These are some things that just simply prevent one’s ability to navigate therapy smoothly. When present, they can multiply one’s ability to grow and recover by a factor of five. The affect not only one’s mental health; they can amplify the symptoms you are struggling with. Without addressing these issues in parallel with the individual issues you bring to therapy, progress can be left at a standstill.

Drug & Alcohol Abuse

Combining mental health issues with alcohol and drug use is like pouring gas on the fire. And then we struggle when things continue to fall apart.

It’s not uncommon to be struggling with mental health issues at the same time as having a substance abuse or dependence problem. Nearly 20% of those receiving treatment for a mental health issue such as anxiety or depression also have had a substance use disorder during the past six months. This issue of Dual Diagnosis (mental health issues plus substance abuse or dependence) often complicates treatment and can significantly delay progress in therapy.

Excessive alcohol consumption and drug abuse are not dissimilar to having a second person in therapy with you. Since the symptoms of substance abuse or dependence can be similar to many psychiatric disorders, treatment is often complicated in terms of determining cause and effect.

Alcohol disinhibits aggression and can lead to episodes of severely escalated quarrels, emotional abuse, and/or physical violence. Drug abuse may also lead to greater aggression or emotional distance between others, since the person is living at least one part of their lives together behind a mask of intoxication. Depending on the substance being used, there may also be serious medical consequences for continued usage. It’s important to note that marijuana is included under the category of “drug”, and excessive use can greatly impact willpower and focus.

Suicidal Thoughts

It’s no surprise that having active thoughts of suicide can drastically affect the outcome of effective therapy, and the two can’t be mixed together as they are at cross-purposes. If any indication of suicidal ideation is present, this must be addressed first and foremost before pursuing any other type of therapy. The goal is to keep yourself safe enough to tackle the other problems in your life.

Emotional & Physical Abuse

One of the more difficult concepts is that of learned helplessness. When you are a victim of abuse, not only is your safety at risk (which is the ultimate concern), but your patterns of feeling like your choices are yours to make are impaired.

Situational Domestic Violence

Situational domestic violence is minor domestic violence that does not constitute battery and usually does not involve clear perpetrator/victim dynamics. The violence usually follows escalated quarrels in which anger and frustration lead to physical acting out, but there are no injuries in situational violence, and weapons are not involved. Situational violence is usually symmetrical, meaning both parties are violent and take full responsibility for their actions, feel remorse, guilt and regret, and want very much to change. Additionally, research has found that half of violent relationships tend to be reciprocally violent. In non-reciprocally violent relationships, women were the perpetrators in more that 70% of the cases.

It is crucial to clarify the details by asking the following questions:

  • How frequently does the violence occur?
  • How does it begin?
  • How does it end?
  • What specifically happens during the violence and do you attempt to process what happened afterwards?
  • If you do talk about the episode later, what is the outcome?
  • Are alcohol, drugs, or both involved during any of the episodes?

Of importance is whether both partners honestly admit their responsibility for what happened, (especially for the actual violence itself) or if one partner blames the other for it while ignoring his or her own personal accountability. Do you both wish to eliminate the outbreaks of violence? Are you fearful about the other partner learning that you have disclosed information about the violence or that you are in therapy? These issues must be attended to first and foremost before any other personal growth and change.

Characterological Domestic Violence

Characterological domestic violence is defined as domestic violence in which there is a clear victim and a clear perpetrator. The violence is used by the perpetrator as a means to control and instill fear in the victim. Regardless of what the victim does, the violence will continue. The perpetrator does not take responsibility for the violence but instead believes that the violence was “justified” by the victim’s words or actions. The perpetrator may also deny there was any violence altogether and try to convince others that the victim is “making it up.” The perpetrator’s violence is often serious enough to cause injury and poses a severe risk to the victim.

No treatment has been shown to successfully treat characterological domestic violence. If characterological domestic violence exists, a safety plan will need to be created for the victim. Any therapy that does not focus specifically on your safety and recovery from the abuse does not have a good chance of working whatsoever until this core issue is addressed. Specifically, marital therapy is inadvisable and contraindicated.

Social Isolation

Social isolation is a type of emotional abuse in which one partner prevents the other from having friends and social supports outside the relationship. This is usually done so that one person can have complete control over the other. It is likely that this is done because of a fear that a partner may sexually or romantically betray the relationship. This may be a toxic psychological situation that is potentially dangerous to an individual’s mental and/or physical health.

Addressing the tactics being used for social isolation and addressing betrayals of the past is often the first step. It is important that the partner suffering the abuse has a chance to describe how the social isolation has impacted his life. To this end, addressing the emotions and experiences of feeling socially isolated to your partner is key. The goal is not to criticize or blame your partner, but instead to only describes your own feelings when hearing particular words or phrases.

If you do this with your partner and they react defensively, things need to be slowed down. Instead, positive communication needs to be a focus for both persons in the relationship. The goal is to help the couple to reword their descriptions, which can can soften and deepen the speaker’s words and make them less threatening to hear. The point here is to bring out the yearning both may feel for love, loyalty and safe connection with each other.

If a partner has experienced betrayal before the relationship began, it is important to help her describe this betrayal and the impact it had on her so that her partner can possibly understand why she has tried to isolate him. Then, each person can be given aid to discover new ways of express needs for loving safety and security with their partner.

Integrating new rituals of connection with one another will help to deepen their friendship and enhance their romantic interactions. Gradually, the notion that with more feelings of safety and security, it is ok for each partner to have other friendships and supportive connections outside this relationship will be introduced. Then, the therapist can enable the couple to discuss outside relationships they want to have, including what needs those relationships serve for them and the boundaries that protect from these relationships becoming a threat to the couple’s relationship.

In resolving this issue, both partners should ultimately be able to ask for and receive reassurance of being loved from the other if either one feels insecure again.

Degradation and Humiliation

Degradation and humiliation are powerful forms of emotional abuse that can endanger the mental and physical health of the recipient.  When present, one person is degrading and insulting their partner when they are either alone together or with other people. They may also be repeatedly invalidating their spouse’s reality while presenting a different reality that contradicts it, a process that ends up making the other person feel crazy. This is occasionally referred to as “gaslighting”. This abuse shreds the victim’s self-esteem and self-concept, thereby rendering her fearful and easier to control.

Sexual Coercion

Sexual coercion is a form of emotional and/or physical abuse that includes one partner’s sexual insensitivity towards the other, pressuring sex when that partner doesn’t want to, or intentionally hurting the other partner during sex. By using sexual coercion, the abusive partner may be trying to sexually denigrate his or her partner so that the abuser can psychologically and/or physically control the partner. Sexual coercion can endanger the victim’s mental and/or physical health and produce lasting effects such as depression, post-traumatic stress disorder, or other anxiety-related disorders. Any pattern of emotionally abusing a partner through sexual coercion is a serious problem.

Property Damage

Emotional abuse through property damage is defined as one person either destroying items his or her partner cherishes and/or damaging vehicles, house structures (often walls or doors), furniture, or other items. Damage of a partner’s property is a dysfunctional way to express rage, anger, frustration, or other negative emotions. Because it involves physically violent action, it may frighten and intimidate the victim, reminding her of the possibility of bodily violence and thereby increasing her partner’s control over her and jeopardizing her mental and/or physical well-being.

Mental Health Concerns

It’s interesting to list “mental health” issues as a concern when pursuing therapy. The main factor here is that, if unrecognized, the purpose behind pursuing therapy will be hidden behind a shroud of events and behavior that can stop therapy in its tracks.

An example is someone wishing to receive therapy for childhood issues that is also struggling with clinical anxiety and depression. While working on the past will help soothe and relieve some of the pressure, without addressing the impact of the anxiety and depression themselves, you may find yourself running around in circles during recovery. These issues are the virtual “rug pulled out from under your feet” if not addressed.


This reflects distress arising from bodily perceptions. Complaints focused on cardiovascular, gastrointestinal, respiratory, and other systems with autonomic mediation are included. Many of these symptoms are included in diagnostic criteria of anxiety disorders and have a high prevalence in disorders with suggested functional etiology. All of them may, naturally, be reflections of a physical illness.

Obsessive-Compulsive Behavior

This reflects symptoms typical of obsessive-compulsive disorder. The focus is on thoughts, impulses, and actions that are experienced as irresistible by the individual but are of an unwanted nature. Experiences of cognitive attenuation are also included in this dimension.

Interpersonal Sensitivity

This area focuses on feelings of personal inadequacy and inferiority in comparisons with others. Self-deprecation, uneasiness, and discomfort during interpersonal interactions are included here.

Clinical Depression

Of no surprise is that depression can impact and change lives for the worse. Most of the typical symptoms of depressive syndromes according to current diagnostic criteria are included here. Symptoms of dysphoric mood and affect as well as signs of withdrawal of life interest, lack of motivation, and loss of vital energy are represented. Feelings of hopelessness, thoughts of suicide, and cognitive and somatic aspects of depression are not uncommon.

Untreated clinical depression can affect even the most resilient of us. Even Shane Lopez, author of Making Hope Happen and an advocate of positive thinking, struggled with chronic depression. Deep-seated depression can cloud our thoughts and judgment about ourselves, others, and the world around us. If pursuing therapy for a specific issue, if clinical depression is not also addressed as a mental health disorder too, can cause endless complications and relapses despite any amount of individual or couples therapy.

Clinical Anxiety

This dimension is composed of symptoms that are associated with manifest anxiety. Nervousness, tension, and trembling as well as feelings of terror and panic are included. Some somatic correlates of anxiety are also included here, as well as panic attacks and ritualistic (but not compulsive) behavior.


Thoughts, feelings, or actions characteristic of the negative affect state of anger are reflected here. Qualities such as aggression, irritability, rage, and resentment are included.

Phobic Anxiety

Phobic anxiety is defined as a persistent fear response to a specific person, place, object, or situation which is characterized as being irrational and disproportionate to the stimulus. It leads to avoidance or escape behavior. The items of this dimension are actually all manifestations of agoraphobia.

Paranoid Ideation

Paranoid ideation is represented here as a disordered mode of thinking. Projective thinking, hostility, suspiciousness, grandiosity, centrality, fear of loss of autonomy, and delusions are viewed as primary reflections of this disorder.


The scale provides a continuum from mild interpersonal alienation to dramatic evidence of psychosis. Items include withdrawal, isolation, and schizoid lifestyle as well as first-rank schizophrenia symptoms such as hallucinations and thought-broadcasting.