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Collateral Damage in Treating Relationship Problems (and How to Avoid It) Joseph Shay1 issn 0362-4021 © 2015 Eastern Group Psychotherapy Society group, Vol. 39, No. 4, Winter 2015 359 1 Private practice, Cambridge, MA, and Faculty, Psychodynamic Couple and Family Institute of New England, Massachusetts General Hospital Center for Psychodynamic Therapy and Research. Correspondence should be addressed to Joseph Shay, PhD, 1218 Massachusetts Avenue, Cambridge, MA 02138. Email: I am pleased to respond to the issues highlighted in Lee Kassan’s excellent piece. He has drawn attention to a relatively underappreciated phenomenon in therapies of all kinds, namely, what I have termed collateral damage (Shay, in press). By this I mean the unintended negative consequences on individuals who are not the specific focus of a treatment (e.g., individual therapy, as described by Kassan), or may be part of the treatment but receive shrapnel wounds or worse from traveling in the orbit of the therapeutic process of others (e.g., group therapy), or may be part of a collaborative treatment in which the treaters don’t agree (e.g., the couple therapist and the individual therapist; Maltas, 1998). In Kassan’s article, he focuses on at least two very important themes. The first relates to what he calls the “treatment gap,” when an individual therapy process can create negative consequences for a couple, if one member who comes to deal with relationship problems improves while the other stands still. The second theme draws attention to another potentially damaging process, namely, when the therapist , based on the subjective, if not frankly distorted, presentation of the person in the office promotes a particular direction that may, unknowingly, result in collision paths for the individual in therapy and his or her partner. I will comment on the first of these themes only briefly, given that it is better known by clinicians than the second. All of us, patients and therapists alike, live inside patterned relationships that have implicit expectations and responsibilities that result in predictability. At times, what is predicted is a continuation of dysfunctional interaction, although this dysfunction often exists in a state of equilibrium. As Kassan explains, this equilibrium is jeopardized—and perhaps should be 360 shay jeopardized—when only one member of a couple is in therapy seeking change. This raises an immediate question: Does the therapist actually have a responsibility to the partner who is not in therapy, or only to the person in the office? (This question is, of course, magnified when we are talking not about couples but about families, where we will often experience a responsibility, albeit indirect, implicit, and perhaps even out of awareness, to children who are not in the therapy office.) Is there an ethical responsibility to protect a partner (or children) we may never have seen from the possible collateral damage of the individual therapy process? Certainly the therapist is wise to attend to the ramifications of any significant changes in the patient upon the relationship because the relationship preexisted the therapy and may postexist it as well. As Kassan wisely points out, without such attention, the very progress encouraged by the therapist can be undermined by the relationship that may discourage it. The second theme, that of creating possible damage to a relationship based on a subjective, almost certainly biased, and possibly largely distorted view is a significant problem for therapists. Gurman and Burton (2014) did a superb job of analyzing this and other difficulties inherent in providing individual therapy for couple problems. As all therapists know, it is in our marrow to strive to be nonjudgmental, caring, forbearing, and temperate. Also, we strive to help patients be forgiving of themselves as we help them tie their current struggles and even transgressions to their past histories. A very common intervention for all therapists, no matter how they phrase it, is “no wonder” you felt that way, or behaved that way, or failed in that relationship . Therapists encourage forgiveness. Certainly we also encourage responsibility and accountability, but we often start with a supportive, if complicated, version of “it’s not your fault.” Therapists offer empathy. This sounds like a great thing, doesn’t it? And it is, except...