Collateral Damage in Treating Relationship Problems (and How to Avoid It)

Abstract

359 1 Private practice, Cambridge, MA, and Faculty, Psychodynamic Couple and Family Institute of New England, Massachusetts General Hospital Center for Psychodynamic Therapy and Research. Correspondence should be addressed to Joseph Shay, PhD, 1218 Massachusetts Avenue, Cambridge, MA 02138. Email: joseph_shay@hms.harvard.edu. I am pleased to respond to the issues highlighted in Lee Kassan’s excellent piece. He has drawn attention to a relatively underappreciated phenomenon in therapies of all kinds, namely, what I have termed collateral damage (Shay, in press). By this I mean the unintended negative consequences on individuals who are not the specific focus of a treatment (e.g., individual therapy, as described by Kassan), or may be part of the treatment but receive shrapnel wounds or worse from traveling in the orbit of the therapeutic process of others (e.g., group therapy), or may be part of a collaborative treatment in which the treaters don’t agree (e.g., the couple therapist and the individual therapist; Maltas, 1998). In Kassan’s article, he focuses on at least two very important themes. The first relates to what he calls the “treatment gap,” when an individual therapy process can create negative consequences for a couple, if one member who comes to deal with relationship problems improves while the other stands still. The second theme draws attention to another potentially damaging process, namely, when the therapist, based on the subjective, if not frankly distorted, presentation of the person in the office promotes a particular direction that may, unknowingly, result in collision paths for the individual in therapy and his or her partner. I will comment on the first of these themes only briefly, given that it is better known by clinicians than the second. All of us, patients and therapists alike, live inside patterned relationships that have implicit expectations and responsibilities that result in predictability. At times, what is predicted is a continuation of dysfunctional interaction, although this dysfunction often exists in a state of equilibrium. As Kassan explains, this equilibrium is jeopardized—and perhaps should be