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The Thoughts That Wound

Cognitive therapy is teaching troubled couples to listen without getting the message wrong

BY DAVID GELMAN

A chat at the dinner table ...
MARJORIE: I'm fed up with the job. I really should quit. Harry [the boss] is always giving me a hard time.
KEN: (If she quits we won't be able to manage. How can she do this? ) You always do things impulsively.
MARJORIE: (He doesn't trust me. He should know I would not quit. ) I'm just trying to tell you ...
KEN: (This is awful. I've got to stop her from thinking this way. ) I don't want to hear any more about it!
MARJORIE: (He doesn't care about me.) (Starts to cry and runs to the bedroom.)
KEN: ( She always does this to make me feel guilty. ) Don't you run out on me!

-From "Love is Never Enough,"
by Dr. Aaron T. Beck

It sounds like "Scenes From a Marriage," by way of "Strange Interlude" --dialogue seething with masked suspicion and resentment. Almost anyone would recognize it as the mundane and intimate stuff of which real relationships are made and, all too often, unmade. That is the way unhappy couples communicate, by means of small confrontations in which much of the vital information is withheld. Marjorie had no intention of quitting her job; she simply needed to blow off some frustration. Ken hadn't meant to be so harsh. It was just that Marjorie's salary was higher than his--making him a bit touchy to begin with-and she didn't seem to realize how threatened he felt by the idea of doing without it.

But signals are missed, explanations are lost in the skirmishing. "And so begins a vicious cycle of attack and retaliation that can easily whirl into other areas of the relationship," says psychiatrist Aaron Beek, director of the Center for Cognitive Therapy at the University of Pennsylvania, in his just published book, "Love is Never Enough" (323 pages, Harper & Row. $17.95).

Beck, one of the major figures in psychotherapy, pioneered the widely influential cognitive approach, which focuses on rooting out distorted self-perceptions. An offshoot of behavioral therapy, it has been notably effective in straightening out the distorted self-perceptions of depressives. Beginning a few years ago, therapists have been taking the technique into the equally murky realm of couples' relationships, with some strikingly effective results. At scores of counseling offices and cognitive therapy centers around the country, couples seeking help with troubled relationships are being taught the fine points of a skill which surprisingly few of them appear to have grasped: how to listen to each other without distorting the meaning of what they hear.

One of the important ideas in cognitive therapy is that the way we see ourselves often depends on the way we think others see us. As Beck explains it, such perceptions are shaped, in turn, by our interpretation of "signals" we get from people. But the interpretations may be biased by our state of mind. Therapy tries to correct the biases by giving the patient behavioral exercises, such as keeping logs of negative thoughts that he must then measure against the available facts.

Psychologists first began applying Beck's cognitive principles to marital therapy after a 1981 paper by psychologist Norman Epstein noting that couples suffered from some of the same "signal" distortions as depressive relationships can stumble in any number of ways. But cognitive therapists behave much of what goes amiss first happens in the parenthetic thoughts of the combatants, as with Ken and Marjorie.The misunderstandings may be then from the start. Couples often begin with ideal expectations Some spouses assume they have"agreements" that really exist in only one partner's mind--the belief, for instance, that each should sense the other's needs.

Broken Trust: That, apparently, is the underlying problem for Phil and Dot,* who began seeing psychologist Mark Gilson at the Center for Cognitive Therapy in Atlanta, Ga., a few weeks ago. According to Gilson, Phil feels that when he and Dot were married, three and a half years ago, she should have understood that he had a strong sex drive. Because she is balking at the frequency of his demands, he feels betrayed. "When the partner doesn't live up to the expectations, the other becomes an upset as if a legal contract had been violated," says Norman Epstein, now an associate professor at the University of Maryland, who encounters the phenomenon in his own private practice, "Its an if a basic trust had been broken."

Once tryust is lost, couples begin hesitating to say what they really mean. They tend to misread each other's minds, impute the worst motives to each other and "over. generalize" their complaints: "You always come home late." "You never help me with the kids," are typical overstatements. Says Jeffrey Young, who heads the Cognitive Therapy Center in Manhattan: '"The degree to which people misinterpret events and exaggerate their meaning in remarkable. It's the essence of what I deal with everyday."

Building Walls: Eventually, hos- tility colors everything, so that even benign behavior becomes suspect ("What is he after?"). Gilson says that he is struck by the predominance of "self- statements" among couples who come in for help. "They're both saying how unfair things are. Phil says, 'I wanna have sex more often. This is what marriage should be.' Dot says,'I don't think I have to do that, and it's not fair that he keeps pressuring me.' They go back and forth, digging their heels in, and wind up building a wall between them. "

The therapist's task is to got one partner to provide some feedback for the other, even if it is through gritted teeth.- "Did I hear you right? You fed we should have more sex together?'" says Gilson. "It brings down the emotional level by breaking the put- tern of two Persons who keep reiterating their own position. Ultimately, it allows for dialogue-it validates what the other per- am is feeling." Couples are given exercises to do in therapy sessions and at home during which they practice listening without trying to defend themselves. Instead they are told to paraphrase back what their partner is saying Also. the person doing the talking has to avoid Wing provocative. The exercise isn't as easy as it may sound. Couples must work to avoid their almost automatic prosecutor--defendant postures.

For Phil and Dot, it is still too early to tell whether learning to listen will solve their problems. Dot, who has bud other forms of therapy, finds cognitive -a little different. It's being re-educated in the way you thin', Mark (Gilson) says, 'Y'all don't listen to each other, you're so busy defending! That's exactly what we do, and whether we can fix that or not, I don't know."

Cognitive therapists believe that the bias in the way we read each other's signals comes from a kind of personal "script" we carry with us. Robert Leahy, who runs his own Center for Cognitive Therapy in Now York (there are 20 such unaffiliated centers around the country, including Beck's), explains how such scripts operate with Sam and Mary, a middle-age couple he has been seeing. As a child, Mary had formed an alliance with her mother against her rejecting, hypercritical father. But after her father died, she felt betrayed when her mother chose to move to the town where another daughter lived. Out of this came a script in which she in always "second best." Sam developed a script of his own from parents who assiduously concealed any hint of domestic discord, from their children. Sam's script dictates that he must always appear to be a loving father an husband.

Problems arose a few months after San and Mary were married, when Sam's first wife decided to leave their two adolescent children with Mary and him in preparation for her remarriage. Mary felt betrayed when Sam didn't assert himself by getting his ex to set a definite time for when she would get married and retrieve the children. Sam, as usual, was playing the good guy. Mary, as always, was feeling second best. Says Leahy: "He felt everyone should see him as model husband. Meanwhile she's getting more enraged."

At Leahy's suggestion, Mary finally called Sam's ex-wife herself. It turned out her marriage plans by then were set. But as she talked to the woman, Mary began to sense Sam's problem in pinning her down. From there on, matters improved. Leahy gave the couple "homework," asking them to prepare lists of what each wanted from the relationship. Each then had to agree to some of the other's aims. "He also told us to meet once a week at a certain time to discuss things before they get out of proportion," says Mary. "Leahy's phrase with me was, 'Don't go nuclear. You can deal with things more rationally'."

Phasing out: Sam agrees the therapy has been "a course in communication" that has helped "immensely" in a matter of weeks. "It's so simple," he says, "once you see what the issues are and the actions that you can take-- once you start understanding how the system works." Above all, he feels, he and his wife have learned how to receive and send clearer signals. "My assumption was she would support anything I did. I found myself not consulting her, just sort of announcing 'the kids are going to be doing such and such'." Adds Leahy: "The important thing is they both know now that the -other has a script"

Sam and Mary are now beginning to phase out of therapy, seeing Leahy just once a month. The average span of treatment is 12 once-a-week sessions, with some possible "booster shots" afterward. One or both partners may also linger a year or more for individual treatment. To date, there have been no major formal surveys of the results of cognitive therapy for couples. But the anecdotal evidence is generally favorable: in many practices, a significant number of patients have tried other therapies and, by comparison, they tend to give high marks to the cognitive variety. As for the father of cognitive therapy himself, Beck finds the use of his technique with couples as satisfying as anything he has ever done. "I tend to be a Pollyanna," he says. "I always feel a marriage is worth saving, even when they say it's brain dead. Did you love each other once? Well, you can love again."