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Scott Webb: Human beings are social species by design. We know that healthy relationships are so crucial to mental health and wellbeing, and yet in the United States, approximately 50% of marriages end in divorce. Today, we're going to discuss one therapeutic approach to increasing relationship success, integrative behavioral couples therapy.

And joining me today for this conversation is Dr. Anna McCarthy. She's the Chief of Clinical Innovation for the Sierra Tucson group. This is Let's Talk: Mind, Body, Spirit by Sierra Tucson. Sierra Tucson ranked number one Best Addiction Treatment Centers 2020 in Arizona by Newsweek. I'm Scott Webb.

So Dr. McCarthy, thanks so much for your time today. As Chief Of Clinical innovation for the Sierra Tucson Group, what makes relationship distress a compelling topic for you?

Dr. Anna McCarthy: I think it's such an important area to address because we know in research that when our clients are struggling with mental health issues and their family support system is healthy, they recover more quickly. And conversely, when the family support system is dysfunctional, toxic, abusive, not surprisingly, their mental health issues are exacerbated.

We've actually had this research data since the study was done with Vietnam veterans, who had high rates of PTSD. And as I said, when the family system was healthy, they recovered much more quickly from episodes of post-traumatic stress disorder.

Scott Webb: That's really interesting. And I've done some work with Sierra Tucson, talked about Vietnam vets and PTSD, so interesting to make those connections now. So what are the four areas of a relationship that IBCT assesses and focuses on?

Dr. Anna McCarthy: Yeah. So I'll back up a little bit. IBCT stands for integrative behavioral couples therapy. It's quite a mouthful. It was developed by Neil Jacobson and Andrew Andrew Christensen. Neil Jacobson, unfortunately, is deceased. Andrew Christensen is still at UCLA in Los Angeles and they developed this as what we call an empirically supported treatment to help relationship distress. They focused on couples, but actually their methodology can be used with families, with parents and children, with work colleagues. This is really actually just a very good treatment to help with relationship distress. And they looked at four areas of functioning between couples and said basically they're quite predictive of relationship success or distress.

The four areas are differences. So if you think about relationships, we probably start a relationship because we're attracted to similarities and then differences become apparent. And often by the time I'm seeing couples, those differences have been turned into deficits or they're diagnosing each other with things, like, you know, "He's a slob" and "She's a neat freak." So differences are really important category.

We also look at external stressors. So anything external to the couple that are creating distresses between the couple. So this could be, you know, extended family. It could be difficulty with the neighborhood. It could be parenting issues, financial distress, work distress, anything that's impacting the couple.

Then the other area we look at is something they called emotional sensitivities. So I like to think of this as sort of the baggage that we drag into our current relationship. What did we experience with our primary caregivers growing up in childhood? What have we learned from previous relationships? What are the baggage, is the luggage that we drag into our relationship that's creating distress in our current relationship? So for example, somebody who perhaps suffered a lot of abandonment and neglect in childhood might be very sensitized to any perceived neglect in their current relationship.

And then, the last area is something that we call problematic patterns of communication. So not surprisingly, how are we communicating differences with our partner? And if we're doing it in a dysfunctional way, we're likely to have relationship distress.

Scott Webb: Yeah, this is really interesting. And hearing you speak gives me an opportunity. I'm thinking about my relationship with my wife and what are our similarities and our differences and deficits and so on. And thinking about the baggage, those sorts of heavy weights we carry through life. So, a fascinating topic. And maybe you can explain in a little greater detail how the differences between a couple may impact the quality of our relationships.

Dr. Anna McCarthy: Yeah, absolutely. And so I always ask my clients, you know, what are the differences that are causing you distress? Because not every difference is distressing. But some of the key topics that I see coming up repeatedly are things like when one partner is an introvert and the other partner is an extrovert, that can cause distress. You know, the person that wants to stay at home versus the person who gets really energized and recharged by being the life and the soul of the party.

So finances are another area of contention for couples. So often, we see one partner likes to save and plan very carefully. The other partner spends quite freely. That can be a source of distress. There're also sources of distress that come from differences in sex drive, for example, or sexual needs. Distress that can come from differences in parenting style. So there can be a number of variables that creep in that initially weren't really impactful, but they can develop into differences that really are causing distress and causing partners to start diagnosing each other as, you know, defective in some way or the other.

Scott Webb: So interesting the way you put that, the diagnosing each other. My wife and I definitely do that as I'm sure many couples do. And you know, you think about the differences, like I love to talk into microphones, I love to talk to you, doctor. And my wife would never do this in a million years, you know? So yeah, there are those differences that are sort of not a big deal. And then there are those things that are bigger deals and we begin diagnosing each other. And maybe you can go into some more detail about that term, emotional sensitivities. What does that mean?

Dr. Anna McCarthy: Yeah. So again, this was a term that was captured by Andrew Christensen and Neil Jacobson. And it really is talking about sort of the emotional baggage, the trigger points, the vulnerabilities that we bring into our current relationship. I actually think this is probably the most critical part of any relationship distress is figuring out what these emotional sensitivities are and making people aware of them.

So A, they can soothe themselves when they're feeling triggered and, B, their partner can recognize why somebody is having a strong, emotional reaction to something in the here and now that seems fairly meaningless. So I'll give you an example. I have a couple that I'm working with. Again, her history really is being pretty neglected and abandoned by her mother and father growing up. And so things that would activate that in the here and now would be, for example, her husband wanting to go to the gym or leave and go and see friends, and have a social event that didn't include her or even sort of wanting to take time just to hang out in his man-cave. And so she would get very distressed and he'd sort of say, "Well, what? I don't get it. I just want to go and have dinner with my best friends. I don't understand why this is creating such a big emotional reaction." And then, until we talked about her emotional sensitivities, he really didn't have a framework to make sense of her behavior. Once we understood that there was this vulnerability for her, then again, we can work on strategies to help her soothe that pain, to recognize that the events in the here and now are not as big as the events in the past when she was so dependent on her mom and her dad and she wasn't getting her needs met. And also for him to be mindful of how he delivers news in the here and now, that it's not triggering that emotional sensitivity.

So I often give people the visual of, "Look, if you fell over and you had a cut on your knee, that's your emotional sensitivity." And sometimes your partner can come along and just drop some drops of vinegar into that cut, not purposefully, but just because. And when you scream, "Ouch, that really hurts," your partner says, "What on earth is going on?" And it's not until they understand that your knee is cut and then what they did was like a drop of vinegar, that they can really make sense of your pain.

So again, I see this as one of the most useful things in IBCT, is helping people understand the baggage that they bring into their current relationship and figuring out ways to soothe that wound, because nobody wants to be a source of pain for their partner. And simultaneously, there are very benign things that happen in the here and now that can set off a lot of pain and we need to be able to soothe ourselves and recognize our partner is not out to hurt us or get us, you know?

Scott Webb: Absolutely. Yeah, none of us wants to be the vinegar, you know, metaphorically, of course. And you've talked a little bit about PTSD and certainly we've covered this with Sierra Tucson, just trauma in general. And you've mentioned here about that baggage, you know, that we all bring along with us through life, through our relationships. So really fascinating, and I'm sure there's a lot of external stressors right now, whether it's COVID or politics or whatever it might be. So what are some of the biggest external stressors that couples are facing?

Dr. Anna McCarthy: I think you've just hit the nail on the head. I mean, obviously, this pandemic and early on all the social distancing mandates that were so helpful in stopping the transmission of disease. We're actually, you know, a mental health disaster. We're a social species, we need social support and, all of a sudden, we couldn't get any of it outside of our home. It also burdened couples with children who suddenly couldn't go to school. And you can't have childcare providers taking care of your children because, you know, your local program shut down because of social distancing. People who would go off to work were suddenly hold up at home 24/7 with their spouse and their kids. So there are all sorts of ways that the pandemic has really played into relationship distress.

But additionally to that, there was the fallout with economic distress. So small businesses shutting down, people losing sources of income, suddenly having economic instability, threats to losing their home because they didn't have the normal revenue coming in. And then I think layered upon that were all the social injustices that we suddenly started to see with people being shot and killed going out for their morning run or being killed in their own home, and the racial tensions and all of that stuff being played out in front of our eyes.

So just, I think the last couple of years, we've had enormous stressors that we haven't had to deal with before and they can take their toll on a human being. When one human being is out of balance, again, it's very easy for that loving partner to also get out of balance pretty quickly.

Scott Webb: Yeah. I mean, it's just not easy being a human, right? It's not easy being a person. Between all the internal stuff and baggage and the external stressors, it's not easy. And thankfully, we have, you know, compassionate professionals like yourself to help us work our way through this because, as you've said today, we tend to self-diagnose and it's usually not in a nice way. So this has been really educational, really helpful. As we wrap up here, doctor, can you give our audience some guidance on how to practice effective communication skills? And I'm going to be taking notes here for myself. Thank you.

Dr. Anna McCarthy: We can all take notes because we really aren't raised being taught effective communication skills. And actually at the end of the day, you know, the differences we have with our partner, we have choices. We either accept them or we change them. The external stressors, we have to be able to talk about them effectively. Those emotional sensitivities, you know, the wound and the vinegar on the wound, we'll have to be able to communicate about them. So this stuff is so important. And again, most of us were not brought up being taught effective communication skills. Most of the time, we were told by our parents, you know, "Why should you do what I'm asking you to do? Because I said so. Because I'm your parent. Because you're the kid."

Scott Webb: Do as I say, not as I do.

Dr. Anna McCarthy: Exactly. So some quick strategies that people can use, one of the things that IBC talks about is what we call empathetic joining. What does that mean? That means we'll have to have the capacity to listen to our partner's perspective, whether we believe one word of it or not, whether we relate to one word of it or not.

I often tell couples, "You're behaving like you are opposing counsel in a lawsuit, and we need to drop that stance and we need to become really good court reporters. We need to be able to take down someone's testimony without having emotional reaction, without trying to counterargue without mounting a defense." If you think about the person just, you know, on the stenography machine, just taking down the transcript, they're not rolling their eyeballs, they're not shouting out "I object." They're not saying, "You're full of nonsense. That's not what happened." They're just really good listeners.

And so I think step one for empathetic joining is actually saying, "Who's going to be the speaker here and who's going to be the listener?" These are two distinct roles. When the speaker is speaking, the listener is listening. That means we've got to be able to listen with our ears, but we also have to listen with our body language too. It means our eyes have to face the speaker. Our body has to look relaxed, like we're really attending and we cannot be shaking our head or rolling our eyes in response to what the speaker's saying. We really want to be in court reporter mode and giving that speaker the opportunity to speak from an I perspective, so what I heard, what I felt, what I saw, what I connected to, what I needed more of in this life. And we're just taking down their testimony without interrupting them.

When we've given the speaker time to speak, I often give couples five minutes each, and that doesn't sound like a lot of time, but actually when you have the microphone, it's a lot of time to speak uninterrupted, then we switch roles. So, then the speaker becomes the listener. The listener becomes the speaker.

When somebody is finished speaking, part of that empathetic joining is also being able to reflect back what we heard. "So what I heard you say was that you had a really hard day and you felt really disappointed because the trash didn't get taken out. What you needed more of was some support around the house," et cetera, et cetera. And that gives us the opportunity to make sure that our message got communicated effectively and the words we spoke got heard by the person who was supposed to be listening.

So I think as a quick strategy, being able to engage in empathetic joining is so vital to dealing with relationship distress. And if we can really just be effective as speakers, saying "I" as opposed to "you," and if we can be really effective as listeners, like showing with our ears, our eyes, our body language that we truly are listening and that we truly can reflect back what we heard that other person say, the end result is that we both feel that we've, you know, received empathy and respect and caring, and that we're understood. When we're in that place, we're really in a good place to solve a problem and figure out some livable compromise with our partner.

Scott Webb: Yeah, that's a perfect way to end, livable compromise. That sounds like marriage to me, you know? A lot of livable compromises to make this thing work between the internal and external stressors and kids and COVID. This has been really helpful today. I did take some notes. I'm going to share them with my wife as I'm sure listeners will share with their significant others. Doctor, thanks so much for your time today and you stay well.

Dr. Anna McCarthy: Thank you so much. It was my pleasure.

Scott Webb: For more information, visit sierratucson.com or call 800-842-4487. Sierra Tucson, we work with most insurance.

And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest.

This is Let's Talk: Mind, Body, Spirit from Sierra Tucson. I'm Scott Webb. Stay well.