couples therapy

Question 1

main differences between Johnson, Gottman, and Wile’s couples therapy

Answer 1

Susan Johnson: constantly looking for attachment, looking for places where couples do not have each other’s back, places where they are not fully trustworthy with each other

Gottman: research based, has a lot of good data about what works and what does not work in couples therapy, systemic in nature

Wile: examples where couples go from angry to cooperative, collaborative couples therapy

Question 2

basics of couples therapy

Answer 2

Balance
-How to avoid championing one side?
-Have to like both members of the couple

Communication
-How are emotions affecting what is said/heard?

Family of Origin
-What are the relational introjects?
-Where is all this anger coming from

Sense of commitment
-How satisfied and intimate are they?

Question 3

three “don’ts” in couples therapy

Answer 3

Don’t intervene too Quickly
-Why—balance will be upset by a quick jump to one position.
-Get the data first

Don’t answer questions until
-You know exactly that your answer will not alienate you from one member of the couple.

Don’t remain the abstract
-“What if the sense of commitment is cool and I can’t be sure of my footing all the time?”
-Translation needed.

Question 4

explain small problems in couples therapy

Answer 4

While it sounds trite, sometimes we do need baby steps to form a test case of the couple’s intent.
-Date night is a classic intervention for a reason, it is really useful sometimes, find time for people to spend time to talk about things other than the anger or the kids if that is a part of the problem
-A lot of Gottman’s research talks about the initial response from partners, you walk in angry from grad school and your partner is there and they say something that makes you pissed because you are already in a bad mood

Don’t assume that members of a couple see the problem in the same way.
-Some people who feel the same about arguing might mean that arguing might be a good thing, arguing is not necessarily bad

Question 5

explain the bi-lateral intervention

Answer 5

doing an intervention that involves both parties, not blaming one party

Tom, when you make a face, even if it really is based on confusion, it results in you, Beth, pulling away and feeling defeated, which you, Tom, then see as confirmation that you can “do nothing right.”

Question 6

what should you avoid getting hooked in

Answer 6

the past

-Stay present, if possible
–Listen politely if it needs to be stated.
-If paralyzing the couple, consider the Empathy Expansion Procedure (Browning)
-When people apologize for what they did that made the other feel that way, not just apologizing for the other person’s feelings

Question 7

what should therapists ask about and consider in couples therapy

Answer 7

people’s theories

-You want to keep people’s language separate from one side or the other stating “the truth.”
-Truth is contextual, especially in couple’s relationships.

Question 8

who controls the affect in couples therapy

Answer 8

the therapists

-Certainly each member of the couple might bring their own affect into the session, but, you, the therapist should be able to either raise affect or lower it, depending on the goal you are working toward.
-Nothing gained by watching couples go back and forth with sarcasm and belittling comments

Question 9

explain the problem in couples therapy

Answer 9

Both sides of any issue are necessary
-With any problem there are always at least two sides
-Some therapists like to find a problem that people can both agree on being a problem, other people are fine working with two problems

How is each person “part of the problem?”

What is the history of the problem?
-If there have been problems for 7+ years therapy probably will not cut it, not necessarily give up on them right away, but have to look for exceptions where the problem did not exist, if they say no then it probably will be too big of a challenge

Question 10

explain solutions in couples therapy

Answer 10

-What has been tried?
-Is there a lesson learned, or, can the solution be employed again?

Question 11

things to consider about goals in couples therapy

Answer 11

-Is a single goal possible?
-If separate goals were achieved, would this course of action help the couple?
-Is there anyone who is working against the goal? In other words, might an in-law or child be invested in seeing the goal not succeed?

Question 12

stresses and resources

Answer 12

An obvious question to ask, but, a necessary one. Some couples are defeated by an outside stress, and other couples are salvaged by a previously unutilized resource.

Question 13

individual pathology in couples therapy

Answer 13

Is one member suffering from a mechanistic concern that calls for a psychiatric referral, separate individual treatment, or sub-systems sessions?
-If someone’s anxiety or depression is so profound maybe refer to individual treatment, especially if you see the other partner trying, worried unless we address your anxiety in individual therapy, then we can return to doing couples work

Question 14

defining communication style

Answer 14

Come up with a short hand to describe the systemic pattern that they engage in. For example, “Bill tries to be logical, and gets pedantic, while, Julia tries to argue then moves to emotional attacks. Resulting in Bill calling Julia ‘hysterical’ and Julia referring to Bill as ‘a robot.”

Question 15

explain the issue of sexuality

Answer 15

-A resource for the couple
-Diagnostic information
-Small problem to be address
-Referral for Sex Therapy

Question 16

explain educating about therapy

Answer 16

Therapist does not poses a “truth” on what is right and wrong.
-In most cases, what the research has found is….

Couple’s therapy is active.

Subsystem work often is included

Issues of confidentiality

Gender will be considered and discussed
-Try a little bit harder to understand the female perspective if you are a male, also have to consider inequality in gender / relational dynamics

Limits—lateness and phone-ins

Necessity of balance is taught

Question 17

explain balanced interventions

Answer 17

One takes care to move, back and forth, between the two members of the couple with the clear intension, at times, to educate them that “it takes two to tango.”

Speak in interactional terms

Use inclusive language, such as you two, or both

Intensity and confrontation
-These need to be balanced too. If you challenge one, you should be ready to address the other with something.
-If it simply is not equal, then indicate why someone’s style might exist, but why it seems unuseful.

Remember to use metaphor

Question 18

explain physical space in couples therapy

Answer 18

-Even the room should be balanced.
-They need to be able to face each other.
-You should not be talking over one to speak to the other.

Question 19

explain family of origin

Answer 19

-“What were you taught to deal with strong emotions?”
-What were you taught about showing affection?”
-“Is you family of origin still in the room?

Question 20

explain content to process

Answer 20

-Shape the tone of session
-Address “always” and “never”
-Real meaning of “sad”, “blue”
-Emphasize the importance of language—word choice
-Check for reciprocal—anger/defense

Question 21

what is a critical skill in couples therapy

Answer 21

Stopping the Dysfunctional Process
-Draw out and label emotions
-Make language specific
-Ask about “missing emotions.”
-Cut through verbiage
-Model and insert good communication
-Identify similar emotions (e.g. worried)
-Ask hard questions (Do you fear that he could have another affair?)
-Separate “shoulds” from “wants.”

**Be Honest**

Question 22

dealing with core issues in couples therapy

Answer 22

-Point out what you notice about issues that generate stronger than average responses.
-Look for explicit comparisons to childhood feelings.
-Determine how much is done in the couple format, and how much is done with an individual.

Question 23

engagement in couples therapy

Answer 23

How do you initially connect with the couple?
-Exercise
-Video
-Fantasy
-Problem
-Strengths
-History (How did you two first meet?)