Helping Couples Improve Their Relationships

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Helping Couples Improve Their Relationships

• MARRCH Annual Workshop1-240 3-440 pm 10/30/07
• Doug Greenlee MA/MS LMFT, LADC, CGC
• Staff Psychotherapist, Recovery Plus
• Addiction Mental Health Center
• Greenleed_at_centracare.com

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Goals Objectives

• To highlight biopsychosocial evidence-informed
  relational enhancement models that may be useful
  for reducing conflict and enhancing intimacy
  skills in couple and/or family relationships
• To provide opportunity for attendees to review
  and to discuss sample case scenarios via practice
  identifying basic issues, implementing problem
  solving and enhancing intimacy skills development

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Logistics

• Learning level Beginner
• Core Functions Counseling implications
• Presenter Information Experience Education
• Presentation summary Evidence-informed
  relational enhancement models
• Client?
• Cultural Diversity Client as Cultural Unit
• Ethics Informed consent, confidentiality limits,
  dual licensure gray areas

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Overview
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Biopsychosocial Overview(Campbell, W.
Rohrbaugh, R., 2006)

• Biological/Descriptive Data Base
• Symptoms Mood, Anxiety, Cognitive, Substance,
  Psychotic, Personality, Somatic
• Predispositions Genetics, Physical Conditions,
  Medications/Substances
• Demographics disorder epidemiology

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BPS cont.

• Psychological Formulation
• Vulnerabilities developmental disruptions,
  revelatory statements/behavior, recurrent
  relationship difficulties
• Psychosocial Stressors Why Now?

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BPS cont.

• Psychic Consequences Strong emotions,
  thoughts/fantasies, subtle changes in cognition
• Coping mechanisms Adaptive, maladaptive
• Psychodynamic Formulation Dependency, Control,
  Self-esteem, Intimacy/triadic relationships

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BPS cont.

• Cognitive Perspective Dysfunctional automatic
  thoughts, Negative core beliefs, cognitive
  distortions
• Behavioral Perspective Reinforcement for
  maladaptive behavior? Something extinguishing a
  desired behavior? Paired association between
  behavior/environmental cue initiating behavior?

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BPS cont.

• Social Formulation/Database
• Social Stressors Strengths Family,
  SO/friendships, social issues, education, work,
  housing, income, health care access, legal/crime
• Cultural/Spiritual C/S-- identity, explanations
  of illness, psychosocial environment/functioning
  level, therapeutic alliance dynamics

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BPS cont.

• Prognosis
• Compliance with treatment
• Response to prior treatment
• Availability of treatment
• Personality/defense mechanisms
• Social supports

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Addiction Science Overview(Erickson, C., 2007)

• Brain Disease
• Nervous system functions Sensing, integrative,
  motor
• Nervous system CNS, PNS
• Neurochemicals Dopamine, Serotonin,
  Norepinephrine, Acetycholine, Endorphins,
  Endocannibinoids, Glutamate Gaba
• Reward pathway Mesolimbic Dopamine System
• Disease Genetic vulnerability, neuroadaptation
  synaptic plasticity sensitization/desensitizatio
  n, dysregulations

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Addiction Science cont.

• Neurobiological Theories of Dependence
• Allostasis
• Pathology of motivation and choice
• Incentive socialization
• Learning and memory mechanisms

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Affective Neuroscience(Atkinson, B. 2005)

• The Emotional Brain
• Neural architecture favors emotional influence
• Rational decision making emotion dependent
• Brain/emotion mechanisms
• Emotional memory
• Neural back alley
• Unconscious emotional influence
• Neural hijacking

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Affective Neuroscience cont.

• Integrating Neural Knowledge
• Cultivate greater awareness of emotional
  influences
• Treat emotional states as if they had minds of
  their own
• Attend to emotional states before pursuing other
  therapeutic goals
• Focus on the stance clients take toward their
  emotional states
• Work with emotional states when they are active
• Seek cooperation from not control over emotional
  states

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Affective Neuroscience cont.

• Special Purpose Mood States
• Executive operating systems State of mind is a
  pattern of activation of recruited systems within
  the brain responsible for 10 perceptual bias, 2)
  emotional tone regulation, 3) memory processes,
  4) mental models, 5) behavioral response
  patterns.
• State activation motivation to accomplish
  critical survival tasks

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Affective Neuroscience cont.

• Brains Executive Operating Systems
• Rage Evolutionary advantage/self-protection
• Fear E/A - escape danger
• Seeking E/A learning/agency in the world
• Lust E/A motivation to reproduction
• Care E/A protection of loved ones
• Panic E/A motivation for affiliation/support
• Play E/A social bonding, creativity, healing

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Co-Occuring Disorders

• Marital Distress Psychiatric Disorders
  Epidemiological Study (2000)
• Major depression
• Social Phobia
• Simple Phobia
• Panic Disorder
• Generalized Anxiety Disorder
• Alcohol dependence/Abuse

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Attachment Dynamics
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Cultural Competence Process Health Care

• Cultural Competence Healthcare Models
• Campinha-Bacote Model Desire, Awareness,
  Knowledge, Skill Encounter (see handout)
• Purnells model for cultural competence
  Unconsciously incompetent Consciously
  incompetent Consciously competent Unconsciously
  competent. (see handout)

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Sequential Pluralistic Couples Therapy Process
Model

• Examine developmental sources of relationship
  distress
• Challenge cognitive components of relationship
  distress
• Promote relevant relationship skills
• Strengthen the couple dyad
• Contain disabling crises
• Establish a collaborative alliance

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Therapeutic Alliance

• Transtheoretical Dimensions
• Engagement in the therapeutic process
• Emotional connection with the therapist
• Safety within the therapeutic system
• Shared sense of purpose within the family

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Therapeutic Alliance cont.

• SOFTA-O System for Observing Family Therapy
  AlliancesObservational
• Engagement Client/Therapist version
• Emotional Connection Client/Therapist version
• Safety Client/Therapist version
• Shared Purpose Client/Therapist version

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Partnership(Dr. Jan Hoistad)

• Basic Styles
• Traditional dominant non-dominant
• Merged fused personal boundaries
• Roommate independent unilateral
• Big Picture Partnering your, my our world

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Big Picture Partnering10 Essentials

• Create maintain positive feelings
• Talk regularly take turns listening
• Regularly renew your commitment
• Stay committed to Big Picture
• Make win/win decisions
• Pull your own weight
• Make keep clear agreements
• Partnering is joint effort
• Problem solve relationship together
• Create new options

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The Four Horseman of the Apocalypse

• Criticism
• Defensiveness
• Contempt
• Stonewalling

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Relational Success

• Managing Conflict
• Prerequisite 1 Soft Start-up
• Prerequisite 2 Accepting Influence
• Prerequisite 3 Effective Repair
• Prerequisite 4 Respecting Partners Dreams
• Connecting During Non-Conflict Times
• Prerequisite 5 Five Positives 1 Negative

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Relational Success Predictive Habits

• Soft Start-Up
• Avoiding a Judgmental Attitude
• Standing Up for Yourself Without Putting Your
  Partner Down
• Accepting Influence
• Finding the Understandable Part
• Giving Equal Regard

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Relational Success Predictive Habits

• Effective Repair
• Offering Assurances
• Respecting Your Partners Dreams Holding on to
  Your Own
• Understanding Explaining What is at Stake

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Relational Success Predictive Habits

• 5 Positives for Every Negative
• Curiosity about Your Partners World
• Keeping Sight of the Positive
• Pursuing Shared Meaning
• Making and Responding to Bids for Connnection

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Common Issues

• Workaholic Where do we fit?
• The Affair Can I/we get over it?
• Crises Yes! Problem solving but intimacy?
• Stonewalling Why dont we talk anymore?
• Dream loss What about my/our dreams?
• Depressed Why so distant irritable?
• Frustrated So, Im a nag?
• Dead-in-the water Wheres the fun?
• Children-focused What about Us?
• Dramatic Is it really that complicated?

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Conversation Practice

• Living Your Dreams Together Conversation Cards
  for Couples by Dr. Jan Hoistad
• The Art of Conversation The Ouchkit Couples
  Therapy in a Box by Betsy Sansby MS LMFT
• Interpersonal Effectiveness Skills DEARMAN GIVE
  FAST by Dr. Marsha Linehan
• The Peaceful Heart A practical guide to
  unconditional love and forgiveness by Mary
  Hayes-Grieco

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Ethics Law

• Universal Ethics
• Beneficence
• Non-malefalence
• Preserving Independence
• Fidelity or True to Purpose
• Justice
• Legal
• Informed consent
• Confidentiality

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Summary Application

• Biopsychosocial model Addiction dynamics in
  early recovery
• Strategic role of the clinician as guiding
  interpersonal problem solving
• Basic paper pencil or related activities for
  identifying, stimulating potentially resolving
  interpersonal issues
• Review of handouts bibliography
• Applied exercise(s)