How to Stay Emotionally Connected in a Relationship

Clear communication is key in any relationship, but it’s hard to know what you actually need to communicate. As the years go by, expectations change, patience wavers, and we use fewer words to convey our needs and feelings. But our longest relationships need more thorough communication to survive.

Think about a parent and a child. I love my mother, but I expect more from our relationship than my acquaintances. I have little patience when she misunderstands me repetitively and I don’t always tell her what I need in clear language. When I perceive her as unhelpful or negative, I can feel like exploding!

Now think about a romantic partner. We choose our partners for the connection we share and times when we feel they understand us. Partners can know us better than some of our blood relatives. So what happens when we get into an argument with our partner?

Typically, all we really want is to know we’re connected to our partners, for them to say, “Yes, I’m still here for you. I still love you.” We want a hug, a kiss, a sign they’ll show up when we need them the most. But we’ve learned not to ask for those things because it makes us feel vulnerable. But if this is the person you love, someone you want to spend the rest of your life with, then they’re the perfect person to share your vulnerability with.

Phrasing and emphasis are also important to ensuring clear communication. Often we focus on demands and the negative aspects of disagreements in order to keep our vulnerabilities from showing. Instead of saying “You need to come home on time so we can eat dinner together. Why are you so careless?” try “I miss eating dinner and sharing my day with you. At times I’m hurt when you stay at work too long because it feels like you’re choosing work over me and our time together.” Finding and expressing the underlying emotional conflict can help partners understand how much they value their relationship and gives them a path toward reconciling disagreements through reestablishing connections and continued emotional investment in each other.

The next time you have a disagreement with your partner or just feel disconnected from them, ask yourself these questions:

What just happened?

Did your partner not text you goodnight? Did you argue over dinner plans? Is this a repeating argument? If so, you may have an unmet need (words of affirmation, quality time, etc.). This is an opportunity to explore your relationship expectations and how your relationship fits those expectations. Remember, sometimes our expectations are reasonable, and at other times they are not.

How am I feeling inside?

Anger and frustration can be secondary emotions (a reaction you have to another emotion). A primary emotion may be driving that anger and frustration. If you have trouble finding the right words, think about which emoji you would use if you wanted to text your best friend about your feelings. (Still having difficulty describing your emotion? Click [here] for an extensive list). Naming our emotions can help us understand what we might need from our partners.

How can I express this to my partner without using blaming or criticizing language?

This is an opportunity to share vulnerability accurately with your partner. Remember, it’s not about placing blame on them or yourself. Reconnecting and finding a solution together is the essence of reconciliation, and it takes clear and calm communication to succeed.

Additional Resources:

We’re constantly growing and changing as people, both physically and emotionally. Relationships are the same, and sometimes we need to find or create opportunities to reacquaint ourselves with lost or loose connections. For help, try exploring the questions in the Gottman Institute’s Love map.

A shared vocabulary and understanding of supplemental information can be a map for finding common ground. Gary Chapman’s The Five Love Languages is a great start for ways to express and reciprocate needs and wants in any relationship.

Most fights are a protest over emotional disconnection. In Hold Me Tight, Dr. Sue Johnson shows how attachment styles play out in relationships as “demon dialogues,” as well as tips for being more accessible, responsive, and engaged with your partner.

What Is Radically Open Dialectical Behavior Therapy?

Radically Open Dialectical Behavior Therapy (RO-DBT) is a new evidence-based therapy for people who are overcontrolled. A counterintuitive idea behind the therapy is that it’s possible to have too much self-control.  Self-control refers to our ability to restrain acting on our urges, emotions, and wants in favor of longer term goals. Most of the time, self-control is good, but some people can suffer from excessive self-control. For these people, inhibiting and controlling impulses and emotions has become so habitual and automatic that they have problem relaxing control when needed. This can result in overcontrolled people being overly inhibited, perfectionistic, cautious, and feeling exhausted by social interactions.

Where does overcontrol come from?

Overcontrol comes from a combination of genetic/biological factors and social and family experiences. Bio-temperamental factors include high threat sensitivity, low reward sensitivity, high inhibitory control, and high detail-focused processing. In more plain language, this means that people who eventually become overcontrolled are born with a tendency to:

  • notice the difficult things in life
  • be more sensitive
  • be more anxious
  • feel fewer positive emotions
  • have higher capacities for self-control
  • tend to notice details that others are less likely to notice.

These biotemperamental factors combine with experiences with family, school, peers, or culture to produce overcontrol. Life experiences that contribute to overcontrol are those that teach the person that:

  • it’s very important to not make mistakes
  • showing weakness or vulnerability is dangerous or bad
  • it’s important to stay in control at all times
  • winning or succeeding is very important

Some people tend to have more of the biotemperamental factors, while some have more of the environmental factors, and some people have a lot of both. The more of these factors the person has, the more extreme their overcontrol is likely to be.

What does overcontrol look like?

It’s important to note that overcontrol is not just one trait, but a confluence of traits that all come together in this overarching concept. Some people will have more of the traits than others, but there are a number of things that overcontrolled people tend to have in common:

Overcontrolled people have a hard time relaxing their habitual emotional inhibition. People who are overcontrolled tend to be good at inhibiting their emotion-based impulses (for example, delaying gratification) and avoiding expressing emotions they don’t want to express (for example, by masking inner feelings). This often becomes so habitual that they can’t voluntarily relax inhibitory control in situations that call for flexibility, such as those that call for open expression of emotion or unrehearsed responses, for example dancing, parties, meeting new people, during play, or on a romantic date. High inhibitory control often leads overcontrolled people to prefer structured situations and order and to avoid novelty or situations where there are not clear rules about how to behave or where the outcome is uncertain. They will often find being around others for long is exhausting. This can also lead to perfectionism, a strong sense of duty or social obligation, rehearsing extensively before social situations, and high moral certitude (for example, feeling like there’s a right way to do things).

Overcontrolled people often feel lonely and lack a sense of belonging or closeness. They may have friends (perhaps even a lot of them), but don’t feel like any of those friends truly understand them. Alternately, they may not feel particularly close to anyone or may avoid social situations for the most part. They often feel like they are different from others and feel unsure about how to make friends or get closer to people. It’s also common that they may be unsure if relationships are really worth the trouble or effort.

Overcontrolled people tend to mask their expression of emotions or only share socially-acceptable emotions. This can often result in expressions of emotion that are not well-matched to the context, for example having a flat facial expression when a co-worker expresses excitement or gives them a complement. Or they may tend toward insincere or incongruent expression of emotion, for example, smiling when upset or laughing at a joke they did not find funny. As a result, many overcontrolled people may have difficulty knowing what they feel or tend to be stoic and not report distress.They may also engage in a lot of social comparison and, as a result, tend to be quite critical of themselves or others.

Overcontrolled people often find feedback difficult and are rigid and rule-governed. They are often closed off to new experiences, reluctant to try new things if unsure of the outcome, and avoid uncertainty or unplanned risks. They can be suspicious of the motives of others and tend to hide their true feelings until they get to know someone better. They may tend to have a knee-jerk reaction to defend themselves from critical feedback or may do things to avoid getting feedback because it’s so painful.

How does RO-DBT work?

RO-DBT emerged from 20 years of research into how to help people who suffer because of excessive overcontrol. The treatment pulls together experimental, longitudinal, and treatment outcome research in the form of this novel treatment. This website has an overview of the research behind RO-DBT. The most common mental health problems characterized by overcontrol are chronic depression, anorexia, and obsessive-compulsive personality. RO-DBT is meant to reach out these folks who are often suffering in silence, with few, if any others knowing how bad they are hurting.

RO-DBT is strongly informed by basic research on the facilitative and communicative functions of emotions in facilitating close social bonds. According to the theory, bio-temperamental differences combine with experience to lead overcontrolled individuals to engage in behavior that interferes with the formation of close social bonds, resulting in social isolation, loneliness, and distress. RO-DBT focuses on changing social signaling so that emotional expression is more appropriate to the social context. More appropriate emotional expression then results in increased trust and desires to affiliate from others and thereby increased social connectedness.

RO-DBT is typically delivered over 30 sessions of concurrent individual therapy and skills classes. It’s an active and structured therapy in which people learn concrete skills that they can adapt to their own lives and immediately put to use.

What is radical openness?

RO-DBT aims to develop radical openness, which has three components:

  1. Acknowledging stimuli that are disconfirming, unexpected, or incongruous, which are often associated with distress or unwanted emotion. This is in contrast to automatically explaining, defending, accepting, regulating, distracting, or denying what is happening in order to feel better.
  2. Self-inquiry, which involves asking oneself good questions in order to learn. This involves intentionally seeking ones’ personal unknown in order to learn from a constantly changing environment.
  3. Responding flexibly by doing what is effective in the moment, in a manner that signals humility and accounts for the needs of others.

How do I find an RO-DBT therapist?

A list of therapists around the world who have completed the RO-DBT intensive training can be found on this website. Intensive training involves two, one-week long training events approximately six months apart with therapists encouraged to get follow up supervision. We typically run an RO-DBT skills class here at Portland Psychotherapy, but there are also other local therapists on the website listed above.

If you are a therapist wanting to learn more about RO-DBT, you can buy the book here.

The Importance of Acceptance in Dealing with Obsessive-Compulsive Disorder

People with OCD are often plagued with a wide variety of painful thoughts. These include horrible images, worries they might harm themselves or others, or beliefs that they are condemned altogether. It’s natural why people would struggle with these, why they would try to push them away and get rid of them.

However, there’s a wide literature of research demonstrating that efforts to get rid of painful thoughts make them more intense and more intrusive. And there’s newer research that finds that acceptance of painful thoughts and feelings may be the most effective way for defusing OCD.

The study

OCD expert Dr. Jonathan Abramowitz’s lab looked at the relationship of two ways of dealing with OCD. The study found an advantage for mindful acceptance over brute endurance of obsessions.

One way of relating to inner experiences, called distress tolerance, refers to enduring painful emotions. This is akin to “gritting your teeth” and powering your way through it.

The other way is called psychological flexibility, the opposite of what is called experiential avoidance. One major process in psychological flexibility involves experiential acceptance, being “open and willing” to experience uncomfortable thoughts and feelings.

What the researchers found was that willingness (i.e., choosing) to accept painful thoughts and feelings was associated with lower obsessions. They further suggest that this relationship may be especially true for people who struggle with mental rituals (e.g., Pure “O”).

Limitations

There are limitations to this study. It was correlational and involved college students. The study did not specifically look at the impact of treatment.

Summary

New research suggests that how people relate to OCD-related thoughts and emotions may be important in the maintenance of OCD symptoms. Specially, people who are more willing to experience discomfort without engaging in compulsions may do better than those who can resist compulsions but do so through gritting their teeth and enduring it.

For these reasons, newer acceptance-based treatments such as Acceptance and Commitment Therapy (act for short), which already has good research support in treating OCD, may have something unique to offer.

In working with OCD, I often start with ACT skills building to help people learn to mindfully accept unwanted thoughts and emotions before moving into ERP (exposure and response prevention). In my experience, the ACT work offers people—especially those with more mental rituals—additional tools for working with OCD symptoms, and helps prepare them to engage in the tough exposure work.

If you or some you know is struggling with anxiety-related problems, please check out the Portland Psychotherapy Anxiety Clinic. If you would like to learn more about my approach to OCD specifically, check out my OCD website, where I described how I use Acceptance and Commitment Therapy to help enhance exposure and response prevention

People with OCD Prefer Exposure to Alternative Treatments

Mad in America published a summary of a recent study that surveyed people with OCD about treatment preferences. I spent the last hour trying to track down a copy of the actual research article, which has not been officially published yet, but I was unable to locate a pdf and read it myself.

One of the authors is Dr. Helen Blair Simpson, whose brief information video about OCD is a good one.

The study

The researchers surveyed 216 people with OCD about their treatment preferences. Most people preferred Exposure and Response Prevention (ERP) as a 1st line treatment. The 2nd most popular treatment was serotonin reuptake inhibitors (i.e., antidepressants). Based on how the abstract was worded, there may be no statistically significant difference between preference for ERP (55%) and preference for antidepressants (45%).

Interestingly, people who preferred antidepressants were more likely to have higher income, private insurance, and a longer history of OCD treatment. According to the Mad in America article:

The researchers theorized that this may be due to this group having “received high-quality psychiatric care that afforded them the time and attention to discuss and resolve concerns about medication.” That is, people without these resources may have had poor experiences with medication management in which they felt pressured or their concerns were not heard. Psychotherapy may have provided an approach tailored to their individual concerns, making it more desirable.

People with OCD didn’t want antipsychotic drugs

People with OCD already taking antidepressant medication preferred ERP as an adjunct treatment over augmenting the antidepressant medication with an antipsychotic. In a prior post, I wrote about research that suggested that antipsychotics were not a useful adjunct treatment for OCD.

Acceptance and Commitment Therapy (ACT), an evidence-based treatment that we offer, was also well received among alternatives to ERP and medications. In a prior blog I used to write for, I wrote about a study on the use of ACT for OCD without deliberate exposure, and OCD researcher Dr. Michael Twohig has a page about ACT and OCD on the IOCDF website.

One theme that stood out to me reading about the study was how well-informed the sample of people with OCD is. Their preferences are remarkably consistent with current research about OCD treatment.

You can read the Mad in America article here, and an abstract of the research study here.

If you or some you know is struggling with anxiety-related problems, please check out the Portland Psychotherapy Anxiety Clinic. If you would like to learn more about my approach to OCD specifically, check out my OCD website, where I described how I use Acceptance and Commitment therapy to help enhance exposure and response prevention.

The Importance of Treating OCD Earlier: The Washington Post Article on Ethan’s Struggle from Childhood OCD through Adulthood

In people who develop obsessive-compulsive disorder, there are often signs in childhood. However, OCD in children can be hard to distinguish from childhood fears and age-appropriate magical thinking. For OCD Awareness Week, The Washington Post published an article by Sarah Maraniss-Vander Schaaf about the experiences of Ethan, a young man who developed OCD in childhood. It’s an effort to help people look past the stereotypes of people with OCD as being excessively clean and organized or washing their hands excessively. As the writer notes:

“…true OCD is often unspoken. It’s hard to recognize, as well, when growing up in a family where anxiety is normal, or in a school where behavior might be labeled school avoidance, or when no one else talks about the secret rituals that are too private to mention.”

The article traces the development of Ethan’s OCD from early childhood, though college, and the following decade of adulthood. It documents how OCD obsessions and rituals can escalate when left untreated and unchecked, and it provides a sober illustration of how the accommodation by the loved ones of someone with OCD’s obsessions/rituals—however well-meaning—can have disastrous consequences over time.

I’ve written in other posts about how some people with OCD have difficulty accessing appropriate treatments. Ethan was eventually accurately diagnosed and offered effective treatment, but it took several attempts before he was fully willing and able to engage treatment. He was even kicked out of OCD Institute at McLean Hospital, one of the leading residential treatment programs for people with OCD. Ethan didn’t recover from OCD until he was willing to commit to proper treatment—particularly exposure and response prevention. Ms. Maraniss-Vander Schaaf writes:

His improvement came when he accepted CBT and Exposure Response Prevention (ERP). He was taught to develop a new relationship with his thoughts. He learned to live with the uncertainties of life and not push away anxiety with obsessive-compulsive thoughts and actions.

Ethan’s story is inspiring as, even after 2 decades of struggling with severe OCD, he is currently enjoying a productive and independent life. As I work with adults, I don’t often have a full view of how OCD progresses across the lifespan in the clients I see. I found this article of Ethan’s personal journey into OCD illuminating in how it presents a narrative of someone’s struggles with OCD across more than 2 decades, and the way OCD symptoms can change, transform, and evolve over time.

You can read the full article here.

If you or some you know is struggling with anxiety-related problems, please check out the Portland Psychotherapy Anxiety Clinic. If you would like to learn more about my approach to OCD specifically, check out my OCD website.

If you want to learn about OCD, here’s post about a great introductory book, Tompkins’ OCD: A Guide for the Newly Diagnosed.

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