Couples Therapy- PP Lecture – Flashcards

Significant cultural changes in the last half-century have had an enormous impact on marriage, and the expectations and experiences of those who marry or enter other long-term committed relationships Reforms in divorce (no fault) More liberal attitudes about sexual expression Increased availability of contraception Growth in economic and political power of women (Gurman, 2008) Expectations have increased beyond procreation and economic viability....more than cooking and raising children and bringing home the bacon

Recurrent conflict and divorce are associated with a wide variety of problems in both adults and children Divorce and couples problems are among the most stressful conditions people face Partners in troubled relationships are more likely to suffer from anxiety, depression, suicidality, substance abuse, and chronic medical conditions Children of distressed marriages are more likely to suffer from anxiety, depression, conduct problems, and impaired physical health

Emotional disengagement Wanting commitment Power struggles Problem-solving Communication difficulties Jealously Extramarital involvements Value and role conflicts Sexual dissatisfaction Abuse and violence

1) The therapist's clinical parsimony (thriftiness) and efficiency 2) The adoption of a developmental perspective on clinical issues 3) A balanced awareness of clients' strengths and weaknesses 4) A de-emphasis on the centrality of treatment (and the therapist) in clients' lives

The term "couple therapy" has recently come to replace the historically more familiar term "marital therapy" because of the bond between two people, without the associated judgmental tone of social value implied by the traditional term Psychotherapy is part of its surrounding culture . It is a significant source of our current customs and worldview In the world of couples therapy, the de facto substitute for personality theory is usually a theory that defines the "interactive personality" of the couple dyad

1) How decisions are made about who to include in therapy? 2) Are psychotropic medications ever used within your method of couples therapy? 3) Are individual sessions with the partners ever held? 4) Is couples therapy time-limited or unlimited? How long, how often are sessions scheduled and the entire therapeutic process? 5) If either partner is in concurrent individual therapy (with another therapist), does the couple therapist usually communicates with the individual therapist? 6) How are out-of-session contacts handled? Phone calls, secrets, letters... Are there any specific ground rules?

1) What is the therapist essential role? Consultant? Teacher? Healer? 2) What is the role of the therapist-couple alliance? How is the working alliance fostered? 3) To what degree does the therapist overtly control sessions? 4) Do clients talk predominantly to the therapist or to each other? 5) Does the therapist use self-disclosure? 6) Does the therapist role changes as therapy progresses? As termination approaches? 7) What clinical skills or attributes are most essential to successful therapy?

Formal and informal systems for assessing couples, in addition to the clinical interview Assessing for violence, substance abuse, extramarital affairs, sexual behavior, relationships with extended family, parenting issues Assessing gender, ethnicity, and other socio-cultural factors Assessing couples' strengths and weaknesses

1) Reduction of psychiatric symptom (s) 2) Increased couple resourcefulness (i.e., improve communication, problem solving, and conflict resolution) 3) Improvement in the fulfillment of individual psychological needs for attachment, cohesion, and intimacy 4) Increased ability to interact effectively with important, larger social systems 5) Increase awareness and understanding of how couples' patterns of interaction influence their everyday effectiveness in living

Top 5 needs of women:1) Security/Affection: Women often associate affection with security, comfort, protection and approval. When a man shows his wife affection (non-sexual), he's sending subliminal messages to her that he'll take care of her, stand by her, and protect her2) Conversations: When women have intimate conversations with their spouses, it reassures them and make them feel loved and supported3) Honesty and Openness: A woman needs to be able to trust her husband completely. When a man doesn't maintain an honest, open communication with his wife, he undermines her trust4) Financial Support: Many women marry for the financial security their spouse provides5) Family Commitment: A woman needs her husband to be a good father and to be committed to the family Top 5 needs of Men:1) Sexual Fulfillment: Most women can go without sex for months, but for men, it's pure torture. In fact, they would probably do it all the time if they had their way2) Recreational Companionship: Even after marriage, couples should make an effort to involve themselves in their spouses' activities3) An attractive Spouse: A man needs a wife who looks good to him4) Domestic Support: Most men like having domestic chores like cooking and cleaning done for them5) Admiration: Men want their wives to be proud of them. So when you tell your husband that he's wonderful, it motivates him to achieve more

CBCT is the most evaluated couple treatment: about two dozen well-controlled treatment outcome studies All of these reviews reached the same conclusion: CBCT is an efficacious intervention for distress couples Research findings suggested: 1) Between 33 and 67 percent of couples are in non-distress range of marital satisfaction after receiving CBCT 2) Most couples appear to maintain these gains for short time periods (6-12 months) 3) However, long-range follow-up results are not encouraging: in a one to two-year follow-up of strictly CBCT, about 30 percent of couples who had recovered during therapy subsequently relapsed (Jacobson et al., 1987). In addition, 38 percent of couples receiving CBCT has divorced during a four-year follow-up period (Snyder et al., 1991)

I) Behavioral Couples Therapy (BCT), Stuart (1969) Stuart hypothesized that successful marriages could be distinguished from unsuccessful one by the frequency and range of positive acts exchanged reciprocally by the partners. Operant conditioning principles suggested that partners would be more likely to behave in positive ways toward each other if they received positive consequences from each other for those actions Treatment consisted of obtaining a list of positive behaviors that each person desired from the partner and instituting an agreement for the two individuals to exchange tokens as rewards for enacting the desired behaviors The couples' behaviors are shaped, strengthened, weakened and can be modified in therapy by consequences provided by environmental events, particularly those involving the other partner The traditional BCT model posits that a couple's relationship consists of reciprocal and circular sequences in which each partner's behavior simultaneously affects and influences that of the other

An individual's emotional and behavioral responses to life events commonly are mediated by idiosyncratic interpretations that may be biased by cognitive distortions, Beck et al. (1979), Ellis (1962), Meichenbaum (1977) A major promise of this approach is the partners' dysfunctional emotional and behavioral responses to relationship events are influenced by information-processing errors, whereby cognitive appraisals of the events are either arbitrary or distorted Examples: "You stayed most of the day at your parents' house because they are more important to you than I am." "I know that your mom has been sick and you feel responsible for helping take care of her, but you knew I was sitting here by myself--I feel like you don't really love me." "If you really cared, you'd want to spend all your free time with me--that is what a marriage should be."

Social cognition research that made a significant impact is the notion of attributions that individuals make about determinants of positive and negative events in their relationships and relatively stable schemas In example, the concept of a caring partner , developed on the basis of past relationship experiences and subsequently apply in understanding current relationships events

CBCT employs a broader contextual perspective in defining a healthy relationship A "healthy relationship" is defined as one that contributes to the growth and well-being of both partners, in which the partners function well together as a team and relate to their physical and social environment in an adaptive fashion (Baucom, Epstein, & Sullivan, 2004) A "healthy couple" is able to adapt over time to both normative (pregnancy, childbirth, career changes) and non-normative events or stressors (unemployment, death in the family). The partner is able to collaborate in solving problems rather than operating as adversaries or in an disorganized manner (Epstein and Baucom, 2002) A healthy relationship is one in which the partners have positive connections to their physical and social environments

Research has demonstrated that relationships roles, approaches to power, and ways of processing information often differ between males and females as groups, as well as within and between ethnic and cultural groups Findings across studies indicate that females are more likely to be in the demanding role and males in the withdrawing role. These roles often reflect power and gender differences in desired styles of intimacy, because females tend to be more oriented towards achieving intimacy through mutual self-disclosure than are males Females are more likely than males to engage in circular relationship schematic processing, in which they consider both partners' contributions to couple interaction patterns . Males are more likely to engage in individual schematic processing, in which they focus on linear impacts that the individual partners have on the relationship

Rates of divorce vary across ethnic groups and tend to be higher among some ethnic/minority couples Researchers have generally attributed group differences in divorce rates to several stressors that disproportionally affect ethnic/minority couples, including economic instability, joblessness, exposure to poverty and violence, and continued experiences of racism and discrimination (LaTaillade, 2006) Chronic stressors are likely to tax couples' resources, increase vulnerability, to other stressful events, increase partners' negative perceptions of each other and their relationship (LaTaillade, 2006)

CBCT tends to be implemented as a brief therapy approach (no, not a five-minute session). Some therapists might allow longer than the usual 50 to 60- minute session, and it could range from several to over 20 weekly sessions It is common for therapists to gradually phase out therapy as the couple shows evidence of substituting positive interactions for negative ones and of achievement the partners' initial goals in therapy Periodic booster sessions may be scheduled In some cases, more sessions might be needed, as in the case of violence or infidelity, or when dealing with couples or a partner that exhibit a personality disorder or severe pathology Goals are set at both the "micro" level (i.e., increasing number of meals together) to the macro level (i.e., increasing the couple's overall level of togetherness

Homework is routinely assigned between sessions Use of homework is based on the learning principle that to replace existing (and often ingrained) dysfunctional interaction patterns with new positive ones, the couple needs to rehearse the new patterns repeatedly, particularly under "real life" conditions that are different and often more challenging than those in the therapist's office

A partner who is in conflict may desire to form an alliance with the therapist, convincing the therapist that the other partner is responsible for the relationship problems It is important to respond in a manner that demonstrates to the blamed partner that the therapist is not siding with the individual attempting to form an alliance, however, the therapist simultaneously must demonstrate that he/she is taking the alliance-seeker concerns seriously and not siding with the blamed partner (unless the blamer is behaving in an abusive manner) CBCT therapists established guidelines for constructive couple interaction in sessions, formalizing them in a written agreement, and intervening quickly to block aversive behavior Use of emphatic reflective listening with one partner and then the other, followed by statements summarizing the reciprocal and often interlocking concerns of both individuals, can help to establish the therapist as a relative neutral party (i.e., the two of you have been having a hard time lately....

CBCT assessment procedures include both, a joint couple interview that focuses on the history and current functioning of the relationship and an individual interview with each partner (Epstein & Baucom, 2002) Private information shared during the individual interview is encouraged to be shared with the other partner

Roles/Functions Early stages: psychoeducation, establishing alliances, engagement (matching), and motivation to change with the couple During treatment: More psychoeducation around rationales for treatment recommendations and the assignment of homework, models skills, coaches the couple in practicing skills in and outside the sessions, sets pace of sessions, initiates an agenda for each session, discourages the escalation of strong and frequent emotional outbursts Late stages: Direction and imposition of structure diminishes over time, as the partners assume increasing responsibility for managing their concerns

Goals of the clinical assessment (Clinical Interview, Questionnaires, Formal Assessments) 1) To identify the concerns and potential areas of enrichment/growth for which a couple has sought assistance 2) To clarify the cognitive, behavioral, and affective factors associated with the two individuals, the couple as a dyad, and the couple's environment that contribute to their presenting concerns 3) To determine the appropriateness of couple therapy in addressing those concerns

The therapist presents to the couple his/hers understanding of the relevant couple, individual, and environmental factors that significantly influence the couple's relationship The therapist describes behavioral, cognitive, and affective response patterns that the assessment has indicated are contributors to the couple's relationship difficulties The therapist collaborates with the couple in translating descriptions of the relationship problems into statements of positive goals (treatment plan) The therapist models setting realistic goals for treatment The therapist underscores the importance of partners taking responsibility for their own behavior and for improving the relationship The goals of the two partners may be in conflict...accept their differences, compromise or decide whether to continue the relationship

1) Both partners must feel that the therapist is attending to the central areas of concern that prompted them to seek treatment 2) Many distressed couples have a history of negative interactions that interfere with their ability to address their most central concerns at the onset of treatment 3) The therapist needs to help the couple decrease the frequency of aversive interactions and established a safe atmosphere 4) Some couples enter therapy rather disengaged and uninvolved. During the early stage the therapist may help the couple to be more emotionally expressive and/or prescribe activities to foster a sense of closeness

Guided Behavior Change Involves interventions that focus on behavior change without a skills component It is helpful for the therapist to discuss with the couple the importance of each person committing to constructive behavior changes irrespective of the other person's behavior, Halford et al. (1994)

The therapist provides the couple instruction in the use of particular behavioral skills, followed by opportunities for the couple to practice behaving in the new ways Two major types of communication 1) Couple discussions focused on sharing thoughts and feelings (intellectual vs. emotional couples, or mixed partners) 2) Decision-making or problem solving conversations (decision makers, but not implementers)

Skills for sharing thoughts and emotions: 1) State your own feelings 2) Include positive feelings when sharing negative ones (sandwich technique) 3) Be specific 4) Be tactful and watch your timing

Skills for listening to your partner: 1) Show that you understand your partner's statements and accept his or her rights to have those thoughts or feelings 2) Try to put yourself in your partner's place and look at the situation form his/her perspective How do we do that? Ways to respond after your partner finishes speaking: 1) Summarize and restate his or her most important feelings, desires, conflicts, and thoughts. This is called reflection! 2) While in the listener role, do not: a) ask questions, except for clarifications b) express your own opinion c) interpret or change the meaning of your partner's statements d) offer solutions or attempt to solve a problem e) make judgments or evaluate what your partner has said

Skills for Decision-Making Conversations: 1) Be clear about the issue 2) Why it is important and what your needs are 3) Discuss possible solutions (brainstorming) 4) Decide on a mutual solution 5) Decide on a trial period to implement the solution

Cognitive variables that are important in understanding couples' relationships Selective Attention: What each person notices about the partner and the relationship Attributions: Causal and responsibility inferences about marital events Expectations: Predictions of what will occur in the relationship in the future Assumptions: What each believes people and relationships actually are like Standards: What each believes people and relationships should be like

Purpose: For couples to question their thinking and develop a different perspective on the partner or relationship Example 1) Clarify each person's existing standards (what each believes people and relationships should be like) 2) Discuss advantages and disadvantages 3) If standards need alteration, help revise them to form new acceptable standard 4) Resolve problems related to how new standards will be taken into account behaviorally 5) If partners' standards continue to differ, discuss ability to accept differences

1) Normalize emotions, positive and negative 2) Clarify thoughts, then relate these to emotions 3) Use questions, reflections, and interpretations to draw primary emotions (anger, sadness) 4) Describe emotions through metaphors and images 5) Discourage attempts to distract the self from experiencing emotions 6) Encourage acceptance of the individual's experience by the partner

During couples therapy, some couples experience and express high levels of negative emotion or strong positive emotion. A therapist may find such couples quite demanding, because their lives appear to revolve around a series of emotional crises, strong arguments, or extreme behaviors Strategies to contain such couples 1) Have the couple schedule times to discuss issues that are upsetting. The goal is to to restrict or contain the frequency and setting in which strong emotions are expressed 2) Practice "healthy compartmentalization" 3) Seek alternative ways to communicate feelings and elicit support 4) Tolerate distressing feelings

1) CBCT may not be able to treat the couples' problems 2) When goals have been accomplished 3) When the couple no longer needs the assistance of the therapist The therapist may taper the treatment session, from once a week to every other week, to once every three weeks. The therapist can be available for booster sessions

EFT is empirically based: 1) Interventions focus on relational elements that in research have been found to be critical to marital satisfaction and distress 2) EFT is rooted in attachment theory-an empirically validated theory of adult love This model offers a systematic and well-researched change process, including forgiveness of injuries, trust, and partner anxiety and depression An EFT therapist is a process consultant who supports partners in restructuring and expanding their emotional responses to each other, thus, partners restructure and expand their interactional dance and create a more secure bond

EFT is the integration of an experiential/gestalt approach with an interactional/family systems approach The experiential perspective has always seen the wisdom in focusing on emotional responses and using them in the process of therapeutic change In couple therapy, emotional signals are the music of the couple's dance, so a focus on emotion in therapy seemed most natural

1) The therapeutic alliance is healing in and of itself, and should be as egalitarian as possible 2) The acceptance and validation of each partner experience is a key element in therapy—needs to be placed in the context of the negative interaction cycle 3) The essence of the experiential perspective is a believe in the ability to human beings to make creative, healthy choices, if given the opportunity--this approach is nonpathologizing. It assumes that we find ways to survive and cope in dire circumstances, when choices are few, but then later we find those options limiting and inadequate

4) Experiential therapies encourage an examination of how inner and outer realities define each other, that is, the inner construction of experience evokes interactional responses that organize the world in a particular way—focusing on this ongoing process and helping clients bring order to and coherently engage with these realities in the present is the hallmark of EFT 5) Experiential approaches take the position that we are formed and transformed by our relationships with others—by helping partners changing the shape of their relationships, the EFT therapist is also helping them reshape their sense of who they are—couple therapy then becomes a place where partners may revise their sense of self and so become more able to deal with problems such as depression, anxiety, and PTSD 6) Experiential approaches attempt to foster new corrective experiences for clients that emerge as part of personal encounters in the here and now of the therapy session

A healthy relationship, in EFT terms, is a secure attachment bond This bond is characterized by mutual emotional accessibility and responsiveness This bond creates a safe environment in that optimizes partners' ability to regulate their emotions, process information, solve problems, resolve differences, and communicate clearly Research o adult attachment has demonstrated that secure relationships are associated with higher levels of intimacy, trust, and satisfaction (Cassidy & Shaver, 1999; Johnson & Whiffen, 1999)

EFT looks at distress in relationships through the lens of attachment insecurity and separation distress (Johnson, 2004b) When attachment security is threatened, human beings respond in predictable sequences: 1) Typically anger is the first response, a protest against the loss of contact with the attachment figure 2) Separation distress, clinging and seeking, which then gives into depression and distress 3) The relationship is grieved and detachment occurs

Stage I: Cycle Deescalation 1) Identify the relational conflict issues between the partners 2) Identify the negative interaction cycle where these issues are expressed 3) Access the unacknowledged, attachment-oriented emotions underlying the interactional position each partner takes in the cycle 4) Reframe the problem in terms of the cycle, underlying emotions that accompany it, and attachment needs

Stage II: Changing Interactional Positions 5) Promote identification with disown attachment needs and aspects of self—the need for reassurance and comfort...or sense of shame or unworthiness 6) Promote each partner's acceptance of the other experience 7) Facilitate the expression of needs and wants to restructure the interaction based on new understandings and create bonding events

Stage III: Consolidation and Integration 8) Facilitate the emergence of new solutions to old problems 9) Consolidate new positions and cycles of attachment behavior--reviewing accomplishments of the partners...

The therapist is less directive and the partners themselves begin the process of consolidating their new interactional positions and finding new solutions to problematic issues in a collaborative way—they developed a new dance—"it takes two to tango" The therapist offers booster sessions as needed