness If a client is unhappy about the situation, what can they do to shift it? What choices are they making that contribute to that unhappiness? Where are they stubbornly persisting? Bring the discussion back to their decision about changing or accepting And what each would take Deeper Couples Therapy 22 Integrity Matters Most . Tit for tat is a dead end . Ultimately, we are responsible to our own conscience and sense of who we want to be . This takes partner’s feelings into account, but goes beyond it . The challenge in the heat of the moment is to keep this image of our better self clearly in mind . And then requires emotional self-regulation to hold it in mind Deeper Couples Therapy 23 It’s All About Differentiation Deeper Couples Therapy 24 Differentiation: I’m Me, You’re You . Two related facets: . Self-awareness: Ability to identify and take responsibility for one’s thoughts, emotions and actions . Other-awareness: Ability to identify another’s emotions and perspective but make a choice about how it affects one’s own . Intimate relationships challenge our assumptions and dodges and (hopefully) drive differentiation Deeper Couples Therapy 25 Between the Hammer and the Anvil High barriers to exit drive growth by creating a dilemma Ending the relationship is too difficult Staying in the status quo is also too difficult Therefore, happiness requires one of two possible third options: Find a way to tolerate leaving Find a way to make it worth staying This is how relationships push us to become a better person Deeper Couples Therapy 26 This is the Process Intense disagreement can be overwhelming And cause doubt about oneself, one’s partner, and the relationship Remind clients that these are normal and expectable growing pains It’s suffering, but for a purpose Might improve the relationship Might clarify that the relationship isn’t going to work Deeper Couples Therapy 27 Good Behavior Requires Good Behavior At least one partner needs to keep their head on in those heated moments We can change our partner’s behavior by changing our own Defend one’s own truth Nondefensive: By standing strong in the face of partner’s bad behavior and setting limits as necessary Tolerating a partner’s truth Nonoffensive: By managing one’s own behavior and giving partner room to express themselves Deeper Couples Therapy 28 It’s OK to Not Be OK . Sometimes we have to tolerate our partner not being OK . ADHD partner’s self-inflicted problems . Non-ADHD partner’s anxiety-driven need for certainty . Sometimes being caring means holding steady while our partner figures out what they need to do .