Welcome to our
“Who’s Afraid of Couples Therapy?” This exciting series, back by popular demand, is based on our November/December 2011 issue on this topic and will explore the challenges of couples work.
What are the most effective strategies in working with couples? How can therapists structure therapy—particularly in the early sessions—so that couples leave with a sense of hope, rather than frustration? Can working with individuals who have serious issues in their relationships actually be detrimental to them? Find out the answers to these questions and much more. In this first session with expert couples therapists
Ellyn Bader and Peter Pearson, the creators of the Developmental Model of Couples Therapy, you’ll find out why clinicians often avoid working with couples and how you can better prepare yourself for couples therapy work.
How can therapists most effectively work with emotion in the consulting room—particularly when it comes to couples therapy? Learn with internationally known couples therapist
Hedy Schleifer how to help create a nourishing connection between partners, define a role as therapist-as-guide, and much more. Schleifer, who’s pioneered the training of Imago Relationship therapists internationally, will go into how to use this theory in practice and how to best work with emotions.
What happens when partners in couples therapy have two different agendas in mind? Hear from expert
William Doherty on this little spoken about topic. Learn how Discernment Counseling, an approach that helps couples clarify their feelings about the next step in their relationship, can help both clients and therapists.
Is it possible to rebuild trust and intimacy in a couple’s relationship after a partner has had an affair? How can therapists help? Hear from
Esther Perel, author of the international bestseller Mating in Captivity: Unlocking Erotic Intelligence, on how to help couples after an infidelity and the role that cultural perspectives have in this emotional situation.
Explore this classic dynamic of couples therapy—an angry woman and a withdrawn man—that’s often confusing for therapists, with couples therapist
Jette Simon. Learn more about what’s behind the feelings of anger and the behavior of withdrawing, and how clinicians can more effectively work with shame and fear of disconnection.
Hear an unconventional perspective on couples therapy from
David Schnarch, who believes that the best way to help couples is to challenge partners to change their individual behaviors and attitudes. Schnarch’s direct, upfront approach to helping clients will illustrate a different viewpoint on effective couples therapy.
Join
Marty Klein, a marriage and family therapist and certified sex therapist, us for a candid discussion about the assumptions that both clients and therapists often share that can get in the way of improving couples’ sexual relationships.
Discover with
Kathryn Rheem how to respond effectively when clients express strong feelings in session. Based on Emotionally Focused Therapy, you’ll explore attunement and how to use your own emotions to help clients move beyond attachment injuries.
After the session, please let us know what you think. If you ever have any
technical questions or issues, please feel free to email
support@psychotherapynetworker.org.
Thanks for your comments. I have almost no knowledge of the kinds of bodywork that you mention, so I can’t comment intelligently about that work. However, I noticed that most of your descriptions of a client’s problem are metaphoric rather than descriptive, most obviously in your summary sentence, “A person may use the phrase, I'm screwed. Or, I'm all wound up. Or, I'm tied in knots inside myself. Or, It's like a nest of snakes in there. The sense of all these phrases is of being all wound up...and wanting to unwind it all.”
The spinning feelings method elicits a description that is not metaphoric but only descriptive, getting the pathway, the shape of the pathway, its color, etc. If the client says something metaphoric like, “It’s like a blood vessel,” we use that only to ask to augment the description, for instance asking, “Oh, so is it red? Or shiny? Or hollow? Or pulsating,” rather than utilizing the metaphor itself.
However, utilizing the metaphor directly can also be a very interesting and useful way to intervene, and if you would like to know more about that, Andrew T. Asutin’s Metaphors of Movement work is fascinating. Here is a short introduction to it:
http://realpeoplepress.com/blog/how-our-metaphors-reveal-creative-solutions
And if you want to know more, Andy’s Metaphors in my Attic is a quite complete and very reasonably-priced online tutorial: http://metaphorsinmyattic.com/
Steve Andreas
Certainly integration is a central goal; however there are also many different ways to describe what that is—and even more ways to try to achieve it.
I have great respect for Dan Siegal as a person, and I assume that his work in neurobiology is valid. However, I have yet to find anything in his work that directly informs what a therapist does with a client, and when I have viewed his videotaped client sessions, I have been underwhelmed by both the process and the lack of results. For instance, “interpersonal neurobiology” sounds wonderful, but what does that global generalization tell you about exactly what to do with a client? I explore one aspect of nonverbal interaction in a recent blog post describing the nonverbal exchange in a videotaped clip of Diana Fosha, which you can find at:
http://realpeoplepress.com/blog/nonverbal-expressiveness-the-key-to-relationship-and-change
I think “mindfulness” is great—though to this geezer from the 60’s it looks an awful lot like a new name for Fritz Perls’ awareness, or Ram Dass’ “Be Here Now,” or any scientist’s admonition to observe events. Sometimes I have described what I do as “directed mindfulness,” because no matter how long I meditated, I probably would not have noticed the path, spin or color of a feeling. Nor would I have noticed other very important aspects of internal thoughts, like the size and distance of an image or the tonality and tempo of a voice—and there are hundreds of other such process variables that can be changed in order to alter our responses to our internal experience. Most of these distinctions I have learned from others, and would never have discovered on my own—just as most physics and chemistry is the result of many, many discoveries by many different people over more than a century and a half. I think it should be the therapist’s job to know as many of these as possible, so that they can offer these new choices to a client, rather than task them with discovering them on their own. I have a book, Transforming Negative Self-Talk that describes how to use these kinds of sensory distinctions in a wide variety of ways—as well as some of the pitfalls of using them sloppily.
Steve Andreas
I had to look up the “Tin Can Monster” exercise, and found the following description by Stephen Hayes, originator of ACT:
“ACT uses a variety of metaphors and experiential exercises, many borrowed from other experiential therapeutic traditions, to help clients get past the judgments and analytical mind-sets that keep them entangled in unproductive problem solving. When a client complains of being in the grip of a particularly painful feeling, which she feels she must get rid of, we're likely to ask her to spend time getting thoroughly acquainted with it instead. One exercise, called the "Tin Can Monster," suggests that overwhelming feelings are like huge monsters made up of tin cans, bubble gum, and rubber bands. The total effect can be overwhelming, but if we stop to examine their individual elements, we find nothing really fearsome there. In this eyes-closed exercise, we ask patients to get in touch with the difficult feeling and then notice carefully what their bodies do. The goal is to drop any struggle and just notice each specific bodily reaction. So, for example, as each reaction is named, the therapist takes the client into that sensation in great detail--where is it located, where does it begin and end? Or we might ask the client to imagine that the bodily sensation is an object on the floor and to describe its color, speed, texture, and weight. When the client is fully open to experiencing each sensation without defense, the next bodily reaction is sought. This dismantling process continues through urges to act, emotions, thoughts, and memories.”
There certainly are similarities, particularly the sentence, “So, for example, as each reaction is named, the therapist takes the client into that sensation in great detail--where is it located, where does it begin and end?” And the general goal of accepting--and eventually integrating--alienated parts of the person is very important.
However there are also some very important differences. Telling the client that “Feelings are like huge monsters made up of tin cans, bubble gum, and rubber bands,” is offering the client a specific content metaphor, in contrast to eliciting the metaphor that the client may already have. That particular content has implications of unreality, which may be useful in making it possible for the client to examine it more closely, and it also has elements of what Michael White called externalization, and others call “distancing.” However, it is also a direct imposition on the client, in contrast to being mindful of an existing metaphor, or of suggesting a modification of an existing one. (For more on using metaphor, see my comment in response to Lorraine above.) While these can be useful interventions in context, they are also brutally inconsistent with, “in ACT, the emphasis is on accepting rather than changing the experience.”
Finally, I watched a live demonstration by Hayes at a conference, and bought a video of it to study in detail later, and I thought it was dreadful. The client did not get her outcome, and it would take a small book to describe all the mistakes Hayes made. If you know of a video of Hayes working with a client that you think might change my opinion, please let me know.
Yes, the method can be used with addictive cravings. But there is an even more interesting method that elicits the detailed sequence of experience as someone enters a drug state. Once that is known, the client can deliberately experience that sequence without needing to use the drug. This makes it unnecessary to continue the addiction in order to enjoy the benefits of the drug state.
Steve Andreas
Yes, these are examples of using subtle process elements of experience that most people are unconscious of, but that they can become aware of if asked the right kind of questions. Any time you become aware of these elements that you can change voluntarily that gives you additional choices, and a real sense of freedom. The “broader talk” you mention seldom (but occasionally) results in this kind of change. However, if you are aware of the process elements, it is possible to use “broader talk” to influence them in a process that is very conversational, and to a bystander often seems like nothing more than that. Although much of this kind of knowledge derives from NLP, I often hesitate to use that label, because there are so many other people using that label whose “work” is not up to my standards. I have been rereading Erickson lately, and although his work was magical, I don’t think he was specifically aware of this kind of distinction.
Steve Andreas
In order to recommend an appropriate book, I would need to know what you want to learn. Nevertheless, here are a few recommendations. For an introduction, Heart of the Mind. For working with self-concept, Transforming Your self. For a tour-de-force unified theory of personal change, Six Blind Elephants. For working with troublesome internal voices, Transforming Negative Self-Talk. The last one is a Norton book. All the others can be ordered from RealPeoplePress.com
Imagery is a powerful tool.
I think gentleness is a key to working with someone, rather than on someone. It dissolves a lot of “resistance,” and even more important, makes it very hard to impose on a client and harm them with ideas or views that aren’t a good fit for them—even if an observer might think they are correct. My opening frame is usually something like, “I will ask you a lot of questions to try to understand what is going on in you, and I will offer you a lot of specific things to try in order to reach your outcome. Some of them will be useful and others won’t. Your experience of the results of trying them out will tell you which is which.”
Steve Andreas
The two methods are described in great detail at:
http://realpeoplepress.com/blog/some-great-new-methods
One of the clips I used is at:
http://www.realpeoplepress.com/client-session-resolving-music-performance-anxiety-p-71.html
And a different demo of the spinning feelings is at:
http://www.realpeoplepress.com/resolving-anxiety-other-strong-feelings-2009-p-92.html
Other related articles can be found on my web site:
http://www.steveandreas.com/articles.html