367: Treating Troubled Couples, with Thai-An Truong

TEAM for Troubled Couples A New Twist!

Today we are joined by a favorite guest, the brilliant Thai-An Truong. Thai-An is a Licensed Professional Counselor (LPC) and Alcohol and Drug Counselor (LADC). She is the first Certified TEAM-CBT Therapist and Trainer in Oklahoma. She has found TEAM-CBT to be life-changing professionally and personally and is passionate about training other therapists in this "awesome approach."

In her private practice, Thai-An specializes in the treatment of trauma and OCD. To learn more about her TEAM-CBT Trainings, visit www.teamcbttraining.com

Thai-An has been featured on many Feeling Good Podcasts focusing on

• Depression and social anxiety (Live demonstration, 187)
• Postpartum Depression and Anxiety ( 218)
• How to Get Laid (Ep. 264)
• OCD ( 283)
• Grief (Ep 344)

Now Thai-An adds an important dimension to the TEAM Interpersonal Model—working with trouble couples, as opposed to working with individuals with troubled relationships. She also describes a new way to use Positive Reframing to reduce patient resistance to giving up David's famous list of "Common Communication Errors," and she adds five new errors to the list.

At the start of the podcast, Thai-An described a woman who complained that her husband often "shuts down" when they are communicating about a sensitive topic, and she wondered why. Thai-An decided to invite him to join the session so his wife could find out why.

This really opened things up, and the wife discovered that her husband shut down because he was feeling inadequate when she pointed out all the things that were wrong with the house, and he was taking her comments as criticism. However, the more he shut down, the more she complained, and this pushed him away even further since her criticisms intensified his feelings of inadequacy.

Thai-An then used Positive Reframing to help her see why he shut down.

One of Thai-An's new ideas was to use Positive Reframing to cast our list of "errors" on the "Bad Communication Checklist" in a positive light, just as we do with the negative thoughts and feelings of people who are using the Daily Mood Log. By siding with the patient's resistance and listing all the good reasons NOT to change, nearly all patients paradoxically let down their guard and powerful urges to oppose change. Instead, they open up and become receptive to the many methods for challenging distorted thoughts.

Thai-An has observed the same phenomena with troubled couples. When they see the GOOD reasons to why they or their partners use dysfunctional ways of communicating, they paradoxically let down their guard and become more willing to use the Five Secrets of Effective Communication.

She says:

Positive reframing started to open them up to each other, and helped them see each other in a more positive light. At the same time, they discovered that they shared the same values.

Voicing the good reasons to maintain the communication errors as well as the cost of change (e.g., it'll be hard work, I'll have to focus on changing myself, it'll be vulnerable) allowed each partner to melt away their resistance to change.

David comment: This is an excellent example of a "double paradox." Once again, instead of trying to "help," which often triggers intense resistance, the therapist sides with the resistance, and this paradoxically triggers strong motivation to change!

Thai-An reminded us that it's important to go through the TEAM structure before moving forward with tools to help the couple change. For testing, she asks both partners to complete the version of David's Brief Mood Survey that includes the Relationship Satisfaction Scale, and asks both to complete the Evaluation of Therapy Session at the end. She makes sure both partners rate her empathy toward them at 20/20 (perfect scores) before proceeding to the next steps.

During the Assessment of Resistance, she begins to work with David's Relationship Journal to get a specific moment in time of conflict. Then when they do Steps 3 and 4, where they identify their own communication errors and their impact on their partners, she does positive reframing of the bad communication errors, which you can see here, along with five new errors that Thai-An has listed below.

The Bad Communication Checklist*

Instructions. Review what you wrote down in Step 2 of the Relationship Journal. How many of the following communication errors can you spot? Communication Error (ü) Communication Error (ü) 1. Truth – You insist you're "right" and the other person is "wrong." 10. Diversion – You change the subject or list past grievances. 2. Blame – You imply the problem is the other person's fault. 11. Self-Blame – You act as if you're awful and terrible. 3. Defensiveness – You argue and refuse to admit any imperfection. 12. Hopelessness – You claim you've tried everything and nothing works. 4. Martyrdom – You imply that you're an innocent victim. 13. Demandingness – You complain when people aren't as you expect. 5. Put-Down – You imply that the other person is a loser. 14. Denial – You imply that you don't feel angry, sad or upset when you do. 6. Labeling – You call the other person "a jerk," "a loser," or worse. 15. Helping – Instead of listening, you give advice or "help." 7. Sarcasm – Your tone of voice is belittling or patronizing. 16. Problem Solving – You try to solve the problem and ignore feelings. 8. Counterattack – You respond to criticism with criticism. 17. Mind-Reading – You expect others to know how you feel without telling them. 9. Scapegoating – You imply the other person is defective or has a problem. 18. Passive-Aggression – You say nothing, pout or slam doors.

* Copyright ã 1991 by David D. Burns, MD. Revised 2001.

Thai-An Truong's 5 Additional Communication Errors:

1. Shut down—You shut down and ignore the other person or give them the silent treatment.
2. Avoidance—You hide your feelings and avoid talking about hard topics, or disconnect through some form of escape.
3. Rejection—You make threats to leave – "I'm done with you," or "I can't deal with this anymore," or "I want a divorce."
4. Control—You insist that the other person "needs" to behave or communicate differently, or "should" or "shouldn't" behave the way they do.
5. Invalidation—You tell the other person they shouldn't feel the way they feel.

Here's how Thai-An did the Positive Reframing with this couple. First she asked the wife, "Why might your partner suddenly want to "shut down" and stop communicating during a conflicted exchange?" She also asked, "What does this do for the person who is shutting down?"

This is the list of positives they came up with. Shutting down . . .

1. Keeps me safe and protects me from more criticism
2. Protects my partner from hurtful comments I might make.
3. Shows that I value our marriage and my partner's feelings.
4. Shows my love for my partner, and for myself.
5. It shows that I'm feeling hurt and want to be appreciated.
6. Guarantees that I won't make things worse.
7. Shows that I want to protect myself from becoming overly vulnerable and getting invalidated again.
8. Shutting down feels less risky than sharing my feelings.

Once she saw why he shut down, she realized the negative impact of her complaints, and began to provide more genuine words of appreciation to him. He said that this meant so much to him and made all the hard work worth it.

Her common communication errors included "truth" and "making complaints." He realized, again through positive reframing, that she also wanted validation, that raising children can be hard, and that she ALSO wanted appreciation for how well she was keeping up with the home and the care of their children.

So, when she wasn't getting validation and appreciation from him, she was even more likely to complain to try to voice her perspective. Once he was able to stop shutting down, and instead began to make more disarming statements, use feeling empathy, and stroking, she was much less likely to complain. They also realized they had the same values of wanting healthier communication and to provide a safe and happy home for their children.

Was this effective? Both went from 10/30 and 11/30 on the relationship satisfaction scale (shockingly poor scores) to 26/30 by the end of the relationship work together (extremely high scores indicating outstanding scores on my Relationship Satisfaction Scale.)

Thai-An provided us with a cool Positive Reframing document for all of the communication errors. You can check it out if you CLICK HERE.

I (David) pointed out that Positive Reframing can also be used in conjunction with the Relationship Journal in another way. In step one of the RJ, you write down one thing the other person said, and you circle all the many feelings they were probably having, like hurt, alone, anxious, angry, sad, unloved, and many more. In step two you write down exactly what you said next, and circle all the feelings you were having.

This would be an ideal time to do Positive Reframing of your partner's negative feelings, so as to shift you perception that the other person is "bad" or "to blame" or some negative interpretations that you may be making. This reframing might be helpful in the same sense that my technique, Forced Empathy, can sometimes cause a radical shift in how you see the person you're at odds with.

Announcements

On January 4, 2024, Thai-An Truong will be offering a 14-week training program in TEAM couples therapy for mental health professionals. The class will meet weekly from 11:30 to 1:30 East Coast time. To learn more, please go to Courses.teamcbttraining.com/relationships

There will be a 4-day TEAM-CBT Intensive November 6-9, 2023, in Mexico City, at the Hotel Camino Real. To learn more, please go to: https://teamcbt.mx/welcome

Thanks for listening today! Let us know what you thought about our show!

Thai-An, Rhonda, and David