Couples and Sex Therapy: Myths and Truths (Part 2)

Preston: [00:00:00] Hey, welcome back to our special two parter episode. So our first two part episode, our first, our second part of our first two part episode. So if you want to get caught up, make sure you watch last week's episode where we kind of went into the stages of couple's therapy and really began to explore all the, the dyads and some of the stereotypes that.

Um, Nikki comes across when she's dealing with a couple's therapy because this episode's gonna be about applying those principles and we're gonna be doing some role playing. So you can honestly jump right in. I imagine it's still gonna be entertaining, but if you wanna add some context, make sure you listen to the previous episode first.

Margaret: Let us know if you guys like this part where we kind of illustrate the concepts. And I work on my social anxiety and Preston works on his acting skills. We have fun doing them, and I think it can be helpful to under make the material come alive or at least be weird enough that you remember it. But let us know if you like it.

We did it a little bit with motivational interviewing. It 

Preston: will be weird. It will be weird. That's, that's outta the question. Is it that we if it's adaptive, weird is, [00:01:00] is the 

Margaret: question. Yeah. It's weird. In like a fun, cute way. Yeah. 

Preston: Yeah. In like a, like a chill, nonchalant, an educational way. Like we're, we're whatever.

By way, 

Margaret: we're really chill about it. Not worried. 

Preston: Okay. Enough stalling. Let's roll the episode

and welcome back to How to Be Patient, where we have Nikki Haddad. And she's gonna be talking to us about different pairings. Right? That's what you wanna talk about next, Margaret? 

Dr. Nikki Haddad: Yes. Sure. Let's talk about different pairings. So there's, I mean this, there's a lot less to talk about here in terms of, of details of this because the couples can look so different.

But I think that, just to kind of summarize how I think about it, I'm looking for. Where the couple is as a couple, but then also as individuals. And you can imagine that it starts to get complex, um, [00:02:00] because. First of all, every couple is different. The dynamics of every couple is different, but also they can kind of move and oscillate between the session, during the session and um, kind of within themselves as well.

So it can kind of be hard to put your finger exactly on where a couple may lie. But generally we see a few common stages in the couples that present to therapy. 

Preston: Like nurse firefighter. Yes. And teacher cop. 

Dr. Nikki Haddad: Exactly. Yeah, you're right on the money, right on the money first. 

Preston: Okay. Yeah, I, I read a little bit beforehand, but.

Dr. Nikki Haddad: So, so I would think largely, largely the f most common couple dynamic that we see is symbiotic. Symbiotic. And this tends to occur from chronic, I. Failed attempts at differentiation. So, Preston, when you were talking [00:03:00] earlier about having relationship experience where maybe you try to differentiate, but then your partner doesn't like it so much.

Mm-hmm. And tries to pull you back in through conflict, through whatever it is that leads to these different types of symbiotic, symbiotic pairings. And the two most common ones are hostile and dependent. Where each member of the couple takes on one of those roles, although again, they can flip flop. 

Preston: So are are these qualities Yeah.

Of symbiotic? So it's like hostile, symbiotic, dependent. Symbiotic, yeah. 

Dr. Nikki Haddad: Oh, interesting. So they're, these are subtypes of symbiotic. Symbiotic, and the two main subtypes are hostile, independent, and then conflict avoidant. And even within the conflict avoidant, there's more subtypes, which is either very friendly and superficial and smiley or very tension filled.

Like you could cut the tension with a knife in a room with those patients. And [00:04:00] there's not a lot of talking or emotion sharing. Even though the hostile sounds very difficult to work with, I would argue that conflict avoidant is extremely difficult as a couple's therapist, 

Margaret: it's like there's nothing to, it's, it, I'm, it reminds me of an individual therapy patient where it's like, every time they come in it's like, how are you doing?

I'm good. You know? Work's been the same like that. There's, and there's many things that can cause that, but kind of that, like, it's harder to get into someone who's sort of walled off than when the emotions right there. 

Dr. Nikki Haddad: Yes, yes. Yeah, 

Preston: like, like surgery is hard enough as it is, but if I can't even like get into the abdomen, 

Margaret: like where is the.

Dr. Nikki Haddad: Yes, I know. I, I, I can relate to that feeling in individual therapy of like, almost wanting to pull your hair out. Like give me something, give me something. Um, and that we see in, when we see it in couples, it tends to be an indication that this is gonna be [00:05:00] pretty hard work because both members have a lot of work to do in terms of coming into themselves and being able to express their needs.

Preston: Mm-hmm. So when you have multiple failed attempts at differentiation, does it tend to be like one and one the other, trying to pull away consistently? Or does it kind of oscillate back and forth or one tries to differentiate, they fail, come back, the other tries to differentiate and then they fail, come back.

Of those two kind of like dynamics, which do you see more? 

Dr. Nikki Haddad: Yeah, of the two, it tends to be one person who's trying over and over and over and over again, and another person who is just really stuck in symbiosis, usually because of some type of trauma history. In my experience, there's just something. All too threatening about reaching for more independence.

And as you can imagine, that leads to a lot of resentment on behalf of the couple, the member of the couple that's [00:06:00] trying so desperately to differentiate. 

Margaret: What I'm not hearing you say is the Internet's favorite couple, uh, to discuss, which is avoidant and anxious attachment. And I wonder how you think, I know you're also.

You consume on TikTok? I wish you would mm-hmm. Make videos and talk, but, um, takes, took me four years to start talking on, into a mic. So what, what do you make of that? I know that's like a different body. It's in some ways different, in some ways colle, like similar. 

Preston "Marge" Roche: Yeah. 

Margaret: When, when people bring, is this like the avoidant anxious dynamic and what do you think about that term as a couple's therapist?

Dr. Nikki Haddad: No, I actually, I, I really appreciate bringing attachment theory into the room. A lot of patients tend to be much more familiar with that language as well. Um, and from an attachment perspective, I mean, that's again, right on, right on the money. I feel like the, the person trying to differentiate tends to be the more avoidant.

Partner, and then the [00:07:00] person who's sticking in symbiosis tends to be more of the anxious partner. And what is anxious attachment really? I mean, it to me feels a little bit about being scared of the person leaving you, right? That's like what the crux of it is. Mm-hmm. And so I could imagine that seeing your partner trying to differentiate would be very threatening because it would elicit that, that feeling in you as a more anxiously attached person.

And. 

Preston: Prompts me to think about another dyad, not through the lens of personality. The personality clusters. So like the borderline narcissist. Dyad. Mm-hmm. Where someone with BPD maybe has a pretty unstable concept of self, and so they perceive the differentiation of their partner as a almost abandonment.

Preston "Marge" Roche: Mm-hmm. 

Preston: And that kind of triggers them to, to bring them back in. 

Dr. Nikki Haddad: Yeah, absolutely. Whereas a more narcissistic person is much less focused [00:08:00] on the other person because they're so internally preoccupied mm-hmm. And much more, um, interested in that internal space. 

Preston: Yeah. And, and, and they may see like, that their, that person's attachment is almost like a threat to their grandiose idea of self, 

Margaret: right.

So they may almost 

Preston: wanna push back towards differentiation. 

Margaret: I mean, couldn't you all, I, I feel like sometimes, like when people talk about the, like, dynamic between like a more narcissistic personality type with a more like anxious dependent borderline, like, is, is there also something that could be like this person who has a more mutable sense of self for whatever reason?

Preston "Marge" Roche: Mm-hmm. Um. 

Margaret: Like compliments. This idea of the narcissistic centrality of like being at the center of the world like that. Someone who's like, I don't feel connected to a sense of myself. And so in some ways it's anxiety relieving to be with someone who insists they're the center of the world and I'll make them the center of my world.

And for the [00:09:00] narcissistic personality, it's like as long as they don't try to control me, then this actually is coherent with my worldview. 

Dr. Nikki Haddad: Yeah. Yeah, it's so interesting to think about that and the common pairings that we see in all these different dyads and why they may exist, and it's clearly serving both members of the couple, even if it doesn't seem like it from, from the outside.

I think that anyone who wants to stay in symbiosis must be doing so for a reason. You know, it's, it's, mm-hmm. This desperate attempt to just hold on to this comfortable space, and it's not safe. The world has taught that person that it's not safe to go beyond that. Mm-hmm. And that's where we, again, terms like codependence come up here more colloquially of, of what does it mean to just need that person all the time.

Preston: It's, it's really interesting to think about viewing the other person's emerging individuality as a threat. Hmm. Or as abandonment. [00:10:00] And I guess it takes a lot of, I guess, to use the Miller stages again, object constancy, to be able to identify that this person may have a desire to express themselves as an individual and also stay in a relationship with me that these things aren't mutually exclusive and it's really hard to hold that dialectic in the air.

Yes. Especially if you've never been able to like have that modeled for you or kind of develop that within yourself. 

Dr. Nikki Haddad: I totally agree and, and what I'll say about that in terms of the modeling is that a lot of show, like we talked about earlier, shows and movies and all of the media that we consume tells us that actually that's not what we should aspire to.

And if our partner wants to go get a meal with a friend or spend time with their coworkers after work, that that's not a good sign. And that actually that means they don't care about me and they don't love me and they're gonna leave me when in reality. In my eyes, that's the marker of a very healthy relationship because this [00:11:00] person is prioritizing themselves and their partner, because losing yourself in a relationship will lead to disaster over time.

It just will. 

Margaret: Are there, are there any other common pairings that you, so you mentioned symbiosis or symbiotic. Symbiotic, maybe symbiotic, differentiating or trying to, and then failing. Are there any others that you see commonly present to In couples? Yeah. 

Dr. Nikki Haddad: Yeah, I mean, the most common ones tend to be the earlier stages, so symbiotic differentiating, where there's one member that has differentiated or is trying to at least, and the other one is stuck.

We talked about that. And then there's symbiotic and practicing. So again, one member is still in symbiosis, the other one is. Onto stage three and they're practicing. Um, and this tends to be obviously more tension filled because of the stark difference between the, the stages. And then sometimes we'll see differentiating.

Differentiating, which is actually kind of fun to see as a couple's [00:12:00] therapist because each member is, um, reaching a point where they're recognizing the importance of finding themselves again and still wants to work on the relationship. And just trying to see what that looks like. I. What this new dynamic looks like.

Very, very rarely will we see other dyads. Sometimes we do, but we tend to see people who are struggling. 

Margaret: Why? What's like a common made up but like complaint, like a differentiating, differentiating couple would come to therapy with? 

Preston "Marge" Roche: Hmm. Yeah. 

Dr. Nikki Haddad: I think someone who. Maybe they're prioritizing work. You said differentiating?

Symbiotic. Differentiating. Differentiating. 

Preston: Double Ds. Ah, 

Dr. Nikki Haddad: okay. The double Ds. Very professional. Yes. I think that. That might look like, let's say. Okay. I think a common area that might be actually is a couple [00:13:00] that recently got married or is thinking of getting married, and so they know that their lives are going to merge, but also their careers are taking off, let's say in both directions.

Someone just entered this new job, the other person. Either is doing well in their career but wants to start this new hobby. And so they're spending less time together. And that's a little scary for both of them because they're like, oh my gosh, we're about to enter into this marriage and I hardly see my partner and we're spending all this time alone and, and what does this mean?

And so that might be an example of a type of couple that you would see of wanting to kind of tighten things up and understand themselves as a couple before they enter into such a. Binding things such as marriage. Um, I think anyone really going through adulthood is going to reach that stage at some point, um, in a couple, right?

Assuming that there's not something like really, really. Limiting their ability [00:14:00] to move through symbiosis. That it's natural that at some points we wanna fund ourselves within, within a couple. 

Margaret: Is there a path where I'm thinking of like couples where they're like, we've been married, we like, our relationship was different before we got married and then we got married and had a kid and like actually made that it through that.

Well, but like day-to-day life has just made it so we don't spend very much time together and. Is that differentiating or like, do you know what I'm saying? I feel like that's like a stage. Yeah. At least it's in like popular media. This like idea of like, oh, like we're married and we're more like roommates than we are like lovers, like mm-hmm.

Mm-hmm. I like sitcom and like drama TV shows that would like come up. 

Dr. Nikki Haddad: Yeah, absolutely. And actually I see that a lot. Um, again, 'cause I work a lot with. People in the perinatal period. So I see a lot of postpartum women who are navigating this new stage of life, um, with their partner and a baby. And it's really, and you can imagine it's really hard to define that in stages because there's quite literally a third [00:15:00] person now and you know how much energy and time.

Each parent gives to the baby is a whole other diadic relationship. And so breaking that down becomes really complex. And the baby's going the 

Preston: molar stages of development too, at 

Dr. Nikki Haddad: the same time. 

Preston: Exactly. Quite literally. We're at symbiosis. Differentiation. Differentiation. 

Dr. Nikki Haddad: Mm-hmm. 

Preston: And they're going through the Erickson stages of development.

If we just want to throw a whole nother, uh, wrench into the mix. 

Margaret: All the stages. One other question I have before we like do our little cosplay, uhhuh, I can't wait. How in in ci gender heterosexual couples do you see, like are there ways that gender norms or traditional roles make people more or less likely to move in these stages?

Dr. Nikki Haddad: Yes. Such a good [00:16:00] question. I. Heteronormativity generally is a problem. Um, I think it's impossible for any person, by the way, whether they identify as heterosexual or not, to not have adopted certain heterosexual scripts. And I think that gender roles come into play always. Um, can we define 

Preston: heteronormativity?

Because I think that like, this is kind of something that is a bit of a buzzword, and I feel like people almost use this as fodder to kind of push back against woke, um, woke or kind of people who are, I think, like trying to appear morally superior. So like what, what it, because I think. A lay person may interpret, like, say the statement heteronormativity is a problem as like an attack on being heterosexual, but that's not what you mean.

Mm-hmm. You say that, right? Like what is heteronormativity and why is that a problem? 

Dr. Nikki Haddad: Yeah, yeah. It's an important question. My kind of basic definition of it [00:17:00] is that the assumption that heteronormativity is the norm, right? Mm-hmm. Like that is mm-hmm. The only normal and natural expression of sexuality.

Not that it's not okay, but the idea of that heteronormativity culture is so pervasive because people in heterosexual relationships tend to be looked at as the norm, and anything that is separate from that is a problem. 

Preston: So the default ordinary human relationship is between a man and a woman. Mm-hmm.

Along that the implied gender roles mm-hmm. That follow 

Preston "Marge" Roche: Exactly. 

Preston: So exactly as the breadwinner under, and that, that's almost like the rule and anything else is a violation of the rule. Mm-hmm. 

Dr. Nikki Haddad: Right. And I think even nowadays when we know that there's more understanding about gender roles and women have much more power than we've ever had before, I think it's impossible to fully [00:18:00] disentangle ourselves from those roles.

You know, for example, if we think about how net heteronormativity. Comes into play in sexuality, in heterosexual relationships. It's very, very common for both members of the couple to assume that the role of initiation should fall onto the man, for example. 

Preston "Marge" Roche: Mm-hmm. 

Dr. Nikki Haddad: And that can lead to a whole host of.

Issues or whatever you wanna call it in, and be quite limiting too, in terms of that couple's sex life, right? Or roles at home and having to be the caregiver or be a mother, um, or have to mother your partner in some ways too. Um, as a woman can impact people's relationships very, very deeply. And so part of my role as a sex and couples therapist is to help disentangle some of these heteronormative scripts that couples come in with, um, because they're causing them pain.

Preston: Yeah. 

Dr. Nikki Haddad: Because they're causing them pain. The patriarchy 

Preston: hurts everyone. [00:19:00] 

Margaret: Yeah. I think it's, it's just so limiting on everyone that it makes expression be so. I mean, this is, we, we, we, we can't, we'll do an episode on feminist literature books some other time. 

Preston: Mm-hmm. Well, I, I mean, ultimately heteronormativity ho homonormativity, if you were to create that as a concept, is it's a box that someone has to live within, and when you put people in boxes, you kill nuance.

And it's really hard for people to live as like. Liquid identities who have faults and vices and virtues inside of these like very rigid boxes. And so it, it, it's, it's not that there's nothing wrong with a man seeking his identity at a breadwinner and a woman wanting to care for the house and, and, and cherish the children or those things, but it's, if you make these concrete boxes that they have to live in, then it becomes a problem.

When people try to find identity outside of those boxes, 

Dr. Nikki Haddad: one of the, um. Phrases [00:20:00] that I heard a lot early on in my supervision is the phrase all sex is queer sex. And I remember being like, what does that mean? I, I never heard it before. Now I love it and I say it all the time. And the idea behind it is, is that queer people have not had a choice but to step outside of those heterosexual scripts, right?

They don't have a choice in the matter and. Queer people tend to have better sex for that reason. And in many ways, they aren't dealing with the same kinds of heteronormative issues in relationships either. And so the idea that all sex is queer sex, even if you're, you know, heterosexual, you're cisgender, whatever.

Why don't we, as you were saying, Preston, take a step out of the box a little bit and start to see ourselves and into the box beyond these roles and into the.

Preston: You just sit without Margaret. 

Margaret: I can't. 

Preston "Marge" Roche: She's just [00:21:00] blocking 

Margaret: you out. I just over, I'm in, I'm in practicing and you're diffuse. Um. Okay, we will get, we're gonna take a quick break and then we will come back and we will be cosplaying as a fictional couple coming to Nikki for a, a brief, um, we'll say it's the, like second or third.

So you're not doing all your intake questions, but you like, don't super know us, so you can ask some basic questions. Um, we'll be right back.

Okay? So we're gonna give you just a little bit, um. We didn't want, I didn't want you to be able to prepare for this. So are you familiar with the Simpsons at all? My dad used to love The Simpsons. Okay. So we will be, um. Magnolia's here, we will be working, which is great. She can be Maggie, uh, the baby. Um, we are going to be coming into [00:22:00] your office to work on a problem that we are having as a couple.

Um, I will actually be Homer and Preston will, so I'm looking at the time. We'll do this for like somewhere between five to, uh, eight minutes depending on what feels natural, um, and to kind of get in a little bit of what we're doing. So. Scene. Here we go. 

Dr. Nikki Haddad: Okay, so this is session two or three? Yeah. 

Preston: Mm-hmm.

Dr. Nikki Haddad: Okay. 

Preston: And we just sat down. 

Preston "Marge" Roche: Hello? 

Dr. Nikki Haddad: And 

Preston "Marge" Roche: you just sat down. I'm not doing a voice. Hi.

This is gonna be hard guys. This is okay. How are you both doing today? 

Margaret: I mean, I'm good. I just got a beer with the guys before I came here. Having some donuts after this. 

Preston "Marge" Roche: Everything's been going. It's all going fine. Really? I, I think, yeah. No, no. Nothing to complain about. [00:23:00] 

Preston: I don't know. Everything's fine. I'm not gonna do the impression.

Preston "Marge" Roche: No, 

please do the impression. Do the impression. Oh, okay. So everything's fine.

I mean, you are the one who wanted to come to these well. Fine. If, if you wanna 

consider spilling 14 ounces of beer on the couch last night, fine. And vomiting on the steps, and then, then, then everything is really, it's all fine. 

Margaret: Hmm. I mean, I just, I, I spilled the beer on the couch 'cause I fell asleep. I don't, yeah.

I mean, I, I work hard every day and, Hmm. I'm like, Sue me. I was, and no a 

Preston "Marge" Roche: homie, no one's saying that you're not working hard. It, it just takes a little bit of follow through to not drop an 

entire case of beer on the couch [00:24:00] every time you come home. 

Margaret: Well, you get, but you got mad at me when I went, went to the bar to see the guys.

Preston "Marge" Roche: So, so you brought the bar home and decided to empty it all out on the couch. And then, and then whatever bar was left inside of your stomach, you're like, oh, let's just put that onto the steps too. And, and while I'm at it all, I checked it out to the bathroom at two in the morning because I guess nobody else sleeps 

Dr. Nikki Haddad: around here.

So let's take a quick pause. I am sensing a lot of anger in the room. 

Preston "Marge" Roche: Wow. An the on.

Margaret: Okay. Honey, honey, honey, honey, honey, honey. Sorry. She's doing her best. All right. Listen, sorry, sorry, sorry. Being a therapist. 

Dr. Nikki Haddad: Marge, tell me what's going on in your, in your head right now. I am overwhelmed, I think. Mm. 

Preston "Marge" Roche: Mark got in trouble at school again, and, and I feel like, [00:25:00] like I'm a pancake on most days, but today I'm a crepe.

I'm just spread a little thin. 

You are failing Spread thin. Yeah. I didn't know. I didn't know honey, that Bart was, what happened with Bart? Well, he rode his skateboard through the halls of the school as usual, but then 

he tried to do a kick flip over a firetruck and he, he got his underwear stuck in the ladder and then the firetruck drove off to a fire and all of the firefighters had to.

Climb over him while he was hanging over the flames and it made the front page and now he is banned from school. You were at the bar, that's why you didn't see any. Okay, well you didn't tell 

Margaret: me. So how am I supposed to know? 

Preston "Marge" Roche: You see, she, he takes no responsibility for everything. He just, he all responsibility for all information coming in and outta the house 

Margaret: there.

No, I was gonna say responsibility for anything and you don't tell me. 

Dr. Nikki Haddad: Let's slow down. [00:26:00] Let's slow down. Boomer, it sounds like you haven't been around to notice some of the things that are happening within your family. Would you agree with that? 

Margaret: Another genius observation. You get what it's like. I mean, imagine being around someone who's being like this.

And by the way, she hasn't always been like this. I, you can imagine like what? Like, like how you're being right now. Like you're being rude to our therapist who you wanted to see anyway. So I don't know why you're the one putting up a fight and when I get home I'm stressed and I wanna connect with you. I want it to be like things used to be before borrows.

Older and I come home and you're immediately mad at me. And so sometimes I drink a little bit because it makes it easier to not to be yelled at, frankly, or I don't wanna be at home because I'm being yelled at all the time. 

Preston "Marge" Roche: That's what it feels like you're drinking to escape. [00:27:00] Yeah. I mean, I've, I've always liked a beer.

Okay. 

Margaret: I'm no Ned Flander. That's always been true, but. Now you want me to not drink and change who I am and also what, just like let you yell at me 

all 

Preston "Marge" Roche: day. What do you think about this, Marge? Uh, I, you're right. This, this was 

my idea to, to come into therapy in the first place. And I'm sorry I was critical of you.

I don't, I dunno. 

It makes me really sad 

to think that Homer wants to escape.

What makes you feel sad about that? Well, I feel like I should be his, his home base, his landing pad. Not, not somewhere where he needs to get away from. It's you, it, it's the, an antithesis of, of everything [00:28:00] I hope to be as a housewife. What did you hope? Your relationship might look like. I, 

I wanted us to be a team and, and, and, mm-hmm.

The way I see it, we have, we have a lot of things that we have to accomplish and, and not everyone's pulling their weight rather than a, a prison. So, so if I, if the home is a prison, then, then something's wrong and, and I guess I'm contributing to it. I, I don't know. I just feel so bad 

you. 

Yeah, you're not like, like, I did something 

wrong 

and, and 

Margaret: I guess it's just all my fault.

It's not all your fault. Working with Mr. Burns is, I hate it. I hate it every day and I come home 

Preston "Marge" Roche: and I'm not the day you're, she's not mad every time I come home, but it, I, I could do a better job most. Okay. You guys are 

[00:29:00] cured. 

Yeah. 

Margaret: She literally like, I had to like be like literally like pull back and be like, wait, you're that.

You need to say the character. You're not a purpose. Great work Preston accent number. He did a, can you do the Scottish accent for a second? 

Preston: Please. 

Dr. Nikki Haddad: That was so funny. I was crying. Crying. Was it out? Was it actually an okay impression 

Preston: because I was worried 

Dr. Nikki Haddad: it was so good. And also your like aggression at the therapist is so un like that's every, they're like, oh, very smart observation.

It's such a common thing we get. Wow. You think? I think like what's, what's funny about couples work is that anything you say to one member of the couple, especially something that's validating to one member, is going to kind of offend the other one a lot of the time. Mm-hmm. And so you tend to be the bad guy a lot.

So you guys did a remarkable job 

Margaret: is 

Dr. Nikki Haddad: great. 

Margaret: So what, what sort of [00:30:00] things do you notice? Like, oh, wait, sorry, Preston, you were gonna ask something? 

Preston: Oh, no, I was just, I was just trying to see if I could load my Scottish accent. Okay. 

Margaret: You, you work on that. What, as a couple, so you said like some of the things are very common, like Yeah.

What does this, if we were in your clinic, what in your mind are you starting to formulate as the things that are mm-hmm. Not working for us? Or stages? 

Dr. Nikki Haddad: Mm-hmm. Mm-hmm. Yeah. I mean, right off the bat I'm feeling like Marge is. More stuck in symbiosis and Homer is trying but failing to differentiates, and it feels a little bit like this pattern has been going on for a long time.

I'm also picking up on heteronormativity, um, and what expectations should be around, what should a homemaker's life look like in relation to their family? The kind of aloofness of the, the father again, um, goes into kind of heteronormativity [00:31:00] culture as well. Well, I, I had no idea. And the, um, unequal kind of burden carrying.

Parts of that relationship were pretty evident too. So starting there, those, those were kind of my initial observations. Again, you guys both became these like beautiful nirvana like couple, and then like, you know what? You're right. Like I could work on these things. I was impressed with how quickly you got 

Preston: there.

Yeah. I. I mean, we could, we could externalize till the cows come home. We just had to expedite. 

Margaret: No, we could have, we could have stayed in that. Uh, what is it when the acting That method? Acting, 

Preston: yeah. 

Margaret: Yeah. Yeah. Preston could have put on a blue wig. Could have been a whole 

Preston: thing. What was, yeah, 

Dr. Nikki Haddad: what was it like for you, both of you?

Preston: I was really just trying to think about what would piss off a homemaker who felt neglected. Like, I wasn't, I wasn't even trying to think about it, like psycho [00:32:00] therapeutically. I was really mm-hmm. Just trying to like shut my brain off and be like, okay, I'm, I'm pissed off. I'm, I'm alone. I'm overwhelmed.

Margaret: Yeah. I was trying to think of, like, I used, we used to watch The Simpsons a lot when I was younger, so like what actually is true to the character of like, they are in this like very traditional, like blue collar. Depiction of two thousands, like married life. 

Preston "Marge" Roche: Mm-hmm. 

Margaret: And, but he's also very tender with her a lot of the time.

So I was like trying to one, fight my own like therapy podcast instincts of like how I just as a person would respond, but then also being like, okay, but he wouldn't get so mean at her. Like they don't fight that much, but he does drink and he doesn't, he's kind of a like, I don't know person. 

Preston "Marge" Roche: Mm-hmm. 

Dr. Nikki Haddad: Yeah.

Yeah. Yeah. And, and Marge tended, I remember in the show I haven't watched it in a long time, but Marge does get more activated and kind of more reactive than Homer. And so I [00:33:00] definitely saw that coming out and then Homer trying to do his piece to calm things down and actually bring the energy back down and feel more, um, cohesive, even though he tends to be more of the troublemaker mm-hmm.

In the relationship. 

Margaret: What, what kind of, before we started to fix ourselves, what kinds of things do you feel like this kind of couple in couples therapy works on? Or like if you were thinking about even what they work on as individuals in the relationship, like what would you direct Homer towards? Slowly over time and Marge towards.

Dr. Nikki Haddad: Yeah, I think, I mean, of course this was five minutes and can't, normally at the beginning, well, apparently I did, so that's true. But, um, you know, normally in, in a couple session like this, I would allow the couple to, we call it the fight of the week. Usually couples will come in with some kind of conflict that's happened over the past week.

Not always. [00:34:00] Um, and we allow them to, to share that for a period and kind of provide validation, um, when, when it's needed or warranted on both ends. And then trying to unpack the process. That is more important than the content. So the kind of classic thing is, oh, my partner never unloads the dishwasher.

It's so annoying. Okay, well, what is, what are we actually talking about here? Is it that your partner isn't able to recognize what you need before you say it? Is it that your partner isn't showing up as a father or a mother? Is it that your partner is more worried? Whatever? There can be so many different things kind of going on underneath the surface.

So in this example, I would really be curious about what's actually happening when Homer is going to the bar, what's really going on for him, and what's really going on for Marge when she's at home dealing with the kids and unpacking that a little bit more, unpacking where they learned these things about [00:35:00] themselves and the relationship, and then teaching them how to be better listeners.

Is a really big part of the couple's work. Um, we don't have time, but if we did, I would have done the initiator inquire exercise with the two of you, which is basically where I assign one of you a role of the initiator and you talk about a problem in the relationship, and the only job of the inquirer is to listen.

Summarize and then ask questions to understand better what the initiator is saying. And couples are so bad at this, you would not believe how bad they're,

it's hard. It's hard to be a good listener. And so that's a, a really helpful skill for, for, I would say almost all couples that come in. 

Preston: Well, I thought you were, you were already identifying like Homer's escapism. And, um, Marge's perceived neglect. [00:36:00] So I think like that would've been kind of like the course of their, their therapy would be like investigating homer's like desire for escapism and then how it manifests for him and maybe if it, maybe if it was a way for him to do it.

In a way it's more adaptive. 

Dr. Nikki Haddad: Right, because I think the, the escapism part of it, again, is not necessarily a bad thing. Like it's not a bad thing for Homer to have other hobbies, but it's about doing it in a way that is not detrimental to the couple, um, if he's neglecting his duties at home, et cetera. Um, yeah, and allowing both, both people to kind of stay themselves in that process.

Preston: So. I think that now's a good time to kind of move on to some of our questions that we have from listeners. So I know Margaret is usually the one that posts these questions on her Instagram, and we got a lot of interest this time. 

Margaret: We did have a lot of interest. Um, 

Preston: and so, and, but I, I do think there were a lot of very similar themes.

So I'm, so my hope is as we go through these questions, [00:37:00] we can answer multiple. In one round. 

Margaret: Yeah. Um, one question someone submitted also, by the way, for people submitting Yes, we we're keeping these questions anonymous now, um, so that you can feel comfortable to ask anything and not get called out on the podcast if it's sensitive.

This one is not that, but someone asked if you're in a healthy relationship and it feels like things are going well, is there ever a use for couples therapy in 

Preston "Marge" Roche: that part of the relationship? Yeah, I think there's. 

Dr. Nikki Haddad: I'm biased, but I think there's always a use. Um, I think I, I have friends actually that have started couples therapy around the time of, again, getting married or before they have a kid, just to understand themselves as a couple better and their dynamics better.

I don't think it's ever a wrong, a wrong move, and I would actually argue that most couples probably start too late. So starting earlier could be a really, a really important thing. What do you mean by too late? Starting, you know, 20 to 30 years too late, um, [00:38:00] when the patterns have, have been there for a long time and it's, it's really hard to, to kind of backpedal and, and do the work.

Um, it's po it's always, it's always possible, like it's never technically too late. Um, but the couples can feel that it is, or one member of the couple can feel that it is. 

Preston: So, one question I. Kind of around the opposites attract phenomenon. So what, what are qualities or predictors of success or foreboding warning signs that you see in couples and symbiosis?

Dr. Nikki Haddad: Hmm. Couples that tend to be more successful tend to. Tend to be more securely attached from an attachment perspective and can tolerate differences in their, in their couple so couples. I think you don't have to enjoy doing all the same things, for example, I don't think that's necessarily, [00:39:00] um, a prerequisite for being successful.

Um, it does help to have some shared interests generally. So if someone likes running, but I like doing spin classes. We can both value fitness, right? That can be a shared value mm-hmm. Of ours. But it still allows us to do separate, separate things. And so I think that couples that have similar values who encourage.

Each member of the couple to do their own thing, um, and things together is kind of the recipe for success generally. 

Preston: Mm-hmm. So, so the o the opposite would be like foreboding, um, yeah. Almost like warning signs that, you know, there are, the couples excited, they're happy and symbiosis, but you're like, oh, this is kind of, 

Preston "Marge" Roche: mm-hmm.

Preston: A red flag for me as a therapist that, that I'm seeing, you know, that's probably a few miles down the road still. 

Dr. Nikki Haddad: Yeah, that would be, I think a couple that is too codependent. So if I see someone, um, all of a sudden they lose all their friends and they only spend time with their [00:40:00] partner, which is actually pretty common.

Interestingly, like I've, I've known multiple people where that happens. 

Preston: Yeah. Like I have friends that's usually a red flag. Um, friends who are female that say like some of their female friends, they only are friends with them when they're not in a relationship. And then they go back to disappearing as soon as they're in another relationship.

I, I guess I'd just say that 'cause I, I think I see more commonly in women, but like guys, it can be the same way too. Like there are, there are some men that are like, yeah, like they, they're not gonna hang out and play sports, go lifting when they have a girlfriend. They become like totally preoccupied.

Mm-hmm. 

Dr. Nikki Haddad: Yeah, I've seen it too. I've seen it. I've had friends that have gone through that. Absolutely. Um, I think again, this concept, this idea that people have, that they have to give everything to their partner, and that's the indication of a perfect relationship, can be so damaging. 

Margaret: It's also social, um, capital.

Like to have a, I'm thinking about White Lotus. I don't know if either of you guys are watching it right now, but like in the White Lotus, this is not really spoilers 'cause you [00:41:00] weren't in the first episode. There's like a girl group of three women in their like late thirties, early forties I think, and they're one's divorced.

One's in like a long-term like traditional role marriage and one is sort of newly married to like a younger hot guy who's an actor. And the way that that plays out in terms of what that means about their social capital and their value is so interesting in the show. And so I feel like it's like we're given those models, but it's also like we, I feel like we've all had a friend who's like, I don't know if this happens for when.

Straight men are talking, but there'll be like a, someone who's like, suddenly everything's like, oh, my boyfriend says this, or like my boyfriend. Or like, suddenly one month into mm-hmm. She's like, we like this. And it's like, girl. Mm-hmm. Where are you? 

Dr. Nikki Haddad: Yes. Yes. That's so, that's actually such a good example, Maggie.

The, we, so a red, a huge red flag for me is if I have a friend and every text they send me has the word be in it. It's like you don't have your own thoughts at this [00:42:00] point. You know? It, it would just be so, that would be so concerning to me. Yeah. 

Preston: Yeah. It's interesting. I don't think guys see having a, as a girlfriend as social capital in the same way.

Preston "Marge" Roche: Say more. 

Preston: I don't know. Like I, I think if, if someone has a girlfriend, good for them. If they're single, they're not seen as any, as, any less than. I think it might actually be the opposite, like dudes in relationships are like. Seen as like tied down or shackled. And they're not, they're not free independent stags like the rest of the group, you know, 

Margaret: wild stallions.

Preston: No, no, actually no, I, you're right. Um, 

Margaret: you're right. Yeah. You know, like, 

Preston: oh, he, he's not as, he's not as cool. No, he, he can't participate in the shenanigans the way that he used to. So like, in a lot of ways, like, it's almost like a, a guy's willingly taking a. A loss, social capital loss, I guess. Yeah. To, to get into a relationship and, and I think a lot of the things that give guys social [00:43:00] capital in this dynamic is having a lot of women lusting after you and being able to 

Preston "Marge" Roche: mm-hmm.

Preston: To take your pick, you know, someone mm-hmm. Who can be this like cast nova womanizer. That's, that's what, that's what's aspired. So Right. 

Dr. Nikki Haddad: And that's probably why you see more women fall into the trap of giving their full selves to, um, their partner in a way that could actually be hurtful. Because maybe you're saying that societally that's more powerful almost in terms of social capital for women compared to men in in straight relationships.

Preston: Yeah, because as a guy, you're a bachelor, but as a woman, you're like a spinster. 

Dr. Nikki Haddad: We've made progress, but not that much progress. Mm-hmm. You know? Yeah. No, its, haven't had, it's, we haven't had no fault, fault divorce for that long. 

Margaret: We haven't had credit cards for that long. Um, a couple of different it people ask the same question of how do you as a couple's therapist, I see this also people like talking about the show couples therapy or listening to Esther Perel being like, that person in the couple was obviously a [00:44:00] da.

Why? Like, yeah. Isn't she a feminist? Why didn't she call it out? And so the question multiple times is, how do you not take sides? 

Dr. Nikki Haddad: Oh, that's such a good question. Um. So my short answer to that is that sometimes you do actually have to take sides in quotes. Um, in that sometimes you are going to have to align more with one member of the part, the couple than the other, and you have to just oscillate as the couple's therapist.

So sometimes the session can be more focused on one member of the couple, and then the other session. Focused on the other, and you are going to offend people, but you can't actually align too much, um, or you're really damaging the work. And so, regardless of your own perspectives or feelings about the world, or even your own biases as a therapist, you really have to learn to put it aside, recognize what's coming up for you, just like you would in individual therapy, and try to be empathetic to [00:45:00] both sides.

Um, which sometimes is, is easier said than done. It, it definitely can bring up, um, dynamics and stir things up inside of you, but that's, that's the job. That's the job. 

Margaret: What happens if you get a couple in couples therapy where there's like,

I think one of the things I'm thinking about and the people ask this question about is like, in the show couples therapy, there were a couple, there were a few couples that maybe there was like kind of. Strong personality or kind of flagrant like affairs or other mistreatment on one side. Mm-hmm. And not on the other.

And the question becomes, and especially for you who I think knowing you and knowing kind of how you view things and that the, you know, personal is political to some extent, people mm-hmm. Noting frustration of being like, okay, if someone's being like abused and you're seeing them in couples work mm-hmm.

Like how ethically, how does that work? Work. And I think you can think of extremes for that, but the really hard question is like in the middle. Um, [00:46:00] yeah. And I, I wonder your thoughts on that as like an early career couples therapist, the ethics of that. 

Dr. Nikki Haddad: Yeah. Another really good question. I mean, ethically, I, at this stage of my training and probably forever don't work with.

Couples where there is abuse happening, um, that's a prerequisite and I make it very clear. And there also can't be substance use happening. Um, it's just you are not going to have a healthy couple in front of you ever. So you won't, um, if those things are happening. 

Preston "Marge" Roche: No, totally. 

Preston: Are there any other like prerequisites or almost exclusionary criteria?

Dr. Nikki Haddad: I give both members of the couple, a couple's contract to sign before we work together. And so, you know, domestic abuse or any form of abuse is not tolerated. Substance use is not tolerated beyond that. Um, nothing specific. They have to agree to sign the contract, which also says that if they were to end the marriage, if [00:47:00] they're married, that they can't use, um, me in in courts or like anything that was said.

So you kind of have to. Go in with clear boundaries as the therapist about things that you're comfortable and not comfortable with. Um, it, you, you're asking like about the extreme, but also the less extreme cases too. And so in terms of the less extreme case, if I'm seeing a couple where one member is unfaithful, for example, um, and having physical affairs or sexual affairs with, with other people, and the other isn't, it's usually not as simple as.

It sounds, um, I don't think that infidelity is always a deal breaker in couples, actually. And I think that oftentimes it has nothing to do with the couple itself and a lot to do with the individual. Not always, but that could be one, one reason that infidelity is happening. And Esther Perel talks a lot about this in her, in her work and has really helped [00:48:00] me see, um, the complexity there.

And there's also other ways that. That people can betray each other Right. Aside from cheating. 

Preston "Marge" Roche: Right? 

Dr. Nikki Haddad: Right. And so I think that I would just be curious about what else is happening, um, behind the scenes if I were to see a couple like that. 

Margaret: Do we wanna do one more question? That's all for me. Nikki. Thank you so much for being on this episode.

I know we kept you maybe longer than predicted. Um, I also know you have a strict uh. Respected sacred bedtime routine of, because we text, so Preston, Nick, and I'll just text each other with various memes of like me at 9:00 PM and it's like melatonin, like a small cat in a bed, like in a robe. Robe ready for workout tomorrow.

Um, is there anything you want to. Put here in terms of where people can find you. I know that you have a private practice, um, you can mention that or not. If you want to, we can cut this out, but is there anything you'd like to plug here in terms [00:49:00] of your work or. Where people can connect with you if they want to.

Dr. Nikki Haddad: Sure. I don't have much of a social media presence, but if you wanna connect with me as a patient or for a speaking engagement, you can go to my website. It's just my name, so nikki hadad md.com. And um, it has my email there as well, so you can reach out to me. To me there. 

Preston: Hadda. I've been saying haddad I have too.

Like, like a gioni. 

Dr. Nikki Haddad: You, you can, you can say it both ways. It's actually Syrian and so hadda is the right way to say it, but my grandpa Americanized it to Haddad, so I'm just used to saying hadda. Either way is great 

Preston: because in those like. It's so, it's Arabic then, right? 

Dr. Nikki Haddad: Yeah. Mm-hmm. Yeah. So 

Preston: you, you always emphasize the first syllable, right?

Hot. Hot. 

Dr. Nikki Haddad: Exactly. Okay. Exactly. 

Preston: Wow. I actually 

Dr. Nikki Haddad: like Hoda more. 

Preston: Yeah. Hoda hot on Nick. Hot. Hot Hoda. Okay. [00:50:00] Well, um, thank you so much for listening. Thank you for being on the podcast. Um, if you guys enjoy sending these questions and like hearing us talk about them, please send them again. If you really want us to like, like really badly, want us to read 'em out.

You can put like a couple asterisks and then we'll, or you can a higher, 

Margaret: or can put in reviews as well. Uh, that helps us. It it does. I'm sorry. We have to do this. We've been shy about being like, we need reviews, but yeah. We need, 

Preston: we need to plug more. Helps 

Margaret: us and you can. We're doing this as literal exposure therapy, uh, talking about how you guys can help us as listeners.

We're nearing the end of season one and it's been going well. Uh, but reviews always help us and help us be able to bring more people on, like Nikki and like our other guests, to be able to bring their knowledge and wisdom to you. 

Preston: Mm-hmm. And, and same if you have suggestions for guests or other topics, we'll happily investigate those and reach out to people.

We're, we're always. Looking to find new and interesting conversations. That's, this is a, a safe [00:51:00] place to do that hopefully most of the time. Um, if you want to get in contact with us on social media, we're also gonna be starting our own Instagram page, so we'll be having, how do we patient pod as, as like a standalone.

I know Margaret and I will still be. Promoting on our socials independent of that. But then we kind of want a single, um, avenue or home base for this. This is where we're creating our third podcast. Yeah, exactly. And then. I have a Patreon and I'm gonna be kind of back adapting that to include things from the podcast.

And our hope is to start kind of rolling out some, um, other episodes where Margaret and I just kind of play around with different topics and other things that are a little bit less formalized. So if you want to join for like a live q and a or other kind of discussions like that, um, keep an eye for that in the future.

If you wanna look at our full episodes, they're always gonna be uploaded on YouTube at its pre row. Thank you again for listening. We're your hosts, Preston Ro and Margaret Duncan. Our executive producers are me, Preston, Roche. Margaret Duncan, will Flannery, [00:52:00] Kristin Flannery, Aron Korney, Rob Goldman and Shahnti Brooke.

Our editor and engineer is Jason Portizo. Our music is by Omer Ben-Zvi. To learn more about our program, disclaimer and ethics policy submission verification and licensing terms and our HIPAA release terms go to be How to be patient pod.com or reach out to us at how to be patient@humancontent.com with any questions or concerns.

How to be patient is a Human Content Production.

Thank you for watching. If you wanna see more of us or if you wanna see, this is lilac. She's my cat. She's gonna be waving her hand at one of the floating boxes, which will lead to more episodes. Lilac Point to the other episodes. Lilac doesn't know what the internet is, but I swear they're there. They, they probably exist for real.

But in the meantime, I'm just gonna pet lilac [00:53:00] and then I'm gonna go dance in the background.