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:

“…..health 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

Family and friends can be powerful tools in improving health

David Asch MD and Roy Rosin, MBA of The Center for Healthcare Innovation at Penn Medicine have published an article  in The New England Journal of Medicine that supports the involvement of family and friends in improving health and health care outcomes.

At The Center for Couples and Adult Families, we are thrilled to  share this vision: that the quality of one’s relationships matters and has important and measurable impact on health and well being.

CCAF Event 9/28/16 Supporting Transgender Young Adults: Working Collaboratively with Family and Individual Treatment

Join colleagues at Penn Medicine and CHOP for this exciting panel, lead by transgender activist and family therapist, DR. ELIJAH NEALY.  They will address the importance of family therapy in the treatment of transgender young adults.

Dr. Nealy will be joined by Jacqueline HUDAK, PhD., LMFT, The Center for Couples and Adult Families, Perelman School of Medicine, Linda HAWKINS, Ph.D., Gender and Sexuality Development Clinic, CHOP, and Benoit DUBÉ, MD, Perelman School of Medicine.

 Wednesday, September 28th, 2016


16th Fl., 3535 Market Street

Philadelphia, PA 19104

A light dinner will be served

 RSVP sean.smith@uphs.upenn.edu

For the past 25 years, Elijah C. Nealy, PhD, M.Div., LCSW has worked extensively with LGBTQ adolescents and adults in both pastoral and social service capacities. Currently an assistant professor of social work at the University of Saint Joseph, West Hartford, CT, his clinical practice has focused on transgender and gender diverse youth and their families. Ordained with Metropolitan Community Church, Dr. Nealy regularly preaches and provides trainings for clinicians, faith communities, and organizations. An openly identified transgender man, Dr. Nealy lives in West Hartford with his partner and is the proud father of three amazing young people. He is the author of Transgender Children and Youth: Cultivating Pride and Joy with Families in Transition [Norton, February 2017].



Emotional Cutoffs in Families

I had a wonderful time presenting to physicians, nurses, social workers and psychologists at The Reading Hospital this spring.

The audience wanted to understand the meaning of emotional cutoff and the impact of this process on development and family relationships over the course of the life cycle.

Always true to my training as a family therapist, I began with my family genogram, and a story about my father’s cutoff from his family of origin. This happened when I was two years old and shaped the events in our family for many years to come. His alienation from his own family became the landscape of our life; it was always present. At certain times, like holidays, or life cycle events, like death, the impact was more acute. This relational rupture shaped how he was viewed by us, his immediate family members, influenced decisions, and had a grave impact on his health.

Father and daughter

Emotional cutoffs are the natural mechanisms people use to counter high anxiety or high emotional fusion, also known as ‘too much closeness.’ A cutoff can look like physical or emotional withdrawal, avoidance of sensitive topics, physically moving away from family members or rarely going home.

Relationships may look “better” if people cutoff to manage them, but the problems remain, and are dormant.

Although people reduce the tensions of family relationships by cutting off, they risk making their new relationships too important. For example, the more a man cuts off from his family of origin, the more he may look to his spouse, children, and friends to meet his needs. This makes him vulnerable to pressuring them to be certain ways for him or accommodating too much to their expectations of him out of fear of jeopardizing the relationship.

Not all cutoffs are unwarranted, however.  In some cases they are necessary, or preferred, as in the case of emotional or physical abuse.

There are circumstances when someone may be coached to ‘cut off.’ For example, consider the concept of ‘tough love’ or ‘letting someone hit bottom’ that is often suggested when a loved one is suffering with addiction. Post divorce families also struggle with physical and emotional cutoffs as issues of loyalty are prominent.

The words “cut off” imply a static state – a lack of motion or movement.   However, to remain angry or to hold a grudge are in fact, actions.

Consider these verbs: to harbor bitter feelings, resent, brood, or stew.  

Indeed, it is possible to become so wrapped up in the wrong that’s been done to you that you can’t enjoy the present. And there are significant health consequences. Anger, frustration and sadness increase the stress hormone, cortisol.

Experiencing these negative emotions instinctually prepares the body to fight.  A prolonged state of fight increases levels of protein in the bloodstream which promote cardiovascular disease and stroke. But here’s the good news: Studies have found that the act of forgiveness can reap huge rewards for your health, lowering the risk of heart attack, improving cholesterol levels and sleep, reducing pain, blood pressure, and levels of anxiety, depression and stress. And research points to an increase in the forgiveness-health connection as you age.

Chronic anger puts you into a fight or flight mode, which results in numerous changes in heart rate, blood pressure and immune response.  Those changes then increase the risk of depression, heart disease and diabetes, among other conditions.  Forgiveness, however, calms stress levels, and leads to improved health.

Perhaps in the next post I’ll write about the work of forgiveness and repair.  But for now, a return to my own family story.

About ten years into the cutoff, around the death of my paternal grandparents, my father’s siblings began to contact him.  These vaguely familiar men, my uncles, were welcomed into our home, and celebrated.

My father’s expansive capacity for forgiveness has stayed with me, and brought valuable lessons which I apply in clinical work with families: that despite dire circumstances, change can happen, and usually does.

We just need to take the long view – that is, a family life cycle perspective. We are constantly negotiating closeness and distance in our relationships over time; we readjust   according to the phase of the life cycle.  The warmth and closeness around the time of birth is juxtaposed with the ‘letting go’ required for launching into young adulthood.

The practice of compassion and forgiveness, for ourselves as well as those we love, will enhance our health and nourish our spirits as we face the challenges that will inevitably come.


Engaging Family Supports: Free Online Videoconference


Join us for the next CPSP
“Community Psychiatry Forum*”
In Collaboration with
The American Association of Community Psychiatrists

Engaging Family Supports

Learning Objectives – Participants will be better able to:

  • Identify strategies and barriers to engage family members as supportive members of recovery team
  • Enable people in recovery to identify and connect with potential sources of support in the community
  • Describe issues commonly concerning family members and other natural supports and potential approaches for addressing them

CME: You can earn 1.25 CME credits

When: Thursday, April 21, 2016
11:45 am – 1:00 pm EDT

Course Directors: Wesley Sowers, MD
Robert Marin, MD

Guest Experts:

Ellen Berman, MD, Clinical Professor of Psychiatry, Perelman School of Medicine, and Founder and Director of Training, Center for Couples and Adult Families, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA

John Sargent, MD, Director, Division of Child and Adolescent Psychiatry, Tufts Medical Center and Professor of Psychiatry and Pediatrics, Tufts University School of Medicine, Boston, MA

*Community Psychiatry Forum: Free online videoconference offered twice each month. Continuing Medical Education credits

Generosity and Kindness: Key Ingredients of a Long Lasting Relationship

At CCAF, we are committed to bring research about relationships and family life to the public.  In this spirit, I share the article, “Masters of Love” from this month’s Atlantic Magazine.

The article traces the 30 year history of research on marriage; the work of John and Julie Gottman of The Gottman Institute is featured.  Their work is noteworthy for their capacity to  predict, with up to 94% certainty, which couples will be broken up, together and unhappy, or together and happy several years later.

“Much of it comes down to the spirit couples bring to the relationship.”

That’s where kindness and generosity come in.  Those couples who accept each other’s ‘bids’ for contact, who ‘turn toward’ each other, do better in the long term:

“People who are focused on criticizing their partners miss a whopping 50 percent of positive things their partners are doing and they see negativity when it’s not there.”

Gottman found that the more physiologically active the couples were in the lab, the quicker their relationships deteriorated over time. The problem was that these relationships, called the ‘disasters’ showed all the signs of arousal; they were in fact in ‘fight-or-flight mode’—in their relationships. In these highly reactive couples, it was virtually impossible to have a conversation, express feelings, and be heard.

“Having a conversation sitting next to their spouse was, to their bodies, like facing off with a saber-toothed tiger.”

Fortunately, Couple and Family Therapists are trained to coach couples to shift to a less emotionally reactive posture.  In this way, couples can begin to express feelings and desires more effectively, and communicate how their partner’s behavior impacts them.

Read the full article here and learn about how to become more masterful at love.

New Research: Family Psychoeducation Crucial in the Treatment of Schizophrenia

A landmark, government funded study finds that schizophrenic patients who received a combination of drugs, talk therapy and family support made greater strides in the first 2 years of treatment than patients who just received drug therapy.

Featured on the front page of yesterday’s NY Times, the report made clear that  family involvement and “talk therapy” are vital in the treatment of schizophrenia, and this combined approach provided more symptom relief to patients (and thus families) and capacity for higher functioning at the end of 2 years.  The study will be published in The American Journal of Psychiatry, and the article can be found here:


At CCAF we are well aware of the importance of family inclusion and family psychoeducation around certain illness, particularly those that strike in early adulthood.  We collaborate with Dr. Claudia Baldassano and her team of psychiatry residents to facilitate multifamily Bipolar Psychoeducation groups.  We have developed a series of 4 – 90 minute family group sessions during which:

  • information about the illness is presented, and families invited to ask questions,
  • families tell their story about how the diagnosis was made,   
  • families discuss the process of coming to terms with the illness,
  • we discuss how to handle relapse and emergencies, and
  • anything else the family wants to talk about.

The Center for Couples and Adult Families is fortunate to be situated within the Department of Psychiatry here at Penn.  We look forward to further collaboration to develop similar groups for families of schizophrenic patients.