Wednesday, January 7, 2015

Dieting is Bad for You

Dieting is Bad for You. But I Don't Diet Anymore - I know Better!

 

Don't be fooled - If you're "only trying to eat healthier," ask yourself these questions:

  1. Does this "new way of eating lifestyle" require that I change my eating habits to omit or considerably limit one of the three major food groups that all humans need to survive: carbohydrates, proteins, or fats?
  2. Does this "fitness fat-burner menu" cause me to wait to eat for long periods while hungry or to stop eating before my physical appetite is satisfied?
  3. Does this "high nutrition program" require that I eat according to externally dictated menus and schedules, which distract me from my inner rhythms of hunger and satiation?

Food Group or Caloric Restriction = Thin = Better Health?


Thin, very temporarily yes. Better Health -No - Plus, studies show that the best way to gain weight AND to develop an eating problem is to restrict your diet (see below). 

Major Cause of Obesity Epidemic: Weight-Loss Attempts

  • Research on 17,000 children showed that twins who embarked on one intentional weight loss episode were two to three times more likely to become overweight compared to their non-dieting twin counterpart. Furthermore, the risk of becoming overweight increased in a dose-dependent manner, with each dieting episode. #1
  • A 1999 report on 4,193 women and 3,536 men participating in the Finnish Twin Cohort Study revealed that dieters were several times more likely than non-dieters to experience major weight gain (more than 22 pounds) during a follow-up lasting 15 years. (pp.31) #2
#1. Alison E. Field, S. Bryn Austin, C. Barr Taylor, Susan Malspeis, Bernard Rosner (2003)

#2. Korkelia, M., A Rissanen, J Kaprio, TIA Sorensen, & M Koskenvuo (1999)

According to a 2007 Meta-Study (a study of 31 other studies, internationally)

  • Diets do lead to short-term weight loss, on average of 5%–10% of the person's body weight
  • These losses are not maintained
  • The more time that elapses between the end of a diet and the follow-up, the more weight is regained.
  • Among patients who were followed for two or more years, 83% gained back more weight than they lost
  • In studies with the longest follow-up times (of four or five years post-diet), the weight regain trajectories continued to increase suggesting that if participants were followed for even longer, their weight would continue to increase. #3
#3 Mann, T., Tomiyama, AJ, Westling,E, Lew, AM, Samuels, B. (2007) Medicare’s Search for Effective Obesity Treatments in American Psychologist Vol. 62, No. 3, 220–233

Fat Phobia Kills

A study of 36,000 students in Minnesota found that negative body image is associated with a higher suicide risk for girls #4

#4. American Association of University Women (1990). Shortchanging girls, shortchanging America: Full data report. Washington, DC: American Association of University Women.

Overweight girls are far more likely to engage in dangerous practices (fasting, smoking, vomiting, taking laxatives) to lose weight than normal weight girls #5

#5. Wertheim, E., Paxton, S., & Blaney, S. (2009)

The Mayo Clinic researchers note that many adolescents with eating disorders have had a history of being overweight or obese #6

#6. Sim, L.A., Lebow, J, & Billings, M, (2013)

A longitudinal study published in 1999 showed that girls who dieted severely were 18 times more likely to develop an eating disorder #7

#7.  Patton et al (1999)

Even here in Aotearoa New Zealand:

Studies indicate that although 75% of 15 year old girls were ‘healthy weights’ 68% of them wanted to weigh less #8

#8. Worsley, Worsley, McConnon & Silva (1990)

Of the girls that reported dieting, most had started prior to the age of 13 years. #9

#9. Fear, Bulik & Sullivan (1996) 

We have known since the 70's that dietary restriction sets a dangerous trend, And we now know that this trend is far more "dangerous" than the "obesity epidemic" that gets so much more press but that fails to mention that the health risks of obesity are much more related to a lack of physical exercise than to BMI. It is perfectly possible to be "fit and fat"" where it is less possible to be "fit and dieting."

Why Do We Keep Trying to Lose Weight by Restricting Food Types or Intake?


In spite of all this, our drive to diet and get thinner and thinner is getting worse not better. And our children and teenagers continue to get the wrong messages

  • Parental messages about body image and teasing by others (e.g. peers and/or family) have been highly correlated with body image dissatisfaction and eating disorder symptoms #10

#10. Thelen and Cormier, 1995

Because Dieting is Addicting

Compulsions and addictions are defined by one's inability to stop behaviour in spite of known harmful consequences. Given all of the evidence above, why would anyone want to deliberately deprive themselves of food anymore? We know it causes eating disorders, suicidality, and ultimately either death or greater weight gain - this evidence isn't even new. Yet we keep doing it - why?

Dieting, like many addictions, creates false promises. Like gamblers who know full well that the odds are against them, most dieters think they can buck the odds because the false promise - thinness and an end to weight discrimination - is too seductive to ignore or dismiss. The pain of continuing to suffer teasing, discrimination, and judgments overshadows the likelihood of dieting failure. No one wants to really believe they can't diet their way to thinness - it feels too hopeless, too awful. And although exercise offers an escape from most of the physical health risks of a high body weight, it can't promise a quick perfect body. And we humans are famous for looking at the short term results and ignoring the long term, if it doesn't suit us. A gambler makes one big win, then continues to gamble until it's all gone and then some - this is the same thinking as "diet think."

More Myths

BMI, or the Body Mass Index, was originally developed as a statistical tool to study large populations over time. It is completely irrelevant to individual weight and does not even distinguish between weight caused by fat or muscle. Similar to that old fashioned standby, the Metropolitan Life Height and Weight Charts, the original uses for which these devices were developed has gotten completely distorted. Met Life was originally an actuarial study - a statistical population study based on people who buy life insurance. What happened to scientific measures - controlled, double-blind studies that limit the variables they measure? When it comes to weight, our scientific standards seem to take a back seat. This is because no one, including doctors, is immune to cultural pressures, assumptions and stereotypes. Although medical practitioners the world over are trained to used the BMI now as they were the Met Life Charts in the past, they are rarely taught that they are highly inaccurate in evaluating individual weight and fitness.

One of the medical criteria of anorexia nervosa: body weight 15 % below a weight that is considered "normal", is met by the majority of models and beauty contestants.

So, What Size Should I Be?

Since there are no clear markers for healthy body weight that are free from highly questionable social standards, I would maintain that healthy body weight is highly individual and relative, given the various causes of weight gain

Perhaps it is best to consider the size a person naturally returns to after a long period of both non-compulsive eating and consistent exercise commensurate with the person' s physical health and condition. We must learn to advocate for ourselves and our children to aspire to a naturally determined size, even though that will often mean confronting misinformed family, friends, and media advertising again and again.

If you want to know if you are fit, ask yourself how you feel. Do you have energy or do you drag through the day? Are you physically active at least a half hour a day (this means pushing yourself to do something that causes you to pant and sweat)? If not, consider increasing your level of physical activity in such a way that it is woven into your day (e.g. walking or cycling instead of driving).

The benefits of regular physical activity have been demonstrated scientifically again and again - as have the disadvantages of restrictive dieting. It makes sense that we need to be active - we were hunter- gatherers for 100,000 years and had to travel huge distances to follow the edible flora and fauna. We're supposed to move around - and then we're supposed to eat! 

Are you Overeating?


Do you feel overstuffed a good deal of the time, or do you rarely let yourself feel hungry? Do you eat to cope with issues that have nothing to do with hunger? 

What is Non-Compulsive Eating?

Simply stated, non-compulsive eating means eating when you are hungry and stopping when you are satisfied. This involves being able to distinguish emotional hunger from physical hunger, and satiation from over-fullness. This approach, combined with regular physical activity, over the long term,will bring about a healthy ratio of fat to muscle, even if you don't end up looking like a fashion model.

Friday, February 28, 2014

Fight the Brain or Change the Brain

Recent research in neuroscience tells us what we had thought impossible is now possible. Early traumatic implicit (non-verbal bodily held) learning – the kind of learning that drives most forms of psychological distress, can actually be erased without touching the explicit (verbal – story) memory it was associated with. First let’s take a look at what this means.
Implicit learning is laid down in the nervous system – it is emotional and non-verbal. Here are some common examples:

I am inherently bad/dirty/stupid/ugly…etc.

Love is dangerous/painful/violent/exploitive and it’s best to avoid all risk or to expect all relationships to be like that

To love is to be mistreated/to mistreat

If I try I will fail, so best not to try

Dependence is wrong – it’s best not to have any needs

These kinds of “beliefs,” or “scripts” can drive large areas of life. They are usually laid down due to early (as in childhood) repetitive emotionally charged or even traumatic experiences and so tend to be immune to logical questions or arguments. 

This is because they are actually held in the body and nervous system rather than in the “thinking brain” and are faster and more automatic than logical thinking because they were originally somehow tied in to perceptions around survival (the messages may have originally been communicated by needed childhood caregivers, for example).

Fighting the Brain

Since most forms of psychotherapy are verbal, we have believed up until now that the only way to cope with this kind of dysfunctional learning was to challenge the logic of such beliefs and set up competing neural pathways that would eventually, through a great deal of practice, become available as the “preferred” neural pathway.  This is the foundation of much of cognitive and behavioural psychology.

Nevertheless, competing new beliefs learned logically in adulthood can never completely replace implicitly held beliefs laid down and reinforced in childhood, and so relapse must be constantly guarded against, especially when something associated with the earlier learning reappears in the current environment (e.g. a boss or spouse implying the same message).

The most common way set up competing beliefs is via Cognitive Behavioural Therapy, whereby the dysfunctional beliefs are deliberately challenged with new thoughts and learnings which are then rehearsed in new behaviours repeatedly until the old beliefs lose their original power. Psychoanalytic or psychodynamic interpersonal therapies also challenge old implicit learning via the therapeutic relationship itself, whereby repetitive experiences of (hopefully!) non-exploitive, consistent, secure attachment with the therapist replace the old beliefs that were based on exploitive, inconsistent, insecure early attachments.  

Example:

CBT: Old implicit learning: “If I try I will fail, so best not to try” as applied to job hunting (for example). CBT points out the illogic of the assumptions and encourages rehearsing new alternate thoughts such as “if I try, even if I fail, I can still learn something of value – and sometimes I will succeed.”  Behavioural rehearsal might involve the assignment of applying for xyz jobs and keeping track of any learnings or successes to challenge the old learning. Through  repetitive practice the new learning creates a new available pathway that offers an alternative to the older learning – however it doesn't replace it, and confirmations of the old learning (such as failures that don’t result in positive learnings) can always send the person back to the old learning.  I call this approach “fighting the brain.”

Changing the Brain

In their recent book, Ecker, Ticic and Hulley (2012) present the basic components necessary to erase dysfunctional implicit learning, and then examine numerous contemporary forms of psychotherapy to determine which types incorporate these components. Not surprisingly, most do. However, some forms of therapy are more efficient, systematic, and deliberate in their use of these components than others, making for a considerable difference in the likelihood of success and the length of time it takes to get there. The components are as follows:
1.       Identify and access the memories of the original experiences that laid down the implicit dysfunctional beliefs
2.       Retrieve the accompanying  learning simultaneously with the memories:  both emotional and  schematic
3.      At the same time as the feelings, memories and beliefs are retrieved, provide repeated experiential disconfirmation of the dysfunctional learning
a.      Disconfirmation must “make sense” emotionally
b.      Original learning plus disconfirmation must be repeatedly paired within a 5 hour window
c.       After 5 hours a built-in mechanism re-locks the synapses

Each of these steps correspond precisely to phases 4 through 7 desensitisation stage of the standard 8 phase EMDR protocol, even though EMDR was developed 20 years prior to the current confirming discoveries in neuroscience.

My main concern here is that this “new” approach, if applied systematically, will probably have similar limitations and cause similar results to those that have emerged from years of research and practice in EMDR. It will seem miraculous when applied to dysfunctional learning caused by a single –incident trauma; but it won’t be so simple when dealing with the many ego states that develop in response to repeated developmental trauma and dysfunctional implicit learning.



When ego states are split off by trauma, they are sometimes unable to “share” information from one state to another. This is what enables many survivors to function at a much higher level than they might otherwise if the full impact of the traumas were experienced by all parts of self equally. This also means that it is essential, when applying the above steps, to make sure that the ego states that hold the implicit dysfunctional learning are the same ego states that are exposed to the disconfirmation of that learning.

I think we will find, as we did with EMDR, that more complex forms of traumatic implicit learning are most effectively addressed with a combination of trauma processing (or Implicit memory “erasure”), somatic mindfulness, and ego state work.

References:

Ecker. B, Ticic , R, & Hulley, L. (2012). Unlocking the Emotional Brain. New York: Routelege

Shapiro, F, & Forrest, MS, (2004) EMDR: The Breakthrough Therapy for Anxiety, Stress and Trauma. New York: BasicBooks

Tronson, N. C.; Taylor, J. R. (2007). Molecular mechanisms of memory reconsolidation. Nature Reviews Neuroscience 8 (4): 262–275


Monday, December 9, 2013

HUGE news: Judge Rules Causal Link Between Sexual Abuse and Schizophrenia Must be Aknowledged by Insurance Company

This is HUGE! For those not from New Zealand, ACC (Accident Compensation Corporation) is a government-contracted insurance company that covers counselling and psychotherapy for those who can demonstrate  "mental injury due to sexual abuse." It's one of the many reasons I moved to New Zealand as I figured a country that not only recognises that: abuse exists, can be forgotten,and then return in memory; but that actually compensates the people who suffer because of this, can't be all bad. Two days ago...


"A judge has ruled in favour of an ACC claimant in a case expected to have "enormous" ramifications for the way mental health patients are treated.

In the decision, released recently, Judge Grant Powell in the Wellington District Court agreed with a psychiatrist who said a man's schizophrenia had been caused by trauma from sexual abuse in childhood.....

"(The) judge agreed with a growing body of research that says traumatic events can cause psychosis.
The research includes the work of clinical psychologist John Read, who has been at the forefront of research to show a relationship between childhood sexual and physical abuse and psychotic symptoms, including schizophrenia."  Thank you John Read for years of painstaking ground-breaking (and myth-busting) work. .Click here for more on this

Thursday, November 28, 2013

Healing from Childhood Abuse, Trauma and Neglect (Part 1)

When searching for counselling and therapy to heal the wounds of trauma, childhood abuse, and/or childhood neglect one can be faced with an overwhelming myriad of choices.   Most treatment techniques (both  medical and psychological) that are studied scientifically take into  account that a significant percentage (actual numbers vary based on condition or treatment being studied) of those being studied get better spontaneously simply because they believe they are being given a  (called the placebo effect).

A number of new approaches that take into account the recent discoveries of neuroscience, made possible by modern brain imaging techniques, have been shown either scientifically (in placebo controlled randomised blind or double-blind studies) or anecdotally (based on empirical observations and patient/client reports) to be highly effective in a shorter period of time than conventional "talking only" therapy. All of these approaches, of course, need to be integrated by a skilled and experienced clinician, into an overall treatment style and plan that will include talking therapy as well as a healthy respect for the power of the therapeutic relationship and the need for the therapist to earn the client's trust by creating safety.

Below I list some of the approaches that have been shown to be effective  with survivors of adult trauma and childhood physical, sexual, and emotional or psychological abuse, plus a link to another blog entry I wrote on effective  approaches for those suffering from the effects of "poor affect regulation",  commonly caused by emotional neglect or the unavailability of reliable  soothing in early childhood.  I only list those methods that I have personally learned and tried and observed to be effective, and the reasons (if known) that they work. 

Affect regulation treatment approaches are also useful with survivors of trauma and/or childhood abuse. The basis for this is  described in a separate blog entry (Learning to Comfort and Soothe) as they are more generic therapy approaches used for a broader range of problems and causes.  Since writing that entry, I have been learning about "memory reconsolidation" which claims that rather than going through the painstaking process of learning to "regulate" out of control feelings, one can "re-write" the implicit memory itself so that feelings become self-regulating, as they would have been if the original "dysfunctional implicit memory" hadn't been laid down in the first place. I will explore this in depth in another blog entry (coming as soon as I finish writing it).

I mention anecdotal or scientific (placebo-controlled) in brackets next to the name of each approach to identify the type of documentation of  effectiveness. I include approaches that have primarily anecdotal evidence because it is extremely difficult to measure approaches to complex trauma and dissociation in a laboratory setting. In my opinion, there are too many uncontrollable variables once you try to measure treatment effects with this population, especially since it isn't ethical to in any way limit access to anything that might help simply because it could confound the scientific evidence of your study.  The DNMS, Sensorimotor Psychotherapy,  and Ego State Work, for example, have ample anecdotal evidence presented in scientific journals as controlled case studies, and are based upon modern scientific insights into the brain,  but that is not the same as evidence based on rigorously controlled scientific studies.

Ego State Therapy (anecdotal)
Founders: John and Helen Watkins
The concept of segmentation of personality into discreet parts of self has been around for many years, but has only recently been validated scientifically by new brain scanning technologies. These technologies, by measuring blood flow patterns in the brain, demonstrate how ego states are formed by neural clusters repeatedly firing together (and therefore "wiring together"). 
Such neural nets form the basis for most implicit learning - such as learning how to ride a bicycle - a skill that improves and eventually "clicks" as the neurons, which fire together in the same pattern whenever riding is practised, form a network with a particular skill set. When such a neural net forms in the context of a relationship, it will develop a unique point of view and way of behaving.
Ego states exist as a collection of perceptions, cognitions and emotions in organised clusters. An ego state may be defined as an organized system of behaviour and experience, whose elements are bound together by a common principle. Ego states may also vary in volume. A larger ego state may include all the various behaviours activated in one's occupation, whereas a smaller ego state might be formed around a simple action, such as using a mobile phone. They may encompass current modes of behaviour and experiences or include many memories, postures, feelings, etc., that were learned at an earlier age.

The human mind is a collective "family of self" within a single individual. How well these "family" members get along, and how effectively they cooperate can vary considerably from individual to individual. 
This segmentation has been called many names over the years, depending upon which psychological theory is being used. In Freudian language we are all divided into Ego, Id and Superego; Jungians refer to "complexes" which are described almost identically to ego states; Transactional Analysts talk about the internal Parent, Adult and Child; and Psychosynthesis refers to "sub-personalities." Ego states exist on a continuum of separateness, with the most extreme dividedness being caused by the most extreme early relational trauma.
Although everyone has ego states, those states formed in response to loving supportive experiences do not tend to require psychotherapeutic intervention. When ego states are more split off and engage in internal battles, Ego State Therapy can be employed to help resolve some of these conflicts, often using techniques found in conflict resolution, group or family therapy, to enable a kind of internal diplomacy. This approach has demonstrated that complex psychodynamic problems can often be resolved in a much shorter period than with analytic therapies. 


PLEASE NOTE: The techniques described here have been integrated into PSITM (PsychoSomatic Integration), an overall approach I teach for working with trauma and abuse survivors. PSITM is described here in more detail.  

More approaches to come....to be continued

Tuesday, November 26, 2013

Self Empowerment: Actualizing the Power Within



To experience empowerment we must act on a sense of self worth, value and give voice to our own needs, and give equal validity to our own needs as to others'. As we develop a sense of empowerment, we begin to discover that a conflict of needs actually can present us with a creative challenge to imagine solutions that can empower all parties involved (rather than fearing that a conflict of needs must necessarily result in a "win-lose" battle).  I offer the following vignette as an example:
Mary does child care every night so John can go out with the "boys".  Mary becomes more and more resentful of John and their young children.  Finally, Mary initiates an assertive "conflict".  She says:

"I understand that you work hard all day and need time in the evenings to relax and unwind, but I've never pointed out to you that for you to relax and unwind by going out every night, you are counting on me to stay home with the kids, which is what I do all day.  So I don't get to relax and unwind and I become more resentful toward you and the kids and unpleasant to be around.  I need escape time too.  I'd like us to work out a way that we can both get what we need."
John agreed that Mary had become very unpleasant to be around (and didn't hesitate to tell her so.)  But after a number of arguments, they came around to agreeing on an experiment.  The experiment was that once a week John would go out while Mary watched the children, once a week Mary would go out while John watched the children, and once a week they both went out while Mary's mother watched their children.  The other two evenings they all stayed home as a family.  After two weeks of this experiment, not only did Mary feel better, but John felt better as well because he was feeling closer to his children and getting less resentment from his wife--and he still had time to see his friends.

The word "compromise" does not adequately describe the process of creating a "win-win" solution.  Compromise implies that neither side really gets what they want, whereas in "win-win" solutions, both sides get as much if not more than they wanted originally.  Assertiveness means acting from a place of respect – for self and other – and assuming equal value to the needs of self and other.  This presents many dilemmas that can also be seen as possibilities.  Power--the power of creative problem solving and acting--is mobilized rather than suppressed.

Power
Traditionally power has meant different things for men and women, taking on more positive connotations for men.  Think of the following words, first for men and then for women.  Pay attention to the feelings they evoke:

Men
Women
Powerful
Powerful
Aggressive
Aggressive
Forceful
Forceful
Ambitious
Ambitious
Assertive
Assertive
Competitive
Competitive
Authoritative
Authoritative
      
1. Women have traditionally been expected to defer to men, and have internalized the dominant cultural expectations of females as submissive and powerless
and
 2. There is something wrong with the present system of power distribution for all people, which we, as women, may be particularly sensitive to, having so deeply learned to respect the importance of other people's needs.

 As we endeavor to compete with men as their equals, some of us feel there is something sour about climbing up a ladder on top of other worthy people's heads, something deceitful about the notion of inferiority and superiority in our fellow human beings. We see that to gain others must lose, and having been relegated to losing for thousands of years, we may not feel comfortable inducing that experience in others.

When some people have less power than others do because external forces (e.g. money, status, physical strength, military force) block them, many problems arise for both the "winners" and the "losers".  The "losers" become afraid to express their needs because they fear (often rightfully) that what little they have will be taken from them.  They then become afraid to even feel their needs, to admit to themselves that they want something.  They become immobilized.  And, in certain critical ways, they stop growing; cease to thrive; development (the Power from Within) is blocked. The "winners" then miss out on the experience of sharing with equals and become self-preoccupied.  Their development is also blocked.
Let's consider these questions:

1. How do we reclaim our rights to power and effectiveness in the world without doing so at the expense of others?

2. How can we, as women, integrate the profound knowledge we gain from mothering and being nurtured by our mothers -- i.e., that we are each special, unique, and worthy in our own right, into a culture where value is so often seen in material terms?

We may want to begin by developing our own vocabulary to describe our experiences and perceptions.  Without words to communicate our experiences, we are trapped and limited.  If power only means the power to force others to do our will, we will feel that power is foreign to us, awkward and unfamiliar.  But power means many things, and many aspects of power can feel right for us.
I offer the following words and phrases to begin reclaiming our own vocabulary taken from Simos 1987 - (see below*)

 Power Over: the ability to force others to do your will through physical or financial coercion.  The power inherent in social or economic positions, or physical size or strength, regardless of skill or ability.

 Shared Power: power whose goal is to uplift or teach others to bring them to parity, as with a parent/child, teacher/student, or psychotherapist/client relationship

 Referred Power: the power others give us because they value, respect, and/or are attached us

 Expertise Power: the power others give us because they count on our knowledge and judgment

 Power With: the power to be effective interpersonally, to persuade, to inspire (not “command” or force) respect

Power From Within: the power of growth and development inherent in all living things.  It is the power to change, to overcome obstacles, to face our own fears, to learn new skills, to fail, and to try again.

Power can be used to destroy or create, to belittle others and over-inflate the self, or to belittle the self and over-inflate others.  We may call the use of power to harm or belittle the self passive power, and to harm or belittle others aggressive power. In contrast, assertiveness can be seen as the use of power to enhance and respect both self and other.  Assertiveness training, then, can be a way for women to reclaim their rights to power and effectiveness in the world without doing so at the expense of others.

Recommend this on Google Plus  
 * new vocabulary words taken from Miriam Simos (Starhawk) Truth or Dare, Harper & Row Publishers, New York, 1987

 Suggested Reading

Jean Baker Miller, M.D. (1976). Toward a New Psychology of Women. Boston: Beacon Press
Pamela Butler (1981) Self-Assertion for Women. New York: Harper & Row Publishers
Margaret McIntosh () Feeling Like a Fraud a Work In Progress Paper of the Stone Center for Developmental Studies at Wellesley College, Wellesley, Mass., 02181

Miriam Simos (Starhawk) (1987) Truth or Dare. New York: Harper & Row Publishers 

Tuesday, July 3, 2012

Myths and Truths about "Happy Couples"



                                        by Judy Lightstone © January 2012


This article is partially based on extensive laboratory and longitudinal scientific research about couple satisfaction in long term relationships as presented in the book The Marriage Clinic, by John M. Gottman, published by WW Norton & Company in 1999.  Please see this book for more resources.
Most of us know by now that the fairy tale happily ever after stories are full of holes. Dashing men on horses don't usually rescue helpless women and live happily ever after in real life.  But most of us don't know how inaccurate our current popular expectations and beliefs are about what makes "marriage" work are (and by this I mean any long term committed romantic relationship).  

Mostly we look around at such things as divorce statistics and see that a lot of them don't work  This assessment is also unfair, given that this doesn't include long term committed relationships outside of marriage, nor does it consider that relationships may last several decades and still be included in divorce statistics. Most importantly, the numbers don't tell us what allowed some relationships to last and others to break up, and they don't tell us how much overall satisfaction existed in those relationships that stayed together or broke up.

Many of the following cultural myths perpetuate some of the problems that bring couples to counselling.

MYTHS
1. Arguing = trouble.
2. Distance = trouble.
3. Opposites attract.
4. Flattery will get you nowhere.
5. You have to agree on the BIG issues (like children, sex and money).
6. People divorce because they “grow apart”.
7. Couples divorce because they get older and change physically.
8. The more sex the better.
9.  A fat woman will lose her man.
10. Both partners have to be equal in a good marriage.

TRUTHS
1. Fighting per se is not necessarily a problem.  If there is basic mutual respect, the ability for partners to cool down and soothe each other afterward, and lots of good stuff in the "emotional bank account", the tendency to fight is more a result of personality style than trouble in the relationship.  In his book The Marriage Clinic, John Gottman talks about the "emotional bank account"  and the "fondness and admiration system" in which he describes the ability of a couple to draw on "stores" of good feelings that have been deposited there by each partner.  It is the ratio of negative interactions and positive interactions -he advises the ratio should be at least 5 (positive) to 1 (negative) -that is more of a predictor of a satisfying relationship than the number of arguments.  Some couples like to handle problems directly, and if each of the two people are this way, then they may resolve their problems more quickly and with less bitterness if they approach them head on.

2. Other couples are more avoidant and have a similar level of tolerance for putting off confrontations.  It is the compatibility of problem solving style between the two people rather than the style itself that is more predictive of failure. When two people prefer to avoid conflict together they don't necessarily get into trouble unless this escalates to avoidance of positive regard for one another.  If they can accept each other's differences and remain loving toward one another they may be able to avoid conflict for a long time.  It is more a problem if one is a conflict avoider and the other is a conflict confronter.  This difference can be worked out (although sometimes help from a therapist is required) if there's a lot of overall positive regard.

3.  Differences may make the courtship stage of a relationship more exciting, but they can make a lasting relationship more difficult.  Not all differences are alike, however.  The most important differences that can cause trouble are: difference in conflict style (see above), differences in mutual respect for each other's life dreams (note I did not say the dreams had to be alike, only the amount of respect accorded the other person for his/her dreams), differences in libido (sexual drive), differences in lifestyle (e.g. degree of accumulation vs. simplicity desired), etc.  All of these differences can be worked out in a healthy relationship and don't necessarily signal danger - they just make things harder rather than easier.

4. Some would say the solution to all marital difficulties is honesty - always saying what is on your mind because that is the Truth.  But in my practice I have seen this become an excuse for disrespect and contempt, and these are the things that will cause ruptures rather than healing.  True, people need to be able to express themselves freely to their partners, but this doesn't mean there is no room for tact.  And what may feel "honest" at one moment, may feel irrelevant at another.  Flattery, if that means complimenting your partner frequently, showing your affection regularly in symbolic or romantic ways, and bragging about her or him to others - will get you everywhere.  I don't mean saying things that aren't ever true, but focussing on the positive and building up credit in that emotional bank account makes a huge difference in how well your relationship will weather rockier times.

5.  There isn't a couple around today that doesn't have some "BIG" issue that it can't resolve.  There are too many choices and options available today to assume they must all be agreed upon in each romantic partnership.  Gottman estimates that 60% of all problems couples encounter are ultimately irresolvable.  Once again, the issue isn't the problem itself,  it's how couples learn to manage perpetual problems over the long haul.  This point is critical to understand.  As in other areas of life, many problems stay with us a long time- some throughout the life span - what matters is how we cope with this fact.  Do we comfort each others' experiences of frustration? Do we accept that there are some things that may never be perfect but know that we can keep trying anyway? Do we have enough good stuff in the bank to get us through? Gottman calls this the ability to "dialogue with perpetual problems".  Ultimately, it's the quality of the dialogue, not the seeming seriousness of the problem itself, that will predict the success of the relationship.

6.  Although this may be somewhat true when couples meet at a young age, because the younger they start, the more quickly they will change and might simply become so different they are no longer compatible, for most couples who claim they just "grew apart", this is an excuse that tends to gloss over the deeper issues that can cause serious trouble in a love relationship. 

So if fighting, avoidance, differences, growing apart, and "honesty" aren't the real problems, and huge differences like children, sex and money don't necessarily predict disaster - why is there so much divorce? And what is the solution?  Gottman refers to the "Four Horsemen of the Apocalypse" as being:  1. Criticism 2. Defensiveness 3. Contempt and 4. Stonewalling, and says these 4 patterns are the most reliable predictors of divorce/separation or of a long but miserable relationship. When these four horsemen take over a relationship, the end is near, even if the couple physically stay together.  But with help (professional help is usually necessary for this) you can learn to consistently "build in the antidotes.1"
Here are some "antidotes" I have found effective:
*for Criticism: try complaining without suggesting that your partner is somehow defective
*for Defensiveness: try accepting responsibility for a part of the problem
*for Contempt: learn to create a marital culture of praise and pride to replace the contempt, and
*for Stonewalling: provide self soothing, stay emotionally connected and give the listener nonverbal cues of your attention.

7. Attraction is more related to what's in the emotional bank account than to physical appearance.  When loss of attraction or change in physical appearance is used as an excuse for divorce or constant criticisms,  it is more indicative that the person doing the criticising is having self esteem or identity issues.  Although these problems may require individual or couples treatment,  it is not physical changes that are at the heart of the deterioration of a marriage.

8. Sexual compatibility, not frequency, is the key to couple sexual satisfaction.  Difficulties (again, not irresolvable) arise when there is a difference in the amount of sex desired by each member of the couple.  Many satisfied couples have little or even no sex because this is all each of them desires.  Gottman found that it is the nature of the friendship, more than the frequency of sexual relations, that gets people through in the long run. When frequent sex is desired by both partners, and sex is part of the overall fondness and affectional system, it can be a wonderful asset.  When one is wanting more sex than the other, it is likely to cause stress in both partners.  However, more often than not, the development of sexual problems is a symptom rather than a cause of relationship difficulties. Because sexual intimacy requires each partner to be vulnerable to the other, when the relationship is experienced as emotionally unsafe by one or both partners, sexual disturbances will likely arise.

9.  I have worked with many couples who were dealing with changes in one partner's body size.  I have seen some couples break up when there was no perceptible physical change and other couples thrive through considerable physical changes. When there is a wealth of positive regard in the relationship, physical attraction tends to follow that regard.  It is unfortunately common for someone with an eating problem to project their body image insecurities onto a partner.  This can be true for certain same sex couples too- one partner "absorbs" the bad body feelings and the other projects them.  When this is the case it is important for each member of the couple or family to work separately on his or her eating problem and put a special effort into being loving and respectful of the partner's food and body boundaries.  It is not easy to go against the cultural dictate of thinness for everyone, but a family can work together to develop a culture of love and respect for differences that will ultimately solve way more problems than the temporary (for usually it is no more than that) weight gain or loss of one or more of its members.

10. There are many ways for couples to share power and responsibility that do not necessarily correspond to absolute equality in all areas.  What is more important is that each partner have equal influence on the other.  Weiss'2 coined the term: "positive sentiment override" (PSO) to describe this ability.  He coined the term "negative sentiment override" (NSO) for the opposite. What this means is that when partners feel trusting  of one another, they tend to hear each other's suggestions and complaints non-defensively. There doesn't have to be agreement on the issue, just willingness to talk about the differences. Statements judged neutral or negative by observers can be interpreted positively by a partner with a couples history of respectful conflict (PSO) just as statements judged neutral or positive by observers can be interpreted as negative by a partner with a  couples history disrespectful conflict (NSO) as in the following examples.

PSO Example:

Partner 1: Will you shut up and let me finish?
Partner 2: Sorry, go ahead.
Though partner 2 may not be very happy about this comment, he still recognises that his partner felt hurt by his interruption and gives her the benefit of the doubt.

NSO Example:
Partner 1: Will you shut up and let me finish?
Partner 2: To hell with you, I’m not getting a chance to finish either. You’re such a bitch, you remind me of your mother.

Here partner 2 assumes negative intent and feels he must defend himself.

In summary, this does not mean that a couple in trouble can just start being loving and affectionate during their arguments.  It takes work and often professional intervention to get out of negative cycles.  Repeating affirmations that have no meaningful basis is not the solution either.  Genuine positive regard, if not already deeply embedded in the marriage, can only emerge once the relationship is made emotionally safe for both partners.
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*   * This article does not apply to couples struggling with physical or sexual abuse. Much stronger interventions are required in those cases to first and foremost keep all parties physically safe.  For resources on this topic, please see: http://www.womensrefuge.org.nz
Link to:  Couples therapy

Notes:

1. Gottman, John M.  The Marriage Clinic, NY:  WW Norton & Company; 1999, page 193.
2. Weiss, R. L. (1980) Strategic behavioral marital therapy: Toward a model for assessment and intervention. In J.P. Vincent (Ed.), Advances in family intervention, assessment and theory (Vol. 1, pp. 229-271). Greenwich, CT; JAI Press.