Sometimes when I speak with a potential client they ask how couples therapy helps. This blog entry is designed to give you an idea of what I actually do during my sessions and how each intervention helps the couple get out of the negative pattern that brings them to my office. In this post I identify seven of the most common interventions that I use in relationship therapy: Set Limits, Identify the Problem, Identify Goals, Identify Needs, Emphasizing Process Over Content, Stop and Correct Problem Communication, and Check My Assumptions and Interpretations.
There are limits that I have both in the sessions and in the therapy in general. For example, I set limits about working with couples with a history of violence or where either member has a current problem with substance abuse. I also set limits in the session about yelling, name calling, and other hurtful behavior. I believe that these limits are a prerequisite to successful relationship therapy because without the basic kinds of safety that these limits protect, the members of the couple are not free to be vulnerable enough to allow for emotional connections.
Identify the Problem
I have written in another blog post that in the first session, I try to identify the nature of the challenges. More specifically, what I am doing during the discussion is looking for the way that the cycle of challenge begins and gets perpetuated. There is a homeostasis in a couples system when they walk through my door that keeps the problems in place. I need to find out how each member does something to try to fix the relationship, which (for example) gets misinterpreted by the other, who then responds defensively, which the first takes as rejection, which causes an argument, which then keeps them afraid of really communicating. Once I think I have identified the cycle I describe it to the couple. If they nod easily in recognition then I take that as a validity check. If they don’t then I need to ask more questions to better understand what has brought them to my office.
In a previous post I spoke more about treatment plan I bring to the couple, usually in the fourth session. Beyond that treatment plan, I try to identify what specific topic we’re working on in each session. Usually this comes from the couple’s last week together. Identifying the session goals focuses the conversation and makes sure that we are improving things that have real bearing on the couple’s life together. Yet, even more narrow than identifying the goal of the session, I might interrupt a communication in progress during the session to find out what that member of the couple is hoping to accomplish with their phrase or statement. This helps me better understand what the person is trying to get from their partner and helps me coach them in changing their communication to more effectively request that or to help the partner see what is being requested.
When one person is pulling away during a tense conversation, I try to find out what need the pulling away is intended to fulfill. When one person is asking for their partner to attend a party with friends, I try to find out what this signifies to the person making the request. These kinds of actions and behaviors are all trying to meet a core need for connection and intimacy but it isn’t always easy to know what the need is underneath the behavior. By asking about the meaning behind behavior and then beginning to theorize with each client about their core attachment needs (e.g., belonging, respect, acceptance, being wanted) I begin to understand the internal process inside the client that contributes to their behavior and once I have that I find that this understanding will generalize across situations. This way I’m not just helping a couple compromise on the trip to Aunt Mildred’s in June, but helping them understand how that trip relates to each of their attachment needs which will come up in many other situations.
Emphasizing Process Over Content
As mentioned above I try to make sure that there is a topic to focus the conversation in ever session. Yet I have a saying that I developed in my own marriage of 15 years, “It’s never about the dishes”. That is, though the topic during the session might be the dishes, the real thing that is happening, the real reason the dishes are a problem, is that there is a challenge in how the conversation about the dishes gets resolved. On the one hand there is probably an attachment need underneath the problem like “If you really loved me you wouldn’t deal with the dishes this way”. But on the other hand the process of communicating about the dishes doesn’t touch the heart of that need. I help couples identify the process of the communication about the dishes, This helps them go from, “Why don’t you ever do the dishes?” to “A clean home is very important to me and when I see you taking care of the housework with me, I feel closer to you. Would you please do the dishes today?” It might sound contrived at first, but this is just an example and all skills feel inauthentic and awkward when we are first learning them. When clients shift the process of communication from accusation or blame to communicating the actual needs, the process goes much more smoothly. Moreover, the gains in the conversation about the dishes are then transferrable to other situations.
Stop and Correct Problem Communication
Whether the negative communication pattern is blame, name calling, overgeneralization, raising a voice, threats (emotional or physical), shutting down (also called stonewalling), or some other hurtful behavior, I do not let it continue in my office. This is one of the biggest things that my clients identify as a difference between my style and the style of prior therapists that they have worked with. My theory is that you already know how to fight or treat each other badly and you are in my office to stop that pattern. In sessions I stop negative communication immediately by naming the negative pattern for what it is in a compassionate but firm way, then offering support to help the client communicate in a more direct but respectful tone. This is just like any other kind of practice. Your coach doesn’t let you make a lazy lay-up in basketball practice, your fitness coach doesn’t let you do the last half of a set half way, and I don’t let my clients get away with negative communication patterns in session that will stop them from getting what they want out of their relationship outside of session.
Check My Assumptions and Interpretations
A colleague of mine, Kathryn Ford, recently referred to our psychotherapy practices as labs. So, as part of running my marriage therapy lab, I am constantly developing hypotheses. For each couple and each new person, I need to find out what each tilt of the head, or shift in intonation means. I have a lot of experience working with couples but each person is so unique that I try not to assume that I know what is going on. So I frequently test my hypotheses during the sessions. I might say, “Kim, when you said to Joseph, ‘I don’t want to do that for you’ did you mean you don’t want to do that ever or that you don’t want to do that when the two of you are experiencing emotional tension?” This kind of hypothesis testing tends to be a nonthreatening way for me to make sure that my impressions are correct, that I am understanding what you mean and not just what you say. Once I have tested enough of these hypotheses, I begin to make more assertive comments based on my working impression of your needs and how you express them in your relationship. However, I always try to hold a beginners mind about that working impression and I encourage my clients to correct my interpretations as often as necessary.
I am only half-way through my list of most commonly used relationship therapy tools. So far I have emphasized the less concrete, more relational tools. In the next posts, I will share more concrete tools.
Other posts in this series:
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