The Importance of POWER in Relationship

The Importance of POWER in Relationship

Being a systemic therapist requires ongoing analysis of the ways in which power dynamics organize and shape the life-long relational dances in couples and families.  Experiences of privilege and marginalization in the cultural landscape are critical to the daily lived experience of our clients, and impact their relationships in profound ways.

In working with our Psychiatry residents at Penn, I welcome writing that fosters clarity about the influence of these complex, often silenced, aspects of power.

Once again, my friend and colleague Ken Dolan-DelVecchio has provided a map.  He distinguishes between two types of power:  power over, which is the right to dominate, and power with, the responsibility for shared success.

He states:

Power with, the alternative to power over, sees power not as the opportunity to dominate and control but, instead, as the responsibility to bring about good things for everybody involved. It is the essence of great leadership, partnering, parenting, and friendship. Indeed, power with is the essence of love.

I invite you to read his article Radical Self Awareness #1: The Importance of Power.

In doing so, you’ll access this “essence of love,” and better, help couples and families learn to  “bring about good things for everybody involved.”

After all, isn’t that, quite simply,  what we’re all working toward?


A Little #MeToo for Men

A Little #MeToo for Men

Several heterosexual couples in my clinical practice have struggled of late with issues related to the #MeToo movement.  Memories can surface for the female partner that engender feelings of rage, tremendous pain, and fear.

Trainees ask how best to help navigate these important, but potentially difficult conversations between the couple.  The work of unpacking the dominant norms of masculinity and their subsequent impact on relationship can indeed be a daunting task in the hour allotted for couples therapy.

Both for couples and the therapists who treat them, I recommend The Little #MeToo Book for Men.

Written by  Mark Greene, whose work I have previously cited on our CCAF blog, it is a call to understand the cost exacted by the rules of manhood, or as Greene describes it “man box culture.”

He states:

For millions of men, manhood can seem like a foregone conclusion, mapped out for us by universally understood rules for being a ‘real man.’ These rules determine how we walk, how we talk, what we think and do, what we view as our responsibilities and most importantly, how we pursue or fail to pursue our deepest needs, wants and desires.
These rules of manhood become so central to what we believe as to render the distinction between ourselves and our culture of manhood invisible to us.
When millions of men live our lives subject to the rules of a culture we are not fully conscious of, it can be damaging for our families, our communities, our collective quality of life, and even our longevity. The Little #MeToo Book for Men seeks to encourage a conversation about how boys and men arrive at what we believe.”

Greene has that rare talent of being able to distill what can feel like such complex, and yes, terrifying, relational issues.  Elusive, and just beyond our reach, we can feel the weight of gender dynamics, and the attendant pain, but are often left without words.

The Little #MeToo Book for Men is a wonderful tool, a clear, and concise map that will help move the conversation forward.

I know my children’s generation has begun to imagine and enact a culture that defies gender binaries.

Perhaps it’s not too late for us.

If this conversation can reveal even the slightest glimmer of daylight between our dominant culture of masculinity and our own daily choices as men, my hope is we will find, in that space, a more vibrant and authentic connection to our agency, our power and our humanity.

Matters of the Heart

As a family therapy clinician and teacher, I am constantly talking about the importance of relationships.  I’m thus thrilled when those outside of my specialty acknowledge that as well – especially when it comes from my colleagues and collaborators in the medical community.

In “Why Your Cardiologist should ask about your Love Life,” Dr. Sandeep Jauhar discusses the link between heart health and our emotional and relational worlds:

We have learned, for example, that fear and grief can cause serious cardiac injury. During emotional distress, the nerves that control the heartbeat can set off a maladaptive “fight or flight” response that causes blood vessels to constrict, the heart to gallop and blood pressure to rise, resulting in damage to the body.

Those of us who are present daily to the intensity of marital strife can certainly attest to this fact. What is more tender to the heart than being hurt by someone we love?

It is becoming a known fact that the importance of relationship, and the quality of relationship, directly impact one’s health and well being.  Researchers here at Penn Medicine have examined the impact of marital status upon the recovery from cardiac surgery, as well as the involvement of family and friends in improving healthcare outcomes.

For example, colleagues at The Center for Healthcare Innovation studied how to engineer social incentives for health, and suggested that more of our healthcare delivery system take advantage of the highly influential nature of social relationships.

Other research focused on the connection between marital status and recovery from cardiac surgery, and found that married people may fare better than those who are divorced, separated or widowed.  Although there is a lot more to examine relative to this connection, it is heartening to see the significance of relationship included as a key factor in promoting health and well being – yes, even in recovery from cardiac surgery.

Indeed, cardiologist Sandeep Juahar suggests we deploy a paradigm shift away from the individualized mode of thinking:

We will need to shift to a new paradigm for heart problems, one focused on prevention, to continue to make the kind of progress to which patients and doctors have become accustomed. In this paradigm, psychosocial factors will need to be front and center. Treating our hearts optimally will require treating our minds, too.

Thank you, Dr.  Jauhar.  I could not have said that better myself.

Dr Hudak featured in Wall Street Journal article, “Here’s When Family Therapy Can Help”

I am so grateful to have had the opportunity to speak with award winning author, Elizabeth Bernstein, who writes the Bonds column for the Wall Street Journal.

She and I spoke, literally, for hours, about families and family therapy; she really captured the value of this approach to treatment.

Here’s the link to the full article.

For those without access to the WSJ, here’s a bit of the content.  You can also try to find it on Google News.

What is family therapy?

It’s a kind of psychotherapy that is different from individual work, in which the therapist interacts with the patient from a pathology-based model. The family is seen as a system. To understand the individual, I don’t look at a patient and think about what is going wrong inside them; I think about what happened between them and the significant people in their life—their partner, siblings, parents, kids. To me, that is the genesis of so many of their problems.

One of the important characteristics of a system is the perpetual movement toward homeostasis. People like things being the same. The response to change can be a very powerful pushback. In a family there is constant tension because a life cycle is about change. And sometimes the system can’t tolerate it. Some of the changes are expected, such as birth, death, marriage and adolescence. But sometimes life hands us unexpected challenges—people can develop other health issues: psychiatric problems, mood disorders, chronic health problems, addiction.

Think of a family system as a bunch of people dancing together in a particular way. They have been doing this a long time, perhaps generations before they ever got to my office. I have to learn the dance steps of each family member. Then I coach them on new dance steps.

How does family therapy work?

There is no one way. Typically I want to see the parents first. I’ll draw a genogram, or family tree, going back several generations. I want to know who came to this country and when. That elicits stories, maybe of what happened during the war, or persecution or loss, or tragedy or resilience or courage. These begin to tell me some of the things that are important to them. And it helps me understand the context of what they grew up in and how it impacted how they parent.

I think people’s notion of family therapy is you just throw everybody in the room together. That’s not true. I bring in different constellations of the family—sometimes individuals, sometimes pairs, sometimes everyone together.

I say you should give family therapy at least nine months to a year. But I don’t believe in keeping people in therapy. I am pushing people to go out and live their lives and if there are problems to come back.

How do you know when a problem warrants therapy?

Often, whoever is suffering—the symptom bearer, the acting-out child or depressed adolescent—is targeted for treatment. They go to therapy. But sometimes it doesn’t work. When symptoms continue unabated despite other treatments, maybe the family system needs support. You can always come for a consultation, to see if it may work.

Has your therapy style changed over the years?

I have gotten much less attached to a particular theory and way of doing things. And I am much more collaborative with my families, to see them as experts in their own story. I am more interested in how they see it, as opposed to how I see it. I am really interested in getting people to be researchers into their own lives.

Can a person go to family therapy alone?

Absolutely. A lot of individual, family-oriented work is around coaching that person to change how they behave in difficult relationships with their family members. Because one person’s change does impact the system. Think of the mobile that hangs over a crib: When you touch one piece, it moves the entire mobile. Such is the case with a family system. Even happy events—going off to college, the birth of a child—can throw a system into a state of disequilibrium. And one person going to therapy and making changes in their role in the family is going to impact that system and effect change.

How can you get someone in the family to go if they refuse?

It is almost like the laws of physics: If you are pushing, you are giving someone the opportunity to resist. So I say invite the person and if they don’t come, tell them you are going anyway. This is very powerful, because it is threatening for that person to be left out. Imagine that shift in energy. I coach clients to say: “We really like working with this doctor and we are going back. And I don’t know what is going to happen but I think we are going to start changing.” The person who has been resisting will probably show up because he wants to know what is happening. And even if he doesn’t, this approach will effect change.

Do you share information from each family member with the others?

The question is not if we share but when and for what purpose. I tell young adults that everything you tell me is confidential unless you’re going to hurt yourself or someone else. But I am going to tell you when you need to talk to your parents. It’s really about selling the idea of family members having a conversation, not me sharing the information. I am the least important person in the room.

Do you take sides?

No, unless there is a case of interpersonal violence or emotional abuse. If someone is calling someone a name, I say you need to stop that, it is going to make things worse. But otherwise I practice multi-partiality—the capacity to see everybody’s point of view. I try to understand why people feel so strongly about something.

Do you give homework?

Yes, a lot. One assignment is letter writing. Sometimes I have them write letters for their own edification, sometimes the letters are meant to be shared.

Sometimes I will say: “Here is a great question. I want you to think about it. What will life be like when all of your kids are gone from the house?” Sometimes I ask them to do more research on their own. I might say: “Call up your mother and ask her what happened in the family in 1962. You got really symptomatic then.”

Has being a therapist affected your own family?

I erred on the side of caution. I had a lot of stories in my mind about what could go wrong, especially from a safety point of view. I think I also have high expectations around our capacity to have conversations, and feel connected to each other.

Are there certain dynamics that can’t typically be helped with family therapy?

Yes, when there is a significant amount of emotional abuse or interpersonal violence. People can’t speak freely with someone they are afraid of for fear of retaliation.

But, in general, I think most problems can be mastered, which is different than being solved. Mastered means you understand what this is and recognize it and can tolerate it. Not everything is resolvable. You can’t always change the circumstances. But you can master the situation.

Grow your Family’s Relationship Superpowers

I’m so pleased to share this recently published book by my friend and colleague, Dr. Saliha Bava, and her partner, Mark Greene.

Although we might agree in theory that parenting is indeed a relational endeavor, our language belies this perspective. For example, we describe the child as “oppositional defiant” as though she existed in a relational vacuum, without that ‘other’ person she must oppose.

Diagnostic criteria focuses on the individual and obscures the parts of the relational system that promote imbalance and ill health.  This extends beyond the family system to the school, community and environment in which families are situated.  But responses to poverty or racism are not part of our diagnostic nomenclature.  We focus instead on the interiorized pathology of the individual, as if divorced from her community and relational world.

Bava and Green eloquently describe what happens in the relationship between parent and child:

“As we are shaping them, they are shaping us”

Indeed, we are changed as we parent,  uncovering parts of ourselves as we are buffeted from one intense emotion to the next.

Green talks about the opportunities in this process:

“for me to discover that I have some agency in those relationships, in those spaces, that there are ways I can operate that help me not fall prey to my own doubts, fears or concerns. “

The doubts, fears and concerns we harbor as parents are openings for change:

“If we have more flexibility, if we can look at problems from more angles, if we can hold our fears and concerns more lightly, if we can be more playful and collaborative,

If we can wait and see what’s emerging before we name and define our responses, all of these things are possible .”


I invite you and yours to hone your “family relationship superpowers” by engaging with this brilliant and captivating guide.  The Relational Book for Parenting: Raising Children to Connect, Collaborate, and Innovate by Growing our Families’ Relationship Superpowers is now available.

Enjoy this video by the authors“>video by the authors and you and your family can grow your relationship superpowers!

Happy Valentines Day

Family historian,  Stephanie Coontz, is admittedly one of my favorites.

Former President of The Council on Contemporary Families, Dr. Coontz brings a much needed perspective to our cultural discourses about marriage and family life.  Her capacity to mine enormous bodies of data and expose trends about the current state of relationships is remarkable – and very much needed.  The landscape of marriage and family is not easy to navigate, and I’m grateful for her clarity and perspective.

In that spirit (and because tomorrow is Valentines Day), I wanted to share her New York Times piece, For a Better Marriage, Act Like a Single Person.

Couple and family therapists are well aware of the hazards when two people believe they can be ‘everything’ to each other.  From a historical perspective, this “soul mate,” “one and only,” “romantic love” narrative is a fairly recent phenomenon.  In the not too distant past, one’s marital partner was not expected to fulfill so many needs; rather, marriage was more of an economic arrangement, with less expectation of emotional fulfillment from that one person. (For a full discussion, check out Dr. Coontz’s 2006 book: Marriage, A History: How Love Conquered Marriage). 

I’ve said before that one of the more exciting things about being a Couple and Family Therapist today is the research that shows the significance of relationship in one’s life.  In a shift from the traditional, individual paradigm that has dominated psychological theory, the new “science of relationship” and data from a wide variety of studies shows what we family therapists have intuited for so long: that the quality of one’s relationships matters to health and well being.

In her Times article, Coontz shifts her lens to the impact of community on marriage.  She finds that social networks of friends and family are enormously helpful to the couple:

“having supportive friendships is associated with more satisfying marriages, even among couples already content with the support they get from each other.”

And, the benefits go beyond the psychological health of the marriage:

“… researchers report that maintaining high levels of social integration provides as much protection against early mortality as quitting smoking. In fact, having weak social networks is a greater risk factor for dying early than being obese or sedentary. One analysis of 148 separate health studies found that people who cultivated a wide network of friends and other social relationships had a mortality risk 50 percent lower than those with weak ties.”

Therapists typically attempt to shift the dynamics between the members of the couple they see for treatment.  Coontz warns against using such a narrow lens:

“Many marriage counselors focus narrowly on improving partners’ couple skills without taking into account how the marital relationship is affected by interactions with other people. Yet a 2017 study found that when people socialize more frequently with good friends, they not only report fewer depressive symptoms themselves, but so do their partners.”

So, Happy Valentines Day.  Here’s to celebrating the many relationships that edify our lives, and contribute to our health and well being.

Read Dr Coontz’s full article here