Couples Counseling

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Couples Counseling

• Changing Beliefs

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Beginning of Counseling

• 1886 - Freud began therapeutic practice and
  research in Vienna.
• 1911 - Alfred Adler
• 1913 - Carl Jung
• 1942 - Carl Rogers
• 1951 The seminal work of Gestalt Therapy is
  published Fritz Perls

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• 1952 - The Diagnostic and Statistical Manual of
  Mental Disorders (DSM)
• 1953 - B.F. Skinner
• 1954 - Abraham Maslow
• 1957 - Albert Ellis
• 1967 - Aaron Beck
• 1968 - DSM II published

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Phase I AtheoreticalGurman and Fraenkel

• 1930 to 1963
• 1929 to 1932 - Three marital clinics opened they
  were service and education oriented, and saw
  mostly individuals
• The closest thing to theory was what was borrowed
  from psychoanalytic - interlocking neurosis
• 1931 the first marital therapy paper was
  published
• Theory was marginalized due to a lack of
  brilliant theorists, and a lack of distinction
  from individual analysis

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Phase II Psychoanalytic Experimentation

• 1931 to 1966
• Mostly individual sessions, but some conjoint
  still treated like seeing two individual clients
  in the same room though
• Some started to downplay the role of the
  therapist
• Family was outshining couples work, and the
  couple techniques weren't innovative or
  particularly effective

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Phase IIIFamily Therapy Incorporates Other
Approaches

• 1963 to 1985
• Family therapy overpowers couples, even though a
  number of big name people really mostly saw
  couples
• Jackson- Coined concepts like quid pro quo,
  homeostasis, and double bind for conjoint therapy
  
• Satir - Coined naming roles members played,
  fostered self-esteem and actualization, and saw
  the therapist as a nurturing teacher

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Phase IIIFamily Therapy Incorporates Other
Approaches

• Bowen - Multigenerational theory approach, with
  differentiation, triangulation, and projection
  processes, with the therapist as an
  anxiety-lowering coach - societal projection
  process was the forerunner of our modern
  awareness of cultural differences
• Haley - Power and control (or love and
  connection) were key. Avoided insight, emotional
  catharsis, conscious power plays. Saw system as
  more, and more important, than the sum of the
  parts

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Phase IVRefining and Integrating

• 1986 to present
• New Theories were tried and refined, like
  Behavioral Marital Therapy, Emotionally Focused
  Therapy, and Insight-Oriented Marital Therapy.
• Couples therapy was used to treat depression,
  anxiety, and alcoholism.
• Efforts were focused on preventing couples
  problems with programs like PREP
• Feminism, Multiculturalism, and Post-Modernism
  impacted the field
• Eclectic integration, brief therapy, and sex
  therapy ideas were incorporated as well into our
  work.

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Quotes about history

• As early as 1960, Gurin, Veroff, and Feld found
  that over 40 of all people seeking psychological
  help viewed the nature of their problem as
  marital.
• Manus argued in 1966 that couples counseling was
  a technique in search of a theory with little
  conceptual clarity in evidence (Jacobson
  Gurman, 1995).

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Quotes about history

• Olson (1970), the fields first chronicler,
  referred to marital therapy as a youngster
  which had not yet developed a solid theoretical
  base nor tested its major assumptions and
  principles.
• Six years later he wrote, the field was no
  longer in its infancy and was showing signs of
  maturing, although it appeared like an
  adolescent, full of undirected energy.

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• 1970s 1980s
• Family counseling killed marriage counseling
  and did not see it as independent, different, or
  important.
• This time period was seen as family therapys
  golden age.

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More history

• Even in the early 1980s couples counseling
  struggled to have a place.
• Haley (1984) put it, marriage counseling did not
  seem relevant to the developing family therapy
  field.
• It was seen that marriage counselors adopted the
  ideas of other therapies rather than developing
  their own.

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Beginning the change

• Going back to the mid 1960s to mid 1980s only a
  few new models appeared and only a handful of
  important texts appeared.
• By the mid-1980s, couple therapy had reasserted
  its existence and established what would become
  more sustained theory development and empirical
  research.
• 1986 was the beginning of couple therapys fourth
  and current phase.

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Conjoint Therapy

• 1940s only 5 of marriage counseling met
  conjointly
• 1950s rose to 9
• 1960s increased to 15
• Not until 1970s did conjoint therapy become the
  predominant technique of couples counseling.

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THEN

• 1965 George Bach published the intimate enemy
  which was a new approach to couples therapy.
• Problem was that people needed to air their anger
  rather than suppress it
• Expressing resentments would be a catharsis that
  would clear the air
• Partners took turns airing their resentments

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NOW

• We now know that there is no catharsis effect in
  voicing anger and that Backs procedure only
  built resentment.

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THEN

• Quid Pro Quo
• A good relationship is based on reciprocating
  positive behaviors and that a bad marriage is
  caused by a breakdown of this contract.
• Contingency contracting give to get
• Each person would identify what behaviors they
  wanted to get from the other
• Counselor would help couple to write a contract
  for the exchange of desired behaviors.

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NOW

• 1977 Murstein found that a reciprocity concept
  was a hallmark of an ailing relationshipnot a
  happy one.
• People became affective accountants when a
  relationship wasnt working well.
• I did this for her, and she never reciprocated.
• When the relationship goes well, they dont think
  of this contingency.

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THEN

• Goal was to have couple identify their problem
  and them help resolve them.
• Therapist was seen as super problem-solver
• Could start anywhere and teach a specific set of
  relationship skills
• Belief was that when specific skills were taught
  all conflicts would be solved.

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NOW

• Focus on resolution of conflict is misguided.
• Gottmans research revealed that most conflict
  (69) in relationships is perpetual.
• Based on lasting differences in personalities and
  needs.
• Couples need to dialogue about perpetual issues
  or live in a state of gridlock
• Goal is to manage conflicts rather than resolve
  them.

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THEN

• Focus on teaching skills
• System therapists taught
• Avoiding mindreading, establishing clear feedback
  loops, being able to meta-communicate about
  double binding messages.
• Rogerian and behavior therapists taught
• Active listening to one another

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NOW

• If you teach skills, these are what need to be
  taught.
• In happy, lasting relationships
• The approach toward conflict is gentle.
• Partners soften the way they bring up an issue
• Partners accept influence from one another
• Relationships have a 51 ratio of positive to
  negative affect during conflict
• Consistently communicate acceptance of one
  another

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NOW

• In happy, lasting relationships
• They keep their level of physiological arousal
  low
• They pre-empt negativity in the interaction
• They repair the interaction and de-escalate if it
  does become negative
• They move gently toward compromise

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NOW

• In relationships that are ailing and failing
• There is either an escalation of negative affect,
  
• a lack of positive affect,
• or a state of emotional disengagement

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THEN

• Assumed all conflicts were alike

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NOW

• Some conflicts are real deal-breakers
• These conflicts contain hidden agenda
• Partners have the same argument over and over
• Positions are embedded with deep personal meaning
  so that compromise seems completely unthinkable
• Need to help couples talk about deeper meaning
• Freedom, power, love, and justice

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THEN

• 1970s therapy had a strong behavioral and
  cognitive base.
• Therapist was the rational and calm one.
• Couple was viewed as emotional and out of
  control.
• Following Bowens ideas, our job was to help the
  couple control their feelings.

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THEN

• Bowen believed that the partners would control
  their emotion using reason.
• The counselor was assisting each partners
  cerebral cortex in gaining dominance over the
  primitive limbic system.
• It was emotion versus reason, and reason should
  win.
• Goal was supporting the process of evolution.

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NOW

• Bowens views about the brain and emotion versus
  reason are wrong.
• In the brain there is an integration of emotion
  and reason
• Without emotion, problems do not get solved very
  well.
• Emotion, prioritizing figure from ground, and the
  intuitive sense of the matter are essential in
  problem solving.

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NOW

• People are not rational decision makers.
• Expressing emotion does not mean being out of
  control.
• Emotion is central to the understanding and
  treatment of couples relationships.
• Gottmans research shows that the nature of
  emotional interaction predicts what happens to a
  relationship.

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NOW

• Affect is not the problem it is central for
  understanding, compassion, and change.
• We need to become the expert on emotion, and on
  helping couples establish emotional connection.

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THEN

• Bowen believed the goal was to help partners
  become less enmeshed and more differentiated.

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NOW

• Dependency is now legitimate in relationships.
• Based on attachment theory, the partners are no
  longer seen as either dependent or independent.
• Dependency is seen as either effective or
  ineffective.

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THEN

• Believed that couples needed to reduce negative
  affect and build positive affect.
• Goal of therapy was to help couples schedule
  love days designed to increase positive
  behavior between partners.

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NOW

• Building positive affect both during conflict and
  in everyday interaction is essential to ensure
  lasting change.
• Love days didnt change positive affect during
  conflict.
• To increase positive affect, need to focus on
  improving both the couples friendship and secure
  attachment.

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THEN

• Assumed that if we dealt with conflict, the
  positive affect systems would be activated
  automatically.

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NOW

• Positive affect systems must be build and
  maintained intentionally as part of therapy
• To build positive affect and secure attachment,
  couples need to work on
• turning toward bids for emotional connection,
• building emotional intimacy, and
• building positive affect systems such as
• courtship, romance, lust, sex,
• play, fun, and adventure

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NOW

• Growing awareness that good friendship, positive
  affect systems, and constructive conflict need to
  be supplemented by building the couples shared
  meaning system.

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NOW

• Couples need to identify and communicate
• their sense of purpose,
• the meaning of how they move through time
  together,
• their priorities and values,
• what they hold to be sacred
• their goals and missions, ethics, morality,
• philosophy of life and religion
• their legacy from their families and culture
• Goal is to build an existential base to their
  lives