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Imago Relationship Therapy was developed by Harville Hendrix and Helen LaKelly Hunt as a way for couples to extend themselves and grow as individuals and as a couple. They based it on their own experience of relationships, including their own marriage. Harville Hendrix often summarises the entire teachings of Imago in one simple phrase:
“You partner is another person – get it!”
Imago creates a safe framework that allows couple to really listen to each other. You get to know who their partner really is. Then it is possible to have deep, satisfying and above all real relationship.Imago techniques include a series of dialogue-based exercises. These exercises help you and your partner understand why you were first attracted to each other. Also why those initial reasons now draw you into a cycle of disagreement. The Imago Dialogue is a practical approach that helps achieve an authentic relationship with your partner.
The Imago Dialogue has three key components: mirroring, validation and empathy. Mirroring is when one person, the Sender, talks and the other, the Receiver, listens and then repeats the words just as they are said. This may seem easy until you try to do it. Often you will have reactions and responses that want to be aired. These defense mechanisms are automatic and come into play before you realise what is happening. It not enough to simply repeat someone’s words. The structured Imago dialogue uses simple questions such as “Did I get you?” and “Is There More?” to slow down the process and reduce reactivity. These simple phrases reinforce the sense of connection and invite the person talking to become more aware of their own thoughts and feel them.
Validation requires you to look through the eyes of the other. To see the world as it appears to them and to understand the other person’s point of view. Simply accepting that the other’s perception of the world is as valid as your own. In the empathy step, you imagine what your partner might be feeling. Feelings are simple words like “Angry, Sad, Lonely, Afraid, Happy, Joyful etc:”
Imago Relationship Therapy is made available through couples workshops, trained Imago therapists and in the books “Getting the Love You Want – A Guide for Couples” and “Keeping the Love You Find – A Guide for Singles” by Harville Hendrix. The Imago Dialogue is Copyright: Hunt/Hendrix and Imago Relationships International 2007.
Each of the three roles of the Winner’s Triangle; Vulnerable, Caring and Assertive, require the development of a different set of skills.
Vulnerable
Skill to be developed: Problem solving
Any technique that the Vulnerable person can use to get themselves thinking about options and consequences is valuable. The first set of the suggestions below are problem solving, self help initiatives. The second set are therapeutic techniques, suitable to group and individual work. The last group of suggestions are non-rescuing invitations that encourage problem solving.
Problem Solving
Training in problem solving techniques like:
- Working backwards
- Assess, Plan, Implement and Evaluate
- Trial and Error
- Lateral thinking
- Brainstorming
- Data collection
- Consulting feelings
Therapeutic
Therapeutic techniques to mobilise personal motivation and raise self-awareness.
- Guided fantasy
- Suggestion circle
- Two chair work
- Re-decision work
Non-rescuing invitations
Non-rescuing invitations to think about and solve problems
- What have you tried so far?
- How did that work?
- What do think went wrong?
- What do think went right?
- What will you do next?
- What do you predict as possible outcomes?
- How will you take care of yourself around negative consequences you envisage?
Caring
Skill to be developed: Listening
The development of listening skills that involve emphathising with the Vulnerable person is required. This might involve reflecting back to them as they speak what you are hearing them say and how they they are saying it, the underlying emotional tone. Interpretation and evaluation are avoided. Listening is frequently the only caring response needed.
The result of good listening is that the speaker experiences their feelings as having been honored and not discounted. Once you have established clear communication the following extras can be added in:
- Invitations to Problem Solving. (see above)
- Offers of specific practical help. The offers need to be genuine and not self-sacrificing
- Feedback about how you perceived them.
- Information. You may know some factual information that might assist the Vulnerable person.
Assertive
Skills to be developed: Assertiveness
Assertiveness is about getting your needs met without punishing. This requires:
- Asking for what you want
- Saying “no” to what you don’t want
- Giving feedback about behaviour that is causing a problem, and stating clearly what you want the other person to do differently
- Negotiating workable plans
- Using problem solving skills to get your needs met, even if the other person stays exactly the same
Based on a paper, ‘The Winner’s Triangle’, presented by Acey Choy of Sydney to the 1985 Transactional Analysis Conference held in Christchurch.
The Drama Triangle was originally developed in 1968 by Stephen Karpman, a Transactional Analysis trainer, as a way of graphically displaying the dance that occurs whenever we make someone else responsible for how we feel. According to Karpman, any time we don’t take responsibility for our feelings we are acting in a part of the Drama Triangle. The Drama Triangle can be a a simple yet powerful mechanism for understanding the relationships around a depressed person.
The roles of the drama triangle are: Victim, Persecutor and Rescuer. Karpman shows the relationship between these three roles by putting them on an upside down triangle. This shows the Persecutor and Rescuer in the one-up position that they take to the Victim.
- A Persecutor is someone who puts other people down and therefore goes one-up. They can act actively or be passive in response to the Victim.
- A Rescuer also goes one-up. They do more than their share and do they things they don’t really want to do.
- Victims don’t take responsibility for themselves. They will often feel overwhelmed with their feelings or even numb to them. They go one-down.
The arrows on the triangle indicate the direction of the transactions, but the drama in the Triangle comes from the switching of roles. As the drama triangle is played out, people change roles or tactics. Others in the triangle will then switch to match this. Sooner or later the Victim, sick of the one-down position, turns on the Rescuer. Or the Rescuer becomes fed up with a lack response or any appreciation of their efforts, becomes persecuting.
The Drama Triangle role names are part of our everyday language. Most people who are in relationship with depressed person will be familiar with being called a Rescuer when they are perceived as helping too much. A depressed person can also be labeled a Victim. While the Drama Triangle illustrates the problem quite clearly, its not always that easy to get out when you are in the middle of the drama. Thats why I like the Winner’s Triangle.
The Drama Triangle has been around long enough for there to be many derivatives and modifications. The Winner’s Triangle uses the same structure as the Drama Triangle but uses adult roles to replace the parent/child roles of the Drama Triangle. I first came across the Winner’s Triangle in a paper presented to the 1984 TA Conference by Acey Choy, she says she didn’t invent it and doesn’t know who did!
The roles of the Drama Triangle each have their equivalent role in the Winner’s Triangle. Each of the three roles in the Winner’s Triangle is an ‘OK’ role and requires the development of a different set of skills (see table below).
| Drama Triangle Role |
Winners Triangle Role |
Skill to be Developed |
| Victim | Vulnerable | Problem solving |
| Rescuer | Caring | Listening |
| Persecutor | Assertive | Assertiveness |
Any technique that the Vulnerable person can use to get themselves thinking about options and consequences is valuable. In the Caring role the development of listening skills that involve emphathising with the Vulnerable person is required. Listening is frequently the only Caring response needed. Assertiveness is about getting your needs met without punishing. Self awareness is essential in all three roles.
Links
Stephen Karpman’s own site
In an online debate on the topic “Can we teach people to be happy?” between Anthony Seldon and Frank Furedi they set out their differing points of view.
Seldon says ‘Yes’ and gives the following reasons:
- if schools do not, children may never learn elsewhere
- depression, self-harming and anxiety among students are reaching epidemic proportions. …. Teaching schoolchildren how to live autonomous lives increases the chances of avoiding depression, mental illness and dependency when they are older.
- since the development of the positive psychology movement under Martin Seligman and developments in neuroscience, we now know how to teach wellbeing, and have empirical evidence of its effectiveness
Furedi says ‘No’ saying “there is no evidence that it works” and suggesting that:
Children are highly suggestible, and the more they are required to participate in wellbeing classes, the more they will feel the need for professional support.
- Cut and arrange flowers or bring a live plant into your office or living space.
- Clean up your room (or start with one small shelf, drawer, or corner).
- Wash your clothes.
- Paint your walls a shade of yellow or another color that cheers you up.
- Try different kinds of music in your home – poppy, mellow, country, opera, pop, etc.
- Try aromatherapy – use different scents of candles, incense, or oils. Choose fragrances that remind you of a happy place or time or those that are known for their uplifting qualities.
- Move the furniture around to create a different feeling in a room.
- Change the lighting – try opening windows or curtains; if necessary, get full-spectrum light tubes
Following up on Dr Paul Keedwell, the expert on mood disorders referred to in Is depression good for you?. I found that he has written a book How Sadness Survived: The Evolutionary Basis of Depression in order to help us understand why something that causes so much pain and disability has withstood evolutionary changes and still occurs so commonly.
The truth is that short-term pain can lead to longer-term gain. A recently published follow-up study of depression in Holland – the Netherlands Mental Health Survey and Incidence Study (Nemesis) – used a sample of 165 people with a major depressive episode, and provides some preliminary scientific evidence to suggest that depression is indeed helpful in the longer term. Researchers who were looking for evidence to suggest that depression leaves people chronically disabled were surprised to discover the opposite.
In the Guardian article Upsides of being down he argues that focusing on depression in a purely clinical way is preventing us understanding our susceptibility to it and ignores the good it can bring.
Keedwell is seen here being interviewed about the publication of a meta-analysis that says some SSRI’s are ineffective.
Possibly as result of the study (see Anti-depressants ‘of little use’), there has been a resurgence of interest in the evolutionary basis of depression that is Keedwell’s specialty.
One evolutionary approach argues that the reduced feelings that are the result in depression are the adaptation. Another approach argues that depression itself is an adaptation.
Evolutionary adaptations generally have four characteristics. They;
- lack heritable variation
- show evidence of good design
- are evoked by appropriate triggers
- fitness is reduced where they are absent
Depression shows none of these characteristics. It is characterized by heritability, recurrence, cognitive impairment, and poor social outcome.
Consider this test, entitled “Five Questions to Determine Whether Drug Use Is Appropriate or Constitutes Abuse,” from the American Family Physician by Eric Voth and colleagues. The authors say that “one to five negative responses usually indicate inappropriate or non-medical use.” Dr. Voth is co-author of ‘AIDS, Drugs And Society’.
In NZ we say ‘medication’ (I notice hospital staff say ‘meds’ for short) rather than ‘drug’ for prescribed medicine. ‘Drug’ is usually reserved for a substance taken for its narcotic or stimulant effects, often illegally. A fine line… read on.
The questions are followed by comments by Dr. Sydney Walker in “A Dose of Sanity”.
- Is the drug used for a legitimate medical purpose? Usually not, because psychotropic drugs mask symptoms rather than treating the cause of a disorder. Furthermore, they are generally prescribed for patients who have been tagged with a DSM label after receiving little or no medical evaluation – the basis for any legitimate medical treatment. And they arc too frequently given to patients with DSM labels such as “phase of life problem” or “dysthymia” (a term that translates to “a mild case of the blahs”) – people with no real medical problems at all. In addition, many psychiatric drugs don’t do what they promise to do. Benzodiazepines, for instance, appear to be ineffective after a few weeks – yet they’re generally prescribed for long-term use.
- Does the drug improve the quality of patients life? Usually not, because the short-term relief psychiatric drugs provide is general, outweighed by, their long-term effects-including addiction, severe sleep disturbance, sexual problems, and profound neurological dysfunction. Furthermore, patients’ underlying disorders are left untreated and generally grow worse. And patients who become addicted frequently, suffer from terrible guilt, because of the stigma society attaches to addiction – even when it occurs innocent victims of improperly, prescribed medications.
- Is the physician helping the patient maintain control over the use of the drug? Almost never. Psychiatric drugs are generally prescribed for long-term use, with little physician supervision, thus maximizing the chance of addiction and reducing the patient’s control over drug use. Most patients have little contact with their doctors after a drug is prescribed, except for quick visits at prescription renewal time. These appointments, which psychiatrists sincerely think of as “evaluations,” usually, are quick in-and-out visits for which the psychiatrist collects $50 to $100 merely, for writing a prescription refill.
- Is the use of the legal and uncomplicated by illegal drug use? Not always. The original prescription is of course legal, but a large number of prescription drug users develop addictions that expand into illegal drug use. A patient given a six-month prescription of Valium or Xanax, for instance, is at high risk of becoming addicted, and is quite likcly to turn to street drugs in desperation when the prescription runs out. And many, patients mix prescription drugs with alcohol use – a legal but potentially lethal combination.
- Is the pattern of use one of appropriate medicinal doses or is it one of intoxicating doses? “Intoxication” is defined in DSM-IV as “disturbances of perception, wakefulness, attention, thinking, judgment, psychomotor behavior, and interpersonal behavior” that arc due to the effects of all intoxicating substance on the nervous system, and that “generally [place] the individual at significant risk for adverse effects (e.g., accidents, general medical complications, disruption in social and family relationships, vocational or financial difficulties, legal problems).” Thus, the 23,000 patients who had complained to the FDA, by 1992, that they had suffered adverse reactions to Prozac – including delirium, hallucinations, convulsions, violent hostility and aggression, psychosis, and suicidal thoughts could be considered “intoxicated.”
According to this test, psychiatrists prescribing mind-altering drugs frequently fail to meet any of the criteria for appropriate drug administration!
Five Questions to Answer before Seeing a Psychiatrist
- Have you had a thorough and satisfactory examination by a family practitioner and/or appropriate medical specialist before considering a psychiatrist?
- Have you obtained a second (or third, or fourth) opinion, and Are you prepared to be assertive, in questioning a psychiatrist’s diagnosis?
- Are you practicing poor health habits (drinking too much coffee, smoking cigarettes) or poor sleep habits that may be responsible for your not feeling like yourself?
- Are your feelings or behavior patterns normal reactions to life events (for example, pressure at work, loss of a loved one, etc.)?
- What medications, vitamins, or over-the-counter drugs are you currently taking?
Five Questions You Should Ask If You Do Go to a Psychiatrist
- Does your psychiatrist believe that DSM labels, such as “hyperactivity” and “depression”, are the same as real medical diagnoses, and does he or she base treatments on such labels.?
- Will your visit include an extensive medical history evaluation and physical examination, as well as appropriate laboratory tests?
- If your tests and examination reveal a biological disorder, will the drug your psychiatrist prescribes correct the problem or simply mask its symptoms?
- Is your psychiatrist recommending psychotherapy for your condition, and, ‘if so, Is the psychotherapy being prescribed in addition to medical diagnosis and treatment, or instead of medical diagnosis and treatment?
- How would your psychiatrist compare the risks and benefits of any drugs he or she recommends?
From “A Dose of Sanity” by Dr. Sydney Walker. Subtitled ‘A psychiatrist explains why why it’s not all in your head’, the book takes us inside the business of contemporary psychiatry and shows how, by sacrificing sound medical principles in favour of cook-book diagnosis and quick-fixes (like Ritalin and Prozac) depressed people’s health is being jeopardised.
If anti-psychotics aren’t working to help people recover from depression, maybe you should just ride with it. Is depression good for you?
“Don’t beat yourself up about being depressed, in most cases it will run its course” says Dr Paul Keedwell. Keedwell is an expert on mood disorders at the Institute of Psychiatry, King’s College London. He says that all people are vulnerable to depression in the face of stress to varying degrees, and always have been.
A question of nature, not nurture?
The BBC News is steady source of useful information. The item Genes ‘play key happiness role’ caught our attention. Happiness (and un-happiness) are very interesting to people experience depression. “The science of happiness is a growing field, with demand from both the public and industry for insights into emotional wellbeing.”
Dr Alex Linley, from the Centre for Applied Positive Psychology, said that even though other studies supported the genetic argument, it was wrong for anyone to think that nature had dealt them a fixed hand in happiness terms.
He said: “What it means is that, rather than a single point, people have a range of possible levels of happiness – and it is perfectly possible to influence this with techniques that are empirically proven to work. “Simple things, like listing your strengths and using them in new ways every day, or keeping a journal where you write down, every night, three things that you are grateful for, have been shown to deliver improvements.”
