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What would you ask a marriage and family therapist?

Ask an MFT is an opportunity to answer questions from my followers on social media who would like some insights into the world of marriage and family therapy on many different topics. I want to reassure my readers that their identities are protected. While I get many questions, not all of them are useful for the general public so I can only respond to a select few each time.

Q: What can I do if I don’t want to go to therapy, but I know that my relationship needs work?

Robin: The first thing I would recommend you do is to explore and write about what is going on in your relationship that needs to change. Therapy can be a very powerful experience to bring about change, but it is not always needed. Most research-informed therapists will tell you that the change that comes about in therapy is roughly 70% attributable to the client. You are the one doing the work, you are the one making active changes to the ways in which you are thinking about your life and the ways in which you are taking action to bring about change. Here are several questions to get you started:

  • What specifically “needs work” in the relationship?
  • Do you and your partner have an agreed upon “shared view” of the events that led to the state of things in your relationship at present?
    • If not, how do you account for the difference in perspective?
    • Are differences in subjective reality respected and honored?
  • Have you and your partner sat down and had explicitly clear conversations about expectations in the relationship around:
    • Communication
    • Conflict resolution
    • Family and friends
    • Gender roles
  • Are your expectations realistic and flexible?
  • Do you know what influences the relationship both positively and negatively?
  • What self-initiated actions are you taking to enhance your relationship?
  • How do you stay attuned and recognize when your partner needs comfort?
  • How do you tune into recognizing your own needs and go about expressing those needs in a gentle, non-blaming way?

These are but a few of the myriad questions that many marriage and family therapists explore in therapy with their clients. There are couples out there who are able to change the way they are currently doing things without the guidance of a therapist. There are many resources out today and self-help books that people find to be effective. Two books that come to mind are Hold Me Tight by Sue Johnson and the Seven Principles for Making Marriage Work by John Gottman and Nan Silver. I hope this is helpful!
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Q: My primary care physician told me I could go on medication for my anxiety but the thought of taking meds is really off-putting. What else can I do besides taking meds?

Robin: With anxiety specifically, there are many different neurochemical changes that you can make to your brain starting today that does not involve medication. For example:

  • Are you sleeping too much or too little? This can affect your mood; Making sure you are taking care of yourself in the domain of sleep can help to reduce anxiety.
  • Are you exercising regularly? Developing and sticking to a consistent exercise regimen can have profound changes on your neurochemistry that can help stabilize your mood (i.e., reduce anxiety), improve concentration, increase libido, and regulate your eating and sleeping behavior.
  • Are you getting all of the vitamins and minerals that are in a daily multivitamin either via a daily multivitamin or better yet, through healthy eating? Are you drinking enough water to stay optimally hydrated throughout the day? Are you putting shitty foods into your body? Your brain chemistry is affected by the things that you eat, when you eat, and how much you eat (not to mention what kind of self-talk you may engage in, in direct response to what you are or are not eating). Making sure to avoid sugary beverages like soda and fruit juice is a good first step to balancing your diet. When your diet is healthy, in conjunction with healthy sleep habits, and a healthy weekly workout routine, you can experience reduced levels of anxiety.

I know that a lot of people share your concern about taking medication. When I discuss the idea of beginning medication with my clients when it comes up, I like to first consider the possibility that it is a short-term intervention. In other words, yes, there are people who are on meds, and they will (likely) be on meds for the rest of their lives. You need not jump to this conclusion at the first mention of medication. Many clients have reported that they found it helpful to be on an anxiolytic or antidepressant for a short period of time in conjunction with psychotherapy to help them get over a mental hurdle they have been facing, and that proved to be just the thing that helped them find progress and change in treatment.

That’s all for now! I try to keep these short and sweet. I look forward to the next Ask an MFT segment!

Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to Your Couples Therapist Blog.
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