Avoidants should take care not to fall for the come-ons of dating services that offer miracles in the form of alluring advertisements virtually guaranteeing to provide them with suitable mates. Disappointment and an unwillingness to try again is their fate, as it is of the avoidants who buy into books and embrace gurus that tell them how to succeed relationally, effortlessly, and in short order, promising an immediate and easy solution to a complex problem that will almost certainly take time and effort to solve.
AVOID GIVING PATIENTS BAD ADVICE
Bad therapeutic advice includes advice best reserved for nonavoidants such as “do your own thing”; “get your anger out”; “play hard to get”; “don’t say yes when you mean no”; and “make complete honesty your best policy.” Avoidants need to become more, not less, connected by keeping their anger in to develop and cement relationships; by generally playing easy, not hard, to get; by sometimes saying yes when they mean no—being cooperative, compromising, and even submissive, if only to temporarily reduce tension; and instead of always expressing themselves and speaking freely and indiscriminately, by being very careful of what they say and do in the recognition that most times they are only one of many hypersensitive people in any given room.
As mentioned earlier, therapists should not routinely give avoidants advice about who specifically is right or wrong, good or bad for them, leading the avoidant on to condemn specific relationships prematurely, and on some trivial and principled but unhelpful grounds. Along similar lines, an avoidant should seek not a compatible partner based on his or her answers to an Internet questionnaire, but a simpático partner, who, whatever his or her specific personality profile happens to be, is motivated to make a relationship work, willing to change if necessary, and especially loath to validate avoidant fears of being rejected by others by actually being rejecting.
SUPPLEMENTAL APPROACHES
At times, I refer my avoidant patients for an appearance makeover, to an exercise guru, or to another physician for needed medical care for physical ailments.
I sometimes suggest tricks avoidants can use to master the anxiety associated with giving a speech or meeting people at a social gathering.
Public speakers can help deal with the fear of fainting associated with stage fright by reassuring themselves that they are not losing consciousness by moving about in place, wiggling toes, tightening the thighs and buttocks in a symbolic attempt to get the blood to flow back to the brain, sucking on a mentholated cough drop or sugar candy to refresh themselves, or having a sip of ice water to “shock” themselves back into focus. They can also make their audience seem less frightening by demeaning them, for example, by imagining them in a ridiculous pose so that the audience looks as ridiculous to the speaker as the speaker feels he or she looks to the audience.
I often recommend the following “healthier” defenses as potentially salutary substitutes for defensive withdrawal (healthy defenses are also mentioned in chapters 11 and 20):
• Healthy avoidance, which allows patients to retreat from unimportant, uncomfortable relationships in order to prevent discomfort in these relationships from spreading to contaminate and destroy potentially productive social and personal contacts (healthy avoidance is specifically discussed in chapter 3)
• Healthy denial and counterphobia, to cope with criticism and rejection and to overcome anxiety about becoming intimate—short of becoming an extensively frantic, gregarious hypomanic who pushes too hard and acts too precipitously to master his or her terror of doing anything at all
• Healthy projection, involving an “it’s you, not me” philosophy (particularly useful in an emergency where one’s self-esteem has fallen and badly needs a temporary lift through a reduction of self-blame via blaming others)
• Healthy identification, becoming like others who are less fearful and less guilty, more self-tolerant, and more self-assertive. While this is controversial, therapists can, in selected cases and in a limited way, become identification figures through sharing personal experiences by telling their patients how the therapist warded off or actually resolved his or her own problems with avoidance, doing this in the hope of encouraging his or her patients to identify with the nonavoidant therapist. However, sharing experiences, life stories, life problems, and personal triumphs, while likely to be effective with dependent avoidants, who hang on a therapist’s every word, and with obsessive-compulsive avoidants, who are so paralyzed when it comes to making any interpersonal progress that they beg to be told what to do (even though, at their most resistant, they plan not to do it, or to do the opposite), is likely to be a bad idea for paranoid avoidants, who suspect their therapists of wanting to steal their money by talking about themselves on their time, and “dime,” and for alarmist histrionic avoidants, who see any signs of avoidance in the supposedly healthy therapist as indicative of the complete hopelessness of their own situation, and as a bad sign for the outcome of their therapy.
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CHAPTER 15
Oth er Forms of Therapy
VIDEO
Bandura has described a process that he calls “observational learning,” a form of modeling through which avoidants and others can learn how to form healthy interrelationships by imitating people who are interacting with the appropriate level of intimacy.1 Buggey uses a special method of observational learning that employs video self-modeling (VSM)—a relatively new technique for modifying behavior using positive examples of interactions created through the editing of videos, where avoidants can view themselves performing a task just beyond their present functioning level. 2 In VSM, the therapist videotapes avoidant patients interacting with others, then edits out the problematic interactions so that the avoidant patients can watch themselves doing better. This has been found to be an especially powerful way to learn nonavoidance since people imitate models they are similar to, and who is more similar to us than ourselves?
MARITAL/COUPLE THERAPY
Marital or couple therapy is a form of interpersonal therapy dedicated to helping two individuals basically committed to each other repair their relationship.
A review of the literature and an informal sampling of therapists reveals that marital therapists do not always agree on the best way to help couples in which one or both members of the dyad are avoidant work out their problems. Possible methods include the following:
• reducing unilateral or mutual avoidances through abreaction and other techniques meant to relieve contributory emotional tension and pressure
• undergoing psychodynamically oriented psychotherapy to resolve marital problems through the development of insight into what is going on individually and interpersonally