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Steven, a 45-year-old engineer, and Linda, a 40-year-old data processor, have been married for 12 years and have a 10-year-old child. In 2018, Steven was fired from his job after he exploded at his boss, who he felt had gone out of his way to humiliate Steven.

Dr. Alison Heru, professor of psychiatry at the University of Colorado at Denver, Aurora
Dr. Alison Heru

He was having difficulty finding a new job. Linda had to pick up extra hours at work and became annoyed with Steven. “What do you do all day? Why can’t you finish all these half-done house projects? What is the matter with you?” Linda felt that he was only half-heartedly looking for a new job and wondered whether he preferred letting her be the breadwinner and the boss.

Steven agreed to seek individual therapy to assuage his wife’s concerns. After several sessions, Steven realized that his father had criticized him in a way similar to the way his wife did, and that this was similar to his perception of his former boss. He began to discuss his parents’ backgrounds to try to understand their behavior. Steven began to change his behavior, looking for work more seriously and finishing up home projects. However, Linda did not accept that these changes were “real” and continued to berate him. She stated that he was doing this only temporarily to appease his therapist. Steven tried to explain why he had changed, with descriptions of his father’s behavior toward him. Months went by, and despite securing an interview for a job and having finished the projects at home, Linda remained steadfast in denying his change. Steven and Linda were referred to couples therapy.

In the first session, Steven complained that Linda had to have everything done exactly her way, and he opined that she liked to be the dominant force in the relationship. Linda countered with: “One time on TV there was this woman complaining about the glass ceiling.” Meanwhile, he said things such as “women seem to think that men work because they like to work.” She countered: “I think he got himself fired on purpose!”
 

Predictive models

Linda had formed a mental model of her husband based on her experience of his repetitive behavior over the 15 years that they had known each other. She had long ago decided that she needed to nag him to get him to do anything productive. This had occurred early in their relationship, and it was her fixed belief about her husband.

Steven entered their relationship believing that Linda would be critical of him, regardless of what he did. This belief was not a conscious belief, more of an expectation based on his prior relationship with his father. He ignored her nagging until it became so persistent than he would eventually do what she asked. When Steven began to resolve his anger toward his father more effectively, he became less begrudging of others and more self-motivated. Linda’s continued nagging made Steven wonder whether it was “worth it” to make self-improvement changes, as Linda did not appreciate his efforts to change.

When we get to “know someone” in a coupled relationship, our experience of the other person falls into predictive patterns. We expect the “usual” responses from them: We “know” how they will respond. This predictability makes it easy for us to understand the other person, so that we do not have to continually analyze and reanalyze each utterance or behavior as a new experience.

Steven’s predictive model of Linda reflects his predictive model of the other as indicative of the fact that he will be always berated. He, at some level, expects others to berate him. Linda prefers to maintain her current model of her husband and believe that his changes are not real, rather than do the work of changing her internal model – work that she does not think is necessary. In their couples therapy, predictive modeling “explains” how Linda and Steven use their internal models of each other to direct their interactions.

Couples therapy helps them describe the change they both want. As Linda approaches Steven, her internal model must now change to incorporate his new interactional style. Of course, she will be suspicious that he might “relapse.” But understanding that he desires to interact with her in this new way, and that she actually would prefer to stop nagging him, helps her to develop a new model of interaction with him.
 

 

 

Relational theories are numerous: Why add one more?

Predictive processing is a paradigm shift in psychiatry. This shift moves psychiatry away from psychodynamic explanations of behavior to explanations that are brain based. Psychodynamic explanations are how our prior experiences in the world get played out in the current world. Predictive processing explains how the brain incorporates the dynamics of child rearing and prior relational interactions into internal models that we use to reduce the work of repeatedly reinterpreting people’s behavior.

The historical explanations that create internal models are interesting, especially to Steven, who felt there was a connection between his prior experiences and his current experiences. Acknowledging the psychodynamic cause is helpful, but it is the how of relational change that is the work of couples therapy.
 

The positives of predictive modeling

Reframing behavior as an error of brain processing reduces blame and the sense that the other person is purposefully disruptive or built a certain way or that the other person lacks the will to change. A neuroscience-based visualization of our internal models of other people helps us more neutrally describe the iterative process that occurs. Other systemic family models use their own languages to achieve the same end, but as Carlos E. Sluzki, MD, opines: We need to update our models to keep up with the times!

Dr. Heru is professor of psychiatry at the University of Colorado at Denver, Aurora. She is editor of “Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals” (Routledge, 2013). She has no conflicts of interest to disclose. The case, which was changed to protect patients’ confidentiality, was provided by David M. Allen, MD, professor of psychiatry emeritus at the University of Tennessee Health Science Center, Memphis. Dr. Allen is author of three books, “Coping with Critical, Demanding, and Dysfunctional Parents” (New Harbinger Publications, 2018); “How Dysfunctional Families Spur Mental Disorders” (Praeger, 2010); and “Psychotherapy with Borderline Patients: An Integrated Approach” (Lawrence Erlbaum Associates, 2003).

References

Friston K. Entropy (Basel). 2012 Nov;14(11):2100-21.

Sluzki CE. Fam Process. 2007;46(2):173-84.

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Steven, a 45-year-old engineer, and Linda, a 40-year-old data processor, have been married for 12 years and have a 10-year-old child. In 2018, Steven was fired from his job after he exploded at his boss, who he felt had gone out of his way to humiliate Steven.

Dr. Alison Heru, professor of psychiatry at the University of Colorado at Denver, Aurora
Dr. Alison Heru

He was having difficulty finding a new job. Linda had to pick up extra hours at work and became annoyed with Steven. “What do you do all day? Why can’t you finish all these half-done house projects? What is the matter with you?” Linda felt that he was only half-heartedly looking for a new job and wondered whether he preferred letting her be the breadwinner and the boss.

Steven agreed to seek individual therapy to assuage his wife’s concerns. After several sessions, Steven realized that his father had criticized him in a way similar to the way his wife did, and that this was similar to his perception of his former boss. He began to discuss his parents’ backgrounds to try to understand their behavior. Steven began to change his behavior, looking for work more seriously and finishing up home projects. However, Linda did not accept that these changes were “real” and continued to berate him. She stated that he was doing this only temporarily to appease his therapist. Steven tried to explain why he had changed, with descriptions of his father’s behavior toward him. Months went by, and despite securing an interview for a job and having finished the projects at home, Linda remained steadfast in denying his change. Steven and Linda were referred to couples therapy.

In the first session, Steven complained that Linda had to have everything done exactly her way, and he opined that she liked to be the dominant force in the relationship. Linda countered with: “One time on TV there was this woman complaining about the glass ceiling.” Meanwhile, he said things such as “women seem to think that men work because they like to work.” She countered: “I think he got himself fired on purpose!”
 

Predictive models

Linda had formed a mental model of her husband based on her experience of his repetitive behavior over the 15 years that they had known each other. She had long ago decided that she needed to nag him to get him to do anything productive. This had occurred early in their relationship, and it was her fixed belief about her husband.

Steven entered their relationship believing that Linda would be critical of him, regardless of what he did. This belief was not a conscious belief, more of an expectation based on his prior relationship with his father. He ignored her nagging until it became so persistent than he would eventually do what she asked. When Steven began to resolve his anger toward his father more effectively, he became less begrudging of others and more self-motivated. Linda’s continued nagging made Steven wonder whether it was “worth it” to make self-improvement changes, as Linda did not appreciate his efforts to change.

When we get to “know someone” in a coupled relationship, our experience of the other person falls into predictive patterns. We expect the “usual” responses from them: We “know” how they will respond. This predictability makes it easy for us to understand the other person, so that we do not have to continually analyze and reanalyze each utterance or behavior as a new experience.

Steven’s predictive model of Linda reflects his predictive model of the other as indicative of the fact that he will be always berated. He, at some level, expects others to berate him. Linda prefers to maintain her current model of her husband and believe that his changes are not real, rather than do the work of changing her internal model – work that she does not think is necessary. In their couples therapy, predictive modeling “explains” how Linda and Steven use their internal models of each other to direct their interactions.

Couples therapy helps them describe the change they both want. As Linda approaches Steven, her internal model must now change to incorporate his new interactional style. Of course, she will be suspicious that he might “relapse.” But understanding that he desires to interact with her in this new way, and that she actually would prefer to stop nagging him, helps her to develop a new model of interaction with him.
 

 

 

Relational theories are numerous: Why add one more?

Predictive processing is a paradigm shift in psychiatry. This shift moves psychiatry away from psychodynamic explanations of behavior to explanations that are brain based. Psychodynamic explanations are how our prior experiences in the world get played out in the current world. Predictive processing explains how the brain incorporates the dynamics of child rearing and prior relational interactions into internal models that we use to reduce the work of repeatedly reinterpreting people’s behavior.

The historical explanations that create internal models are interesting, especially to Steven, who felt there was a connection between his prior experiences and his current experiences. Acknowledging the psychodynamic cause is helpful, but it is the how of relational change that is the work of couples therapy.
 

The positives of predictive modeling

Reframing behavior as an error of brain processing reduces blame and the sense that the other person is purposefully disruptive or built a certain way or that the other person lacks the will to change. A neuroscience-based visualization of our internal models of other people helps us more neutrally describe the iterative process that occurs. Other systemic family models use their own languages to achieve the same end, but as Carlos E. Sluzki, MD, opines: We need to update our models to keep up with the times!

Dr. Heru is professor of psychiatry at the University of Colorado at Denver, Aurora. She is editor of “Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals” (Routledge, 2013). She has no conflicts of interest to disclose. The case, which was changed to protect patients’ confidentiality, was provided by David M. Allen, MD, professor of psychiatry emeritus at the University of Tennessee Health Science Center, Memphis. Dr. Allen is author of three books, “Coping with Critical, Demanding, and Dysfunctional Parents” (New Harbinger Publications, 2018); “How Dysfunctional Families Spur Mental Disorders” (Praeger, 2010); and “Psychotherapy with Borderline Patients: An Integrated Approach” (Lawrence Erlbaum Associates, 2003).

References

Friston K. Entropy (Basel). 2012 Nov;14(11):2100-21.

Sluzki CE. Fam Process. 2007;46(2):173-84.

Steven, a 45-year-old engineer, and Linda, a 40-year-old data processor, have been married for 12 years and have a 10-year-old child. In 2018, Steven was fired from his job after he exploded at his boss, who he felt had gone out of his way to humiliate Steven.

Dr. Alison Heru, professor of psychiatry at the University of Colorado at Denver, Aurora
Dr. Alison Heru

He was having difficulty finding a new job. Linda had to pick up extra hours at work and became annoyed with Steven. “What do you do all day? Why can’t you finish all these half-done house projects? What is the matter with you?” Linda felt that he was only half-heartedly looking for a new job and wondered whether he preferred letting her be the breadwinner and the boss.

Steven agreed to seek individual therapy to assuage his wife’s concerns. After several sessions, Steven realized that his father had criticized him in a way similar to the way his wife did, and that this was similar to his perception of his former boss. He began to discuss his parents’ backgrounds to try to understand their behavior. Steven began to change his behavior, looking for work more seriously and finishing up home projects. However, Linda did not accept that these changes were “real” and continued to berate him. She stated that he was doing this only temporarily to appease his therapist. Steven tried to explain why he had changed, with descriptions of his father’s behavior toward him. Months went by, and despite securing an interview for a job and having finished the projects at home, Linda remained steadfast in denying his change. Steven and Linda were referred to couples therapy.

In the first session, Steven complained that Linda had to have everything done exactly her way, and he opined that she liked to be the dominant force in the relationship. Linda countered with: “One time on TV there was this woman complaining about the glass ceiling.” Meanwhile, he said things such as “women seem to think that men work because they like to work.” She countered: “I think he got himself fired on purpose!”
 

Predictive models

Linda had formed a mental model of her husband based on her experience of his repetitive behavior over the 15 years that they had known each other. She had long ago decided that she needed to nag him to get him to do anything productive. This had occurred early in their relationship, and it was her fixed belief about her husband.

Steven entered their relationship believing that Linda would be critical of him, regardless of what he did. This belief was not a conscious belief, more of an expectation based on his prior relationship with his father. He ignored her nagging until it became so persistent than he would eventually do what she asked. When Steven began to resolve his anger toward his father more effectively, he became less begrudging of others and more self-motivated. Linda’s continued nagging made Steven wonder whether it was “worth it” to make self-improvement changes, as Linda did not appreciate his efforts to change.

When we get to “know someone” in a coupled relationship, our experience of the other person falls into predictive patterns. We expect the “usual” responses from them: We “know” how they will respond. This predictability makes it easy for us to understand the other person, so that we do not have to continually analyze and reanalyze each utterance or behavior as a new experience.

Steven’s predictive model of Linda reflects his predictive model of the other as indicative of the fact that he will be always berated. He, at some level, expects others to berate him. Linda prefers to maintain her current model of her husband and believe that his changes are not real, rather than do the work of changing her internal model – work that she does not think is necessary. In their couples therapy, predictive modeling “explains” how Linda and Steven use their internal models of each other to direct their interactions.

Couples therapy helps them describe the change they both want. As Linda approaches Steven, her internal model must now change to incorporate his new interactional style. Of course, she will be suspicious that he might “relapse.” But understanding that he desires to interact with her in this new way, and that she actually would prefer to stop nagging him, helps her to develop a new model of interaction with him.
 

 

 

Relational theories are numerous: Why add one more?

Predictive processing is a paradigm shift in psychiatry. This shift moves psychiatry away from psychodynamic explanations of behavior to explanations that are brain based. Psychodynamic explanations are how our prior experiences in the world get played out in the current world. Predictive processing explains how the brain incorporates the dynamics of child rearing and prior relational interactions into internal models that we use to reduce the work of repeatedly reinterpreting people’s behavior.

The historical explanations that create internal models are interesting, especially to Steven, who felt there was a connection between his prior experiences and his current experiences. Acknowledging the psychodynamic cause is helpful, but it is the how of relational change that is the work of couples therapy.
 

The positives of predictive modeling

Reframing behavior as an error of brain processing reduces blame and the sense that the other person is purposefully disruptive or built a certain way or that the other person lacks the will to change. A neuroscience-based visualization of our internal models of other people helps us more neutrally describe the iterative process that occurs. Other systemic family models use their own languages to achieve the same end, but as Carlos E. Sluzki, MD, opines: We need to update our models to keep up with the times!

Dr. Heru is professor of psychiatry at the University of Colorado at Denver, Aurora. She is editor of “Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals” (Routledge, 2013). She has no conflicts of interest to disclose. The case, which was changed to protect patients’ confidentiality, was provided by David M. Allen, MD, professor of psychiatry emeritus at the University of Tennessee Health Science Center, Memphis. Dr. Allen is author of three books, “Coping with Critical, Demanding, and Dysfunctional Parents” (New Harbinger Publications, 2018); “How Dysfunctional Families Spur Mental Disorders” (Praeger, 2010); and “Psychotherapy with Borderline Patients: An Integrated Approach” (Lawrence Erlbaum Associates, 2003).

References

Friston K. Entropy (Basel). 2012 Nov;14(11):2100-21.

Sluzki CE. Fam Process. 2007;46(2):173-84.

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