Axioms of The Doherty Approach

What it means:

Most long-term relationship problems started off with active contributions by both partners. (Think conflict avoidance, mutual flare ups, or pursuer/distancer patterns). Even relationship problems that originated via someone’s individual impairment (like an addiction or personality problem) are sustained over time through the contributions of both people. (Think caretaking, avoidance of the obvious, or triangulation with third parties.)  If a problem has become chronic, both partners have developed problematic ways of interacting. No exceptions.

What it does not mean:

That their contributions must be equal or that one person did not create the original problem (as in an affair).  Or that both spouses have an equal degree of change to make (it may be harder to give up alcohol than to stop covering up for the other’s use).  It just means that both people have made meaningful contributions and thus have things to work on.

Why this is important:

Couples therapy gets distorted when the therapist assumes that one spouse carries all the responsibility for a chronic problem, which means that this person is the one to make changes.  The only roles for the “innocent” spouse are chief complainant or cotherapist.  Good luck with that!  Couples therapy has to engage both people in understanding their own contributions and creating a personal agenda for change.  Otherwise, it’s not relationship therapy.   

Want to challenge this axiom?

Think of an enduring marital problem where one spouse plays no meaningful role in why it started, how it endures, or both. 

What it means:

No couple is an island.  What happens inside the relationship affects others and is affected by them. Many marital problems are directly influenced by kids, step kids, ex-spouses, parents, in laws, friends, confidants, bosses, doctors, individual therapists—a long list of potential contributors. And most chronic marital problems impact others who are close in. The idea of the dyad alone is an illusion.

What it does not mean:

That other people are responsible for the couple problems—couples handle third party influences well or poorly.  Or that you have to bring these other people into the couple therapy—it’s their influence that’s crucial to acknowledge when working with the couple.

Why this is important:

Some problems cannot be handled well in therapy without a lens that can focus on the triangles couples deal with.  Prominent examples are in-law relationships and stepfamily relationships where there are multiple loyalties and complex boundaries to deal with.  Thinking only of the couple relationship is like working with a one-dimensional map. 

Want to challenge this axiom?

Come up with a couple problem serious enough to be brought to therapy that does not involve a third party as a contributor or as someone affected.

What it means:

Although our models tend to stress one or a few “strong” forces, all human behavior, including marital problems, arise from countless interacting forces, most of which are not powerful or decisive on their own.  They can range from genes to current life stressors, from childhood adversity to a current bad job, from income insecurity in early adulthood to current threat of unemployment, from each spouse’s personality to how their personalities interact with each other, from an illness at a key moment in the marriage to a recent car accident, from having a young child with a difficult temperament to adult kids who take sides against their parents.  Plus just plain luck: not getting that great, understanding teacher in 8^th grade and then never trusting authority, or getting COVID 19, which tips a getting-by marriage into a troubled one. 

What it does not mean:

That all sources of marital problems are equal, or that none of them are stronger than others.  Research tells us that some factors (like a parental divorce) do influence marital problems, but the effects are relatively small—in research terms, they account for a small portion of the variance.  Same with personality measures: they count, but not for a lot.

Why this is important:

We deceive ourselves if we think we can really pin down how couples developed the problems they have.  We become over-confident in our knowledge and communicate more certainty couples than we can have.  If there are potentially hundreds of interacting influences, including happenstance, we ought to be humble about our ability to explain a relationship based on our favorite few causes: attachment, trauma, personality, family of origin influences, lack of skills, etc.  One problem with “explanatory hubris” is that it leads us to ignore the main corollary of this axiom:  There are many pathways to healing.  We can employ a wide range of tools to help couples become healthy because the problems probably came from many interacting sources.

Want to challenge this axiom?

Come up with any research study on sources of marital relationship problems and show that the variables accounted for a large percentage of the variance in outcomes.  And don’t present studies that correlate dysfunctional communication patterns with bad outcomes—that would be cheating. You have to find studies that demonstrate where those dysfunctional communication patterns came from.

What it means:

If clients bring their whole selves to us as therapists, they are bringing their ethical/moral dimensions of their lives, by which I mean their sense of how their actions and choices affect the welfare of others. Their narratives have questions such as what they owe others in commitment, fidelity, truthfulness, and fairness.  Therapy is suffused with these ethical narratives if we tune our ears to them.  And as we listen and consult, we inevitably bring our own sense of what is ethical in human relationships.

What it does not mean:

That we are ethical experts who get to judge or decide how our clients behave. Instead, we are ethical consultants as they weigh issues such as divorcing or staying married, pulling away from or staying connected to a difficult parent, or how to balance the competing expectations of a new spouse and a child in a stepfamily. 

Why this is important:

In a culture that is largely individualistic, if we don’t take seriously the ethical dilemmas our clients experience and bring up in therapy sessions, we will unintentionally promote an ethic of individual self- interest: do what you need to do for you, which masquerades as ethically neutral in an individualistic culture. In more communal cultures, self-interest is always seen as connected to interpersonal obligations. Either way, there is no escaping the ethical/moral dimension of the lives of our clients. 

Want to challenge this axiom?

Come up with an example in a meaningful dose of therapy—something more than treating narrow symptoms—where a client’s sense of obligation and responsibility to others is not a part of what they bring to the therapy.  

What it means:

Founders of therapy models live in historical and cultural moments when certain problems and solutions become manifest to them.  For Freud it was Victorian era’s fears and sexual inhibitions. For humanistic psychotherapy, it was the flowering of the Human Potential Movement of the 1960s and 1970s. For family therapy, it was the enmeshed, conformist family systems of the 1950s and early 1960s. In more recent years it’s been attachment-oriented therapies in a time of social disconnection, and trauma therapies in decades of war. Taking a socio-historical-cultural perspective, we can see both the strengths and the blind spots of our models of therapy.

What it does not mean:

That great therapy models are simply trendy or outlive their usefulness when the culture changes.  Understanding the broader connect of therapy models illuminates their contributions and shows which problems they are especially equipped to treat. 

Why this is important:

If we care about the context of our clients’ lives, we have to care about the contexts of our therapy models—or else we may misapply these approaches to therapy. For example, 1960s models that emphasized individual autonomy and personal freedom may need to be updated for an era where the chief social problem appears to be isolation and disconnection. By attending to the distinctive problems of our own cultural moment, we can build on former models and adapt new ways of doing therapy.

Want to challenge this axiom?

Show me a model of therapy that is not partially a reaction or response to models developed in an earlier historical context, and that does not reflect the cultural Zeitgeist of the model’s founders. For one thing, nearly all of our models of psychotherapy have come out of Western culture and reflect assumptions about the primacy of individual autonomy. Tell us that this is not a cultural phenomenon.