All the same, despite Beth’s strong emotional commitment to Bernard, she’s become increasingly disturbed by her husband’s continuing weight gain—which, frankly, repulses her. She also worries that his excess girth makes him particularly vulnerable to a variety of diseases, which might eventuate in his dying early, and so burden her with the role of single parent—as well as leave her children (who “absolutely adore him”) fatherless. She’s talked to Bernard incessantly about the dire necessity of his losing weight (as, too, have his doctors). But though, sporadically, he’ll try different diets, consult with a nutritionist, and even work with a personal trainer, he’s repeatedly demonstrated an inability—or unwillingness—to adhere to others' recommendations.

As already suggested, Beth’s other major frustration with Bernard relates to the present sexlessness of their marriage. And her many endeavors to establish a more normal sex life with him have failed miserably. Despite her not being physically attracted to him, she yet longs for at least more touching and holding—if only to experience being romantically desired by him. But despite his constant reassurances that he finds her sexually appealing, rarely does he attempt the slightest physical contact, leaving her angry and resentful that he’s more like a brother than a husband.

Since Bernard’s sex drive has seemed almost non-existent, at Beth’s urging he’s actually discussed with their family doctor his low libido. And although diagnostic tests revealed significantly low testosterone levels, it seemed that much of his sexual disinterest was probably linked to a poor body image, relative sexual naiveté, and anxieties about erotically asserting himself, . Which is why it didn’t surprise me that when their doctor prescribed a testosterone supplement, he continually “forgot” to take it. Eventually, when Beth (frustratedly throwing up her hands) stopped reminding him, he discontinued it entirely.

It’s crucial to note that both Beth and Bernard were very pious—devotees of a religion that Beth had herself converted to prior to marriage. And the platonic nature of their relationship was not one that she felt their God would approve of. Given its almost complete absence of physical intimacy, their sibling-like conjugal bond felt almost sacrilegious to her.

Even in the broad context of her love and devotion to Bernard, because of Beth’s ongoing exasperation with him—not only for what seemed his “willful” obesity but also for his unmanly asexuality—she’s regularly had to deal with an abundance of negative feelings toward him. She constantly struggles with the likelihood that he’ll never change. Yet she can’t give up her (increasingly frantic) attempts to influence him to do so, even though she reports that these efforts are “bending [her] out of shape.” And since she hasn’t been able to accommodate her husband’s failings, her marriage to him is plagued with barely concealed tensions. Intermittently, and despite herself, they leak out—at times, gush out.

By far the most dramatic example of this discord took place when Beth, Bernard, and their three children were dining at a restaurant with Bernard’s brother and his family. When they needed to leave, and Beth was getting the children ready, she looked over at Bernard—grimacing. At the same time everyone else was rising from the table, Bernard (seemingly oblivious to what was going on around him) was busy raking up the final crumbs on his dish—and hurriedly devouring what remained on Beth’s plate as well (!). Staring daggers, with hands menacingly pressing against her hips, Beth exploded—in the most scolding tone proclaiming: “Bernard, we have to leave! Will you STOP EATING already?!!”

When they got home that evening and the kids had been put to bed, Bernard approached her in an aggressive, authoritarian manner she’d never witnessed before. Seething, without even raising his voice, he informed her that if she EVER spoke to him like this again in front of his family, he’d divorce her immediately. Initially she was too stunned to reply. Then, overcome by a really “dark” side of her, she counter-threatened by screaming that if he ever divorced her, not only would she take sole custody of the kids but she’d make sure he never even saw them again. Though the next day he apologized to her—and she to him—internally, they were both still reeling from the scene.

So finally Beth decided that she was only hurting the relationship by repeatedly confronting Bernard, whether about his failure to lose weight or be more intimate with her. Since, nonetheless, she genuinely cared about him and felt ashamed of her most recent outbursts, she requested that—as her therapist—I try to help her accept what she now perceived as utterly hopeless.

Many years ago I wrote a text for therapists on employing paradoxical therapeutic methods—which for the most part are more intricate, refined, or elaborate versions of reverse (or negative) psychology techniques. This book, entitled Paradoxical Strategies in Psychotherapy and noted in my last post (on “positive manipulation”), is primarily about motivating (though quite deviously) highly resistant clients and families to alter dysfunctional behaviors. So, to me, Beth’s current attitude of discouraged resignation was, well, premature.

Certainly, she’d exhausted all the direct approaches to prompt Bernard to change. But she hadn’t thought to explore more sophisticated, indirect ways of challenging him to reevaluate his behavior. I therefore suggested a radically different approach for Beth’s persuading her husband to apply himself more rigorously to issues detrimental both to their relationship and himself. Obviously, his overarching defenses would first need to be neutralized if he were to become sufficiently motivated to tackle these psychologically (and physically) complex problems. So I suggested to Beth that before giving up, she once more address her frustrations with him—but in an unprecedented, far more paradoxical, fashion.

Even though, as a male, Bernard was clearly not satisfying Beth, the fact that he could threaten Beth with such passion for shaming him in front of his relatives was, I thought, extremely telling. For it conveyed a strong sense of masculine pride gravely wounded when Beth so publicly “spoke out” against his gluttony. Having been reared in a strongly patriarchal culture, where wives were clearly subservient to their husbands and never confronted them in such fashion, he’d been utterly humiliated by Beth’s restaurant eruption. And being addressed so demeaningly obviously continued to fester within him after the event—to the point that even though his non-professional life revolved exclusively around his family (and his domestic M.O. was to keep everything tranquil and harmonious), his personal dignity had felt so assaulted that he’d actually threatened to leave the relationship.

So I felt that appealing to Bernard’s masculine pride and personal sense of honor offered Beth the most effective way of getting him to look anew at his longstanding problems with obesity and sexual expression. To me, such an approach could powerfully increase Bernard’s motivation to adhere to a newly formulated and multi-pronged plan for change (vs. his sabotaging the simpler, non-psychological plans tried earlier). Attempting to effectively “utilize” the information embedded in Bernard’s recent flare-up, here’s what I suggested Beth say to him:

“Bernard, I really want to apologize to you for being on your case so much about your weight and your having so little interest in sex with me. . . . For one thing, I’m sorry it’s taken me this long to realize that it’s really not possible for you to control your weight. Some people can—but some people just aren’t able to. And I need to accept that you’re one of those people who can’t, and stop badgering you about it once and for all. Whether I—or your doctors—think your weight’s a health risk, it’s not my business (or theirs) to try and change you. I finally realize how unkind I’ve been, how unfair all my expectations have been, and how hurtful all my nagging must still be for you.

“I also need to accept the fact that you’re just not interested in sex with me—or maybe you’re just one of those men who doesn’t like sex that much. You were willing to have sex with me so we could have a family, and I really need to be more grateful to you for this. But now I see that being sexual with me just isn’t anything you’re cut out for. And I know I have to accept this about you, too.

“. . . But, unfortunately, the problem I’m dealing with now is that even though I know what I have to do, I’m having tremendous difficulty letting go of all my concerns—maybe ’cause I’ve had them like forever. So I need to ask you—beg you, even, Bernard!—to help me out here. I finally realize it’s not you that has to change, it’s me! But I just feel so stuck with all this. Could you please think of all the ways you might help me better accept your weaknesses and limitations, and make me more comfortable with a sexless marriage?! I know it’s my duty to love you unconditionally—just as you are—and I really need your help in resigning myself to what you’re obviously not capable of changing. . . .”

Note that although Beth’s “tack” here might seem sarcastic, it really isn’t. She does, in fact, have every reason to believe that Bernard is incapable of changing—at least given the considerable obstacles that have continued to stand in his way and, presumably, defeated his best intentions. For though in the past he has made a variety of efforts to alter his behavior, his obvious internal conflicts—most likely revolving around sexual anxieties and an addictive relationship to food— have doomed all of his attempts. And if his earlier endeavors were half-hearted, it was because he could hardly help but be ambivalent about all that such change might involve. Moreover, as long as Beth continued to express the positive part of his ambivalence, he seemed compelled to passively “act out” the negative part (a phenomenon we therapists call “homeostasis”).

So, in the script I proposed to Beth, I was granting her the permission to “take over” the negative side of his indecisiveness, giving him the freedom to explore anew the positive side. Which meant facing head-on the positive challenges he’d so long shied away from. After all, for him to agree to Beth’s request—that is, actively assist her in fully accepting him as the weak, ineffectual, sex-scared partner he already saw himself as being—he’d be tacitly “owning” the disrespect and humiliation he’d experienced in the restaurant scene.

To put it somewhat differently, Beth’s new paradoxical approach (at once declaring helplessness and supporting/validating the behaviors so disturbing to her) would be to appeal to Bernard’s masculine pride by siding with all the resistance he’d demonstrated. And rendering these past defenses unnecessary would put him in a double bind. For now he had to be the one to make the argument that he was capable both of controlling his weight and being a sexually adequate husband. By removing (even reversing) all external pressure, the possibility of some desperately needed self-confrontation could be maximized—as could his motivation to seriously apply himself to all the changes his wife now claimed to relinquish any hope for.

Needless to say, I believed his whole being would rebel against Beth’s new, much more empathic position. His self-respect, his dignity, all that he needed to feel good about himself as a man was being put at mortal risk. He’d have to tell her that he would not—could not—accept the appointed role of helping her “successfully” give up on him. He could no longer “hold his own” against his wife by failing at the two things she’d been complaining of. (And I’d already concluded that at least some part of his resistance was passive-aggression.) Given what was at stake (though in a sense it had been at stake all along), the only viable way of preserving any positive sense of self was by confronting his wife about her loss of faith in him, by telling her that he could—and would—prove to her that she unjustly deprecated him. That if he really set his mind to it and got the right sort of professional assistance, he’d lose the weight she wanted, and be more assertive in bed as well.

In short, that having to take control of the change he’d been resisting, he’d at last be in the driver’s seat and therefore experience an unprecedented level of motivation. Ironically, Beth’s much warmer, more understanding and sympathetic "reframing" of what bothered her most about Bernard would be the one thing most likely to precipitate exactly the kind of self-examination which, till now, had been missing.

. . . So what happened? I’d love to say that my suggested intervention worked precisely as planned, and that Beth and Bernard lived happily ever after. But, alas, in many therapeutic interventions all sorts of uncontrollable variables are at play, and that’s not how it worked out.

Despite Beth’s various problems with what she deemed the “manipulativeness” of my contrivance, which felt dishonest and deceitful to her, she also acceded that no other strategy for approaching her husband was anywhere as likely to be successful. For weeks, Beth and I discussed how she could (paradoxically) address him. And finally, she did agree to make an attempt—and was frankly amazed at how vehemently Bernard protested that he could be more sexual with her and, too, succeed at losing weight.

But I’d emphasized to Beth that if this approach were to "take hold" long-term, she’d have to continually reiterate her plea for him to help her to change and accept the fact that he himself really wasn’t capable of it. And regrettably, regardless of how effective reframing the problem in this new manner had been, she felt that her personal integrity didn’t allow her to adhere to it. Thus, predictably, in the absence of any follow-up, Bernard’s freshly “earned” motivation eventually dissipated. Since I was convinced that in this case therapeutic paradox would be the perfect vehicle for change, I was naturally disappointed by her decision. But since, also, I never impose my values on another, I accepted this as an unavoidable failure.

Which, again, brings me back to my last post (which I invite readers to look at—or review). As a psychologist, I’ve had abundant success utilizing paradoxical therapeutic methods, for I don’t at all experience my integrity as compromised when I employ them. The “reverse psychology” interpretations I offer my clients to support my recommendations for change (or for not changing) have to me their own authentic truth. It’s simply that they’re truths which prompt clients to reevaluate their former contrary position in a new light.

. . . So, if you yourself would like (gingerly!) to consider using them, first get very clear about whether your motive is largely to give yourself an advantage in the relationship. Or whether it’s driven by a genuine caring, compassion, and respect for the other person. For as long as you’re focused on their deeper ideals, aspirations, and goals, you're likely to find implementing such a strategy remarkably effective.

NOTE: If you know of anyone who might be interested in this post, kindly send them the link.

© 2013 Leon F. Seltzer, Ph.D. All Rights Reserved.

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