Rebuilding After Rupture: Working with Couples Through Betrayal

Welcome back to Therapist Voices at ReachLink. My name is Jessica Hurwitz and I oversee our network of providers. Today I am joined by Miriam Najah and she is a licensed marriage and family therapist in Minneapolis. Is that right? Correct. And you work with Wholehearted Healing LLC. And I know that you specialize Miriam with couples and I wanted to today do a little bit of a deep dive into that, particularly the frameworks that you work within. But I wanted to start off kind of giving you a chance to introduce yourself. Um something that I noticed a lot on your website and everything that I have seen about you and what we discussed was that you hold a really big place in your heart, if I may be so bold to say, for marginalized populations, people that might feel misunderstood by the mental health world.

Tell us if you could a little bit about that, what that means, what that means to you, how you got here, all the good stuff so we feel like we know you. Yeah. Well, thanks for asking Jessica and thank you for having me here. So I do have a special place in my heart um for marginalized populations. Um and I think that probably started when I like first started. Um a lot of therapists talk about this that what piqued their interest is some of their own curiosity about their own mental health. And for me that's also true. Like before becoming a therapist, I was interested in finding myself a therapist. And I found that it was it was a little hard because I felt a little scared. I felt a little misunderstood. And I think a lot of the people that I like consulted with or like chatted with, they they probably were really good therapists, but maybe they just did not have the like nuancedness or sensitivity to working with someone who has a very different life experience than their own.

Um because a lot of mental health has been developed and normalized on like white middle-class folks. And so a lot of times when a person who's seeking therapy is a little different than that, they might find their own challenges. And also the therapist too might find it challenging to tailor like this education that they got to a different life experience. And so all of that stuff was like going on for me at the time and it ended up being like I decided at the time that I'm going to figure out this therapy thing by becoming a therapist and then like figure out my mental health stuff that way. That doesn't work. You need a therapist. I got myself a therapist eventually. But it was really helpful in find it was really helpful to go about it that way because I I feel like you were about to say that it was fun and you stopped yourself.

And I think that you meant I think that you meant it if I may call you out. I think that you meant that it was fun. was. It really was. Um I I enjoyed the journey and um continue to. But I that continues to be a thing that's important to me to really find ways to uh make this lingo like therapist lingo accessible and match a diverse experience not just you know a specific kind of people. I'm glad you're saying this because I feel like we are so at a point where you know everyone's saying we're therapists are accessible regardless of background, life experience, lived experience, everything. But at the end of the day, that's not necessarily true. Any therapist might have a client sit on their couch or sit across the video from them and say, "Oh God, I don't know. I don't know much about this culture.

I don't know much about what what this person went through." And I don't care how worldly someone might be as a therapist, you are always going to learn something new. So, I I feel like you having that as a motivator for your work is so important. Just gets you ahead of the game. Is so you do you market a lot of your practice toward populations again that feel might feel more marginalized and are hesitant to reach out for care based on maybe a bad past experience or just not knowing? Yeah, it's important for me that I put that on my marketing material on my website just so that if there is someone who that's their experience, they see a hello and an invitation because a lot of those people tend to be like a little scared and hesitant. So, um it's it's important for me that it's on there more so for that sake um than anything else.

So, yeah. So, that's kind of the thing that if you had to pick something to put as a banner everywhere, like FYI, this is I'm a safe space in this way. If you're feeling this way, I'm your person. Absolutely. You're you're good here. I love that. Yeah, that is really important for me. So, when you decided you wanted to to be a therapist, so you went to school, what was that experience like for you? Did you have an internship when you were in school? Did you know actually I think spoiler alert because I saw this on your website that you weren't sure that you were going to work with couples as a main specialty, but what was your education like? Yeah, um I had a class called intimate relationships and that class introduced me to uh a teaching assistant, a TA, um her name is Molly. Um and I'm still, you know, I have a good relationship with her.

So, she at the time she was um doing her PhD in marriage and family therapy and now it's called couples uh and family therapy. And she was the one that was like, "By the way, there's a master's program called Marriage and Family Therapy and you should definitely sign up." Um and it was me and my friend who were taking that class and she was our TA. And so she was definitely the person that like opened the path for us because at the time, and I think this is still the case, like mental health world is predominantly like just psychology and uh like LPCC like that route it was all that I saw and knew at the time, just that individuals to clients. And I was like, "Mm I like this worldview, I appreciate it like the little things that it brings, but I'm not sure if it aligns with like my worldview and how I approach healing."

And so when I took that class and I ran into um Molly and she was like, "By the way, there is this field called Marriage and Family Therapy." It was like a kid in a candy store, like, "Wow, this is it." And so it just felt like a good fit, you know, I applied and got accepted and the rest is history. That's amazing and it seems like you so after you got you got your degree, it seems like you really went for it and got these specializations. I know you've done significant training. Tell us a little bit cuz there's something that you do that I've never heard of um which I probably shouldn't have said and I should take out but I'm not going to because this is supposed to be human. Um I know you I know you're do a lot of Gottman method work but what's I want you to tell us about that. What's the other one?

The maybe Bader-Pearson is it? Yeah, um it's the Couples Developmental Model and person the two people that developed it um are Ellyn Bader and Pete Pearson and so it's uh named after them but you know, they call it the Developmental Model for Couples Therapy. What type of model is that? And then I do want to get back to Gottman of course, but I feel like and maybe it's It's me listeners by the way, if you're so familiar with both these models, ex- excuse me, but I want to I want to learn about them. Please tell us a little bit, especially if we want to start with Bader Bader-Pearson. Tell us a little bit about about that and how that how you work in that model. Yeah. So, the developmental model is rooted in this idea. Well, I'll take a back step. Yes, the developmental model is not that well known.

Not that many people know about it. So, yeah. Even if you're just saying that, thank you. No, I do mean it. It's It's one of those like I like randomly ran into it and I was like, "Wow, this is really cool." So, that's what piqued my interest in it. There are many different theories for how relationships heal and how to repair them and how to do them. Gottman knows a lot about that and a lot of his work is solid. The developmental model takes a slightly different approach in that it believes that a lot of times when there there's a couple that is stuck, it's stuck because there is often developmental trauma that is there for one or lots of times both partners. And what's happening is that stuckness is really just I'm bumping up against that. And in a way, they just end up like retraumatizing one another.

And this is we're talking about, of course, back and forth. Exactly. And this is like little t trauma. So, it's not This is more just like that feeling of being rejected and unwanted and unloved. Lots of times when a couple is stuck, they're stuck in some version of impasse where they are just that dance between them is reenacting some kind of developmental trauma that they have experienced. And so, that is what the model is like focused on. And as a therapist, you kind of adopt that lens to help couples kind of see that for themselves. And also, you as a therapist begin to develop like this leadership role where you guide these two people out of that dance into new into a new healthier dance with one another. So it is so your role within this model is more of kind of a guide to get them to get them out of this.

How does the work start? Especially and particularly thinking compared to maybe more common more common modalities with couples. What are some more differences especially when when you start out with a couple and you think this is what I'm going to do. This is this is the modality. Yeah. Yeah. I I do mix modalities a lot. So I borrow like for me Gottman is like a framework that I have in my head for like what a healthy relationship looks like. So I borrow a lot of that framework. But in terms of like when I'm in the room I could tell people until I'm blue in the face like we do not criticize one another. Instead we use a gentle startup. If you will know that like no one doesn't know that. You can remind them in the moment but if there is this like trauma enmeshed pattern people don't even have access to that cognitive skill.

They're just looking back into this like uh survival way of being of just fighting for their own needs. So how I typically start out is by developing goals individual autonomous goals for each partner. And this is slightly different than what um couples therapy goals are because what this is is you're really getting individuals buy-in. So you have the couple in front of you and you're getting each person's individual buy-in for what is it specifically that they would like to work on for themselves in this relationship. You're asking them this relationship is inviting you to grow as a human in some way. And what is that invitation? Can we Can we label that name that put it into concrete terms so that you are growing cuz this is exactly what this relationship is doing to you. It's stretching you and growing you as a human.

So, so let's develop to that for you and for you and that's how change happens when each person kind of develops those. So, that's how we usually um that's how I usually start out. Now, it's not usually that smooth of a process because most people will come into couples therapy because that person needs to change. I was going to say, "Okay, that sounds perfect." But, what what happens? Because if I may, when I remember being in in grad school and thinking, "Oh, I can learn exactly this. This is what you do now. This is what you do when they say this." But, then you you get into practice and you've got people sitting across from you and you're like, "Oh, they didn't They didn't do what they were supposed to do. They didn't say what they were supposed to say." So, I imagine lots of pivoting.

I mean, I I bet that's best case scenario, they both have those perfect individual goals to bring together to the session. What about when it doesn't happen? Yeah, like you said, lots of pivoting. Um someone from the like training training course said sometimes it takes a year for a couple to establish their individual autonomous goal. And I was like, "Wow." All right, I guess it makes sense that then I will need to do a lot of pivoting. So, you would like try It's It's like I feel like couples work is a lot of slippery work. You can You think you just like you're about to nail it with this one person. They're about to kind of recognize like, "Oh, maybe I get big in these interactions and my individual autonomous goal is to figure out how to not get big and scare my partner away." And like right when you're about to get to that, they're like, "But, they" and then they switch to the they.

And so, it's like it's it slips right out of your hands, but you pivot and you try to bring it back to them like, "All right. And and and let's bring it back to you." And sometimes you get like a mini individual autonomous goal and for me, that's enough. I have a buy-in. And that's like I'll work with that until eventually we can develop a person's capacity to really look at their piece and own it. The whole but they thing it just cracks me up so much because I'm sure that's what you hear all the time. You think you're getting somewhere. Maybe you are getting somewhere and then it's but did you hear what he did? Did you hear what she did? What about Wait, I Yeah, we almost got somewhere with me but what about him? Yep. What about this thing that he does? We should really get back to that. All the time.

So probably not probably not great work for for a therapist with significant ADD or difficulty difficulty staying on on one of those. for sure. So how then once you get once you eventually get all of that aligned, how is the treatment how does the treatment go? How does how is progress made especially versus other other modalities? Yeah, that is a good question. In the beginning it feels a little bit like a wrestling match of some sorts. You're kind of like working in the moment and so you don't have as much clarity as like what will it look like for sure but after a few sessions then you begin to develop clarity and what it looks like is different for different people. Sometimes couples people who are able to do a little bit of that U-turn they create a list of start stop behaviors. And so that is is like them beginning to realize like okay, say we use the same example from before I tend to get big in relationships and scare my partner away then they break that down to like okay, that means that part of my start behavior is to begin to notice when that happens.

So I'm going to start noticing when I begin to escalate and so we'll kind of just focus on that creating a start stop list for each partner. Sometimes it is helping each person realize when they are in that when they slip back into that survival part of their brain and helping them develop like literacy for that and also doing some work with them in session to develop grounding tools that can help them ground and connect back to themselves to operate from that wiser version of themselves and not that survival part. And so a lot of times those pieces are foundational. The one other thing I will say is that like an a next level kind of piece of work sometimes is to do something called like the II intervention, which is basically like helping a couple have a conversation or dialogue about a difficult topic and that a lot of times puts them like in against their like developmental edges right up against them.

And so there's a lot of like work as a therapist that you do in that moment such as like helping somebody remain in curiosity or stay curious to their partner. And can that shift just the way of being that they have with the their significant other from this like knowing judgy place to like a I wonder what more I can learn about you or what more I didn't know about you. So that is like kind of like next step or a little more advanced where you kind of just work with the nitty-gritty ways of being that you help people shift out of. Do people often once they've gotten to that stage I guess if you will, does it advance much more like have you had people where you think oh they did this they did this great I didn't think we'd have so few hiccups. What now? What do we move on to? Is there another deeper level of that or more intense level?

Yeah, that's a good question. I haven't gotten there yet Jessica. Then well that's perfect then you'll come back on when you do. And report back on. And you'll say [clears throat] it happened and I've a good example. We're there. Yeah. Yeah, absolutely. I'm waiting for that to happen, but I I've seen a lot of little wins, and as a therapist, you always celebrate those, right? So, a lot of little wins, like someone emphasizing about something that they were like never had no idea about before, or someone being able to finally put words to something that, you know, before like this is an example of someone who played small. So, someone finally being able to be like, "That does not work for me." And like saying that, like those are little wins that I celebrate. Um but I they usually take a lot of like elbow grease to get to, and they're cherished when they do happen because they matter, too.

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With the ReachLink app, you can connect with licensed, experienced therapists through secure, convenient telehealth sessions from your space on your time. No commute, no waiting rooms, just real support when you need it. So, whether you're ready to start therapy or ready to offer it, ReachLink is here. Download the app or learn more at reachlink.com because better mental health should always be within reach. Absolutely. Well said. Is there is there homework with this with this method? Is there a lot of homework? Is it more we're doing the work in in office or are there assignments that that you offer? Yeah, the model leaves it up to the therapist. Um, and so How kind. How kind, right? How kind. Yeah, so some Where's the guidance? Where's the guidance? They have like a lot of handouts and like homework assignments a therapist can do.

So, you know, if any therapist is interested in that, that is available, which is always fun. And and also some of it also depends on the couple. There are couples that really enjoy having it. There are couples that don't. I tend to be more on the side of not assigning homework. And that's partly because one of my professors what like first said in graduate school in one of our first classes, he said that I stopped giving homework a long time cuz nobody ever does it. And you're And I I remember thinking about that. Um, so throughout the years of my practice, I came to realize that like is it really useful cuz a lot of times it just people don't have time or don't remember to and then it just makes them feel bad, but it's you know, just is my experience. I definitely get that part of that it's a whole other element than when they feel bad.

A whole other almost thing to work through of well, where does where does this come from? And can't imagine that always being pleasant for for either party. So, in addition to couples work, I know that you do, I think, correct me if I'm wrong, a little bit of maybe gentle trauma resolution. Is that something that you you work with with your your couples or is that more individual? Yeah. Um, I would say both. When you work with couples [snorts] for at least the population that I see or a lot of people that I see, you inevitably bump up against trauma. You can I I don't know how you can do couples work without bumping into that. And so it's some of that trauma resolution can just be in the moment. Like can happen, you know, someone connecting to a part of themselves that they have not connected with before.

Them being able to share that with their partner or share part of themselves that they've never shared with their partner before. Those are all like little pieces of trauma work that we can do and a lot of times do in couples work and it's some of the most beautiful work. I love it when that happens. But I also do it individually, too. And it's very similar, you know, helping people connect with parts of themselves that they didn't connect with before. And and so very similar except you only have one person in the room rather than two. I hear you. Okay. And how with what we're talking about with with that method, now just thinking of anything that I know about the Gottman method, for example, what are the biggest differences? I know I'm really putting you on the spot now. What What are the biggest differences with those two modalities?

Yeah. And do they clash? Yeah. I found I I was wondering about the same cuz I my first training was in Gottman and I loved it so much. But I I struggled with the how to part Gottman. It was very theoretical and I loved that. My knowing parts enjoy theory. But when it came to like the in the moment, I I struggled with that. And some of that might have been my own struggle. But when I first joined the developmental model, I tried to figure out like how do they work together? And I realized that they actually work hand in hand together. Like Gottman gives you the theory part and then the the developmental part gives you a lot of the how to parts. And so in my mind when I'm working with a couple, I I often have that theory in the back of my head for like, okay, diagnostically, why is this couple really struggling?

There's a trauma piece, but like relationally, what is it? Is it the criticism? Is it the contend? What What pieces are most at play? Um and and then I lean on the developmental model for the like in the moment, um how do I help each partner tweak things and adjust things so that they have a different experience of one another in the room. Well, that sounds like a perfect, you know, borrowing and and complementing each each method, kind of marrying them to get marrying, how ironic. Let's talk about a book. Yeah, absolutely. Um that's that's really helpful though that it's not such conflicting, like, oh gosh, I've learned this one first, now now I've got this that says something completely different. It seems like you're really able to meld them and and have them compliment each other. Absolutely, and I attribute that all of to like the the models themselves that they are very like good buddies, they could work hand in hand.

They're friends. They would have a good relationship. How How about I know you've also got training, I think, in um in narrative exposure therapy. What is that, if you will? Yeah, that that is one of the like more less known, you know, trauma treatment modalities. Um I think EMDR, you know, art, like those tend to be ones that are like really well known. Um and NAT or narrative narrative exposure therapy is one of the less known, partly because it was developed, you know, only more recently. Also partly because I think it was developed on, you know, in refugee camps and in working with populations that we often do not actually see in the therapy room in in the world that we live in today. Wait, can you tell us more about that? Sorry, can like how it was developed cuz this is hopefully not just me, this is a bit new to to How was How was it developed?

Yeah, I think if I'm remembering correctly, it was a group of like I want to say I know for sure they're European. I'm not sure if they're German, but European psychotherapists um that were working with victims of torture and violence uh in refugee camps after war. And I think it was in like countries like Uganda, Kenya, and a few other countries around the world where they were trying to help develop like a short-term treatment modality for PTSD for capital T trauma. And so that was how the modality was um developed um and it's it's it works. It's like a short-term treatment modality that helps people get rid of their like big T trauma symptoms such as nightmares, intrusive thoughts, dissociation, all of that and that could help with. That's really interesting. So that's something else that you were So you've got specialized training.

What was that training like? Yeah, it was really interesting. It was my first like trauma training. So it was very interesting. Um and then the training itself, they have us like practice on ourselves, which I know a lot of like uh trauma trainings do as well. So it was it was also very interesting to see it work on us and like on our the you know like people um that we were the cohort that we were training with. It was a four-day training, so it's short um and by the end you you know have you're certified in treat working with that modality. I found that it also works uh very well with populations, you know, in the US who have experienced capital T trauma. So people who have you know been uh who have experienced domestic violence, people who are have been involved in addiction, all of those um populations that have that are involved with you know, those kinds of experiences, I found that net like tend to can work really well for as well.

So, if you had, let's say, just for example, like a domestic violence situation, how would how would that look if you were using this this form of therapy? Good question. First thing would be to, of course, make sure the client is safe and out of that situation. So, assuming that's the case, um and now the client is basically in a place where she's trying to rebuild her life, but just has these active PTSD symptoms. She can't sleep at night, can't interact with people, like all of these things that are happening in the moment, um then I would propose net to her as a possible treatment. Um we would the first session we would meet and we would just lay out a timeline of her life for all the traumatic moments that she has experienced. For someone who's experienced domestic violence, a lot of that will probably center around the time period that she was in that relationship or they were in that relationship, but, you know, trauma can be from before as well.

But, we would identify like six to 12 incidents or moments that we would do that we would pick as something to do an exposure on, and we would have basically anywhere between six to 12 sessions, taking each of those really difficult moments and processing it, um you know, processing it in a way that helps the client reintegrate it, narrate it, and then doing that with all the moments until we get to the end of the timeline or lifeline. How long, and I know there's probably no way to answer this, how is this more of a brief a brief modality or is it is it more ongoing, long-term? Definitely a brief one. Like, net has a start a specific start, middle, and an end, and you're always encouraged that you end it with people because it it's a it's more a intensive kind of a treatment. And so, a lot of times if you start it, like you really like rip the band-aid off and you cannot leave people that way.

So, you do a lot of paperwork before. Like, are you in a place where you have enough support in your life to continue with this? It doesn't always work. You have seen people who eventually like fall off in the middle of it and come back, hopefully. Um but, you really want to try to set them up to let them know like this is just a little thing that we're doing. It has a beginning, it has a middle, it has an end, and I want you to get to the end. I could see that almost being more palatable sometimes for people that are again, of course, appropriate for for this type of work, knowing that, you know, depending how this goes, there is a beginning, middle, and end, cuz I think so many people think of therapy as, "Oh my gosh, I'm going to be doing this forever. I don't have that in me." I think in all the short-term therapies that we've got, especially for things like like trauma and things that we're talking about, that's so such a relief, I imagine, to some people.

Am I going to be talking about this forever? Am I going to be analyzing all of this forever? Absolutely. It gives a lot of people buy-in in that way. Buy-in, absolutely. Agree it. Do you feel like you ever mix So, I know you mix the Gottman and the Bader. Do you ever mix in this other one? No, I don't mess with net. That's like a sacred process. You don't mess with it. It's its own thing. Because it's it's really um it's really like an invasive form of treatment. And I always tell people that like there is the like um antibiotic, and then there's like the surgery. Like net is more like the surgery. And so, it's like it's own process that you carve out time for. And you you if you started it, that's all that you do. You don't do any like processing or like little trauma stuff in the middle.

There's no chitchat. There's no side chitchat. This is what we're doing. If someone really needs it, and a lot of people do cuz this is hard, then we'll schedule like an extra session to do that, but like we're doing that and we're doing that. That's all that we're doing. Got it. Yeah, makes sense. With I know you mentioned EMDR just as an example of you something else that we might use for traumatic situations. Do you Do you feel that this is I don't want to say better or maybe just very different from the way that that EMDR I mean I know it's different with in terms of how it logistically works, but the goal I'm guessing is is a bit similar. They share the the goal of of trauma resolution and and better functioning. It definitely they do definitely share that and I think some things if work for some people versus not.

I the clinic that I was at before working at Wholehearted Healing, one of my colleagues was trained in both EMDR and NET and she was telling me that different things work for different people. NET really tends to just offer like short-term immediate release and it's more short-term, more structured. And and it specifically works well with populations who have experienced like big T trauma. So it's most effective there and gives the most results there. Miriam, something that I have noticed on your website time and time again that really is so warming to see and I just want to kind of call out. You have mentioned several times holding a special heart for certain populations, marginalized populations, biracial couples I saw on your website. That and I could tell from the second that that we met when we were speaking before we started recording here that that that's definitely you.

Would you say that that that's accurate? 100% yes. So you've got a big heart. to try to have my heart Well, thank you so so much for being here. I think that that that really symbolizes so much of of what you've talked about everything that you brought the conversation back to really keeps in my mind your heart and what you want for people and the healing that you want for people. So I'm so glad that there's somebody like you out there and you'll need to come back. Absolutely happy to be back anytime Jessica. Thank you so much. Thank you for being here. Thank you guys for listening. I'm going to make sure that all Miriam's information is linked here especially some of the modalities that we talked about. Thanks so much Miriam. We'll talk to you soon and thank you guys for listening.