RELATHERAPY

Relational Therapy

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GUIDE FOR THERAPISTS

Introduction
According to the hypostatic view of personality, there are four main things
that people do: they think, act (including through words, or verbal
communication), feel, and express through their body language (nonverbal
communication).
Changing the relationships between these four dimensions of doing - both
within the person and in her relationships - is the scope of relational therapy
(or relatherapy, as we like to call it), just a part of a broader approach to
psychotherapy.
Well-adjusted people act what they think, and express what they feel. These
are called direct intrapersonal relations. Also, in a relationship, they think
about others' acts, and feel about what others express. These are called
direct interpersonal relations.
Unadjusted people act what they feel, instead of what they think, or express
what they think, instead of what they feel. These are called crossed
intrapersonal relations. In a relationship, they think about what others
express, or feel about others' acts. These are called crossed interpersonal
relations.
Many conflicts and relationship problems arise from the fact that we
act to please or harm others, and we feel pleased or harmed by other's
actions. If we act to inform or change others at a rational level, and
assess rationally instead of emotionally the actions of others, then we
can avoid much of our minor or serious relational problems and
breakups. It's more natural to be upset by the fact that the other does
not value me positively, as I feel that from his body language, than to
be saddened that he did me something wrong. For the latter I should
have no feelings, but rather think and do something about it!
 

Therapy goals
Improving client's communication and relationships through:
1. Replacing crossed intrapersonal relations with direct intrapersonal relations.
2. Replacing crossed interpersonal relations with direct interpersonal relations.

Indications
All kinds of relational problems or discontents, relating to dating, family and
work relationships and/or casual social encounters, anxiety, depression, and
other mental problems. In the case of problems in stable relationships, both
partners should be assessed and participate to sessions, if needed.
 

Client-therapist relationship
During the course of the therapy, both client and therapist should promote
direct relations between each other. This means they should let their feelings
for each other be expressed through their body language, and avoid
verbalizing what they feel about each other. Also, they should freely and
boldly verbalize what they think about one another, and not let their body
language be the mean of communication of thoughts they do not dare utter.
Both client and therapist should try to feel each other's emotions as they are
expressed through their body language, and not let themselves be moved by
each other's actions, and should reflect about the actions of each other, and
not try to discover some meaning in each other's body language. These
relational rules should be made clear by the the therapist in the first sessions,
and the client should be assured that the rules she is requested to follow
will also be closely followed by the therapist.
  

Initial assessment
First, as always, you have to establish what is the main problem that led the
client to your office.
Second, you have to identify crossed relations within the person, and
between her and others. In the preliminary interview, you may want to ask the
client questions like:
 

Tell me if it ever happens to you to act what you feel? For example, to buy
something to the one you love, instead of telling her you love her, or just
letting that show in your gestures and facial expressions?
Tell me if it ever happens to you to express what you think through your body
language, instead of using words? For example, to try to show somebody
through your body language that you do not agree with her, instead of just
saying it to her?
Tell me if it ever happens to you to feel about what others act, instead of
thinking about it? For example, to feel happy about a gift you receive from a
loved one on your birthday, as if it meant that he is loving you too, instead of
maybe just being polite?
Tell me if it ever happens to you to think about what others express, instead
of feeling about it? For example, thinking that if someone frowns, something
is wrong with her or with you, instead of just feeling that she is sad or
angry?

Crossed relations questionnaire

Check in the answer you see fit:
1. I decided that's better for me to leave my boyfriend, and
a. I tried to show him that
b. I told him that

2. Today I decided that it's better for me to break up with my girlfriend, and
a. I'll behave so that she will leave me
b. I will tell her that

3. I love my girlfriend, and

a. I always buy her what she wants
b. I'm always gentle with her

4. We love each other;

a. that's why we are moving in together
b. that's why we can't spend much time being apart

5. My girlfriend wants to make up with me, and

a. I'm thrilled about it, 'cause this means that she loves me
b. I agree, because that's better for both of us

6. My partner wants to buy me a house, and therefore

a. I assume he/she loves me
b. I assume he/she wants to make me understand he/she is serious about us

7. I can feel in her eyes that

a. She thinks that I'm smart
b. She likes me

8. He is giving me a bitter look, and

a. I'm wondering what is wrong?
b. I feel that he is angry
 

Answers (a) to questions 1 to 4 indicate that the person is likely to have

crossed intrapersonal relations, whereas answers (a) to questions 5 to 8
indicate that she is likely to have crossed interpersonal relations.
 

Therapy sessions and techniques

The recommended length of a session is one hour, two or three times a week,
for a period of three to six weeks.
In the first two sessions the therapist gathers information about the client
through interviews and questionnaires, like described above.
In the next two sessions the therapist teaches the client how to replace
crossed intrapersonal relations with direct intrapersonal relations, and crossed
interpersonal relations with direct interpersonal relations.
This is made through explaining, exemplifying, questioning, and trying to
change specific relations of the client.
In the next eight to ten sessions the client, helped by the therapist, tries to
change problematic relations in her life.

A session in this part of the therapy has the following steps:

1. The client presents her crossed relations, as they occurred since the last
session;
2. The therapist asks the client how she thinks the correct relation should
sound like, and tells her that, if she could not say;
3. The therapist, along with the client, tries to identify crossed intrapersonal
relations in people with whom the client interacts;
4. The therapist asks the client about what she thinks she could do to
counteract those crossed relations, in order to have good communication
relationships with those people, and makes suggestions to her, if she has
no ideas.
 

A short fragment of a session:

 

Client: The other day my boss frowned at me, and I wondered what was wrong. I
mean … did I do something wrong or what? I just accomplished all the tasks I
was assigned in the morning. Then I thought maybe he is not feeling well, he
is exhausted and is just upset.
Therapist: But he was just frowning, right? Why is it that this always has to
mean something? But what have you felt that moment? What feelings did
that frowning stir up in you?
C: I think I felt that he was angry . . . . I'm not sure I felt something. But I don't
understand why . . .
T: Maybe there is nothing to understand. Have you ever thought that way? Feelings of
others are meant to be felt, not thought about, right? Can't you just feel his anger
and move on, concentrating your thoughts - and I underline, your thoughts, not your
feelings - on what he is doing and saying? What effect do you think will that have on
you?
C: Maybe you're right. I don't know, I think that would make me less worrisome [he
smiles].
T: Now, the fact that you said you're not sure you felt something makes me think of
something else. How well do you know your boss?
C: Not so well. I started working there just a couple of months ago.
T: Maybe it's a good idea to find out if your boss is the one that is worrisome [the
client laughs].
Maybe by frowning he wants to make you understand that he indeed thinks your work is
not good enough, and frowning in this case expresses no feeling whatsoever. Has this
happened before? I mean, the frowning?
C: Maybe a couple of times, yes.
T: I think you have to try to know him better, to do a little research. See if this
is not something that he does with other employees also. If that's the case, you
have two options: to understand that when he frowns, it's about your work, or to say to
him that when he has something to say, he better say it, instead of frowning [the client
laughs].
Which one do you choose?
C: I don't know, I have to think about it [he smiles].
T: Then you'll have to go with the first [client and therapist laugh].
 

Here the therapist suspected that the client had a crossed interpersonal
relation with his boss, thinking about his emotional expressions instead of
feeling them, but then, when the patient declared that those expressions
were in fact not seeming to really express some feeling or emotion, he
investigated the possibility of a crossed intrapersonal relation on the part of
the boss, who seemed to express his thoughts through body language,
instead of acting them out or telling them.
 

The final assessment

A final assessment through interview and questionnaire is made, to see:
1. If there are residual crossed relations in the client's life;
2. If she is able to prevent new crossed relations to occur;
3. If she is able to counteract crossed relations in others with whom she
interacts, in order to maintain good communication relationships with
those people;
4. To what extent the initial problems for which she addressed the therapist
have been solved.
 

Treating a typical problem

Patient's complaint:
“I want to go to college, but I feel anxious and afraid.”
Defining intrapersonal relations (crossed):
 I want to go to college [thought], but I can't do it [emotional expression]

I feel anxious and afraid [feeling], and I try to do something about it [action].
These formulations are not necessarily thoughts of the client, but statements
that - patient and therapist agree - can accurately describe the client's state
at a given moment.
Here we see the individual focusing on his own thoughts and feelings, and not
linking directly the cause - anxiety, with the effect - being unable to go to
college (in fact, the client does not even mention the effect in his formulation
of the problem).  
Feelings of helplessness, and later, hopelessness are generated by the fact
that the individual tries to act according to his feelings, and on his feelings,
but as feelings cannot be changed by voluntary action, he becomes helpless
and thinks nothing can be changed. Also, thoughts not acted out, and not
acted upon, give rise to pathological expressions (symptoms), because only
feelings - and not thoughts - can be really expressed.
First step: creating direct relations between thoughts and actions, and
between feelings and expressions (this is similar to what psychoanalysis
calls “insight”, cognitive therapy – “restructuring cognitive schemata”, and
person-centered therapy – “achieving congruence and genuineness”). Only
this way can the client's thoughts really get in touch with her feelings,
and her expressions really support her actions.
I feel anxious and afraid [feeling], and I can't do it [go to college] [emotional
expression].
I want to go to college [thought], and I try to do something about it [action].
Second step: the result of direct relations is that problem ceases to
exist
I want to go to college [thought], and I try to do something about it [action].
Therefore, I don't feel anxious and afraid [feeling gone], and I can do it
[emotional expression gone]. When I'm afraid about it, I express my fears.
  
Treating anxiety and depression
Relational therapy of mental disorders involves changing both crossed intra-
and interpersonal relations within patient's relationships, and crossed
intrapersonal relations directly linked with the symptoms of the disorder. The
latter are changed through treatment models specific to every disorder.
These are just examples, as for each disorder  there are many possible 
models, and the patient may exhibit only part of the characteristics
described.The models are flexible, as the therapist adapts them to every
patient and creates new models if needed in order to respond to patients'
demands.
 

Treatment Model for Anxiety

Before therapy: Crossed intrapersonal relations (pathologic)
I feel menaced, and I try to avoid the hazardous situations.
As there are hazards on the street (in the world), I have panic attacks
(symptoms) there.
During therapy: Direct intrapersonal relations (recovering)
I feel menaced, and I have panic attacks
There are hazards on the street, and I try to avoid the hazardous situations.
After therapy: Direct intrapersonal relations (healthy)
There are hazards on the street (in the world), and I try avoid the hazardous
situations.
Therefore, I don't feel menaced, and I don't have panic attacks (symptoms).
When I'm afraid, I express my fear (e. g. I'm shaking).
 

Treatment Model for Depression

Before therapy: Crossed intrapersonal relations (pathologic)
I feel depressed, and I try to do something about it.
As the situation is difficult, I cry all the time.
During therapy: Direct intrapersonal relations (recovering)
I feel depressed and I cry all the time.
The situation is difficult and I try to do something about it.
After therapy: Direct intrapersonal relations (healthy)
The situation is difficult and I try to do something about it.
Therefore, I don't feel depressed, and I don't cry all the time. When I'm sad, I
express my sadness (e. g. weep or cry).
 

See also the Case of Jim. For more clinical applications, see Disorders. For
group assessment and counseling, see Groups.
 

 
 Bibliography
Tapu, C.S. (2001). Hypostatic Personality: Psychopathology of Doing and
Being Made. Premier.
 

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