Lecutre 6 couple therapy psychotherapy

Excursive feedback loops

one person’s behaviour leads to others behaviour

First generation approaches

Jacksons systemic focused therapy that cnetered on creatin gpositive reciprocal exchanges between couples, improving communication and strategic intervention

1960s/70s

Marital therapy became couple therapy , pointing to the emerging greater diversity of couple relationships, more than just for higher upper class and middle-class white people

21st century

EFT, CBT and integrative behavioural couple therapies, gottman therapy

Split alliance

When one partner has a strong alliance with the therapist and the other does not.

Satisfied relationship

Positive to negative behaviour in small and large exchanges runs from 5 to 1

Less satisfying

There are as many, if not more, negattive behaviours relative to positive ones

Sentiment overrides

How partners view behaviour is as important as the behaviour itself

Positive sentiment override

Reshapes behaviour to be seen as positive rather than negative

Negative sentiment override

Reshapes behaviour to be seen as negative rather than positive

Gottmans focus on each partners view of the other, what is the focus for behaviours that can be changed and what is dont for behaviours that cannot be change

Behaviours that can be changed: behaviour change

Behaviours that cannot be changed: attention is on acceptance

Time of couple therapy

Short-term, weekly sessions

What do conjoint meetings focus on?

Identifying and working on shared patterns

What do individual meetings focus on?

Addressing skills and building around deficits viewed as essential treatment progress

3 intervention steps of couple therapy

1. activation: efforts to find or reinvigorate lost parts of the relationship

2. teaching of relationship skills

3. identifying distorted cognitions: four hourseman: criticism, contempt, defensiveness, stonewalling

What are the four horsemen in couple therapy?

Cricism, contempt, defensiveness, stonewalling

Social learning theory

Classical and operant conditioning are viewed as key mechanisms in how behaviours are shaped over time

Curative factors or mechanisms of change in couple therapy

• skill building and practice of behavioural and cognitive skills

• Social learning theory

• Social exchange

• How partners think about one another: challenging thoughts that promote negative sentiment override

• If behaviour improves then thoughts about behaviour and the general sense of positive sentiment are also likely to improve

Emotionally focused therapy (EFT): partner therapy (Sue Johnson)

Evidence based for ccouples that have a trauma, love relationships thrive in secure emotional attachments. Is based on attachment theory

Attachment theory

Humans are biologically designed to develop secure attachment bonds characterized by mutual accessibility, responsiveness and engagement as part of an innate survival mechanism throughout the life span

What do attachment injuries result in?

Insecurely attached adults who develop rigid patterns to engage their romantic partner

How many sessions is EFT

around 12

What are the 3 aims of EFT?

1. create a safe collaborative alliance with partner

2. TO access reformulate and expand emotional responses

3. to restructure couple’s interactions to sensitiveness and responsiveness (core of secure attachment)

What is the goal of EFT?

To develop secure attachment bonds, identifying the couple’s negative cycle of interaction and subsequently changing it to help the partners reach for each other and express emotions

Three general guides in making descions about emotions on which to focus:

1. most poignant and vivid aspects of either partner’s emotional experiencing

2. salient emotion in regard to attachment needs and fears

3. emotion that appears to influence how negative interactions are organized within the couple

Integrative model the three phases

Focus on healing the difficulties

1. identifying the cycle

2. restructuring of itneractions

3. consolidation and reintegration

Curative factors or mechanisms of change (integrative approach)

Emotional experiences are the keys to change in the couple relationship

Pscyhodynamic therapy for couples

Unconscious wants and desires have the greatest importance in determining couple relationship satisfactions and processes for being in the world that make for coping early in life readily can have negative carryover to couple relationships

What kind of mechanisms have a crucial role in relationship problems according to psychodynamic therapy

Defense mechanisms

Introjection occurs when …. …… foster images and beliefs that are unconsciously internalized, and negative or painful images and beliefs become enduring pathogenic introjects

early interactions

Proximate goals in psychodynamic couple therapy

Fostering insight while repairing and strengthening the couple bond

Therapist errors in psychodynamic couple therapy

• doing too much

• failing to stay neutral

• failure to recognize one partner is in emotional overload

• Emotional overload by not understanding and managing uncomfortable countertransference states

Curative factors or mechanisms of change in psychodynamic therapy

• insight

• emotional intelligence

• mutual empathy and attunement

Integrative approaches couple therapy

Being in a couple is a combination of behaviour exchanges, cognitions, emotional connection, attachment, and out of awareness forces that lead to a sense of relationships being satisfying or not

Are the sessions conjoint or individual with integrative approach?

They are all conjoint

What happens when blocks occur during integrative couples therapy

focus moves to being sure the therapeutic alliance is sufficient or changing the intervention strategy in relation to the block that is occurring

What is a difficulty of integrative approach

Therapists and couples can become lost in the presence of multiple therapeutic perspectives at different aspects of being a couple

Integrative approaches view on the therapeutic alliance

First phase is to establish a working alliance with each patner and healing a rupture is seen as essential to succesful outcomes

Empirically supported principles (ESPs) of integrative approach

• altering the way the partners view the presenting problem to be more objective, contextualized and dyadic

• decreasing emotion-driuve, dysfunctional behaviour

• elicit emotion-based, avoided private behaviour

• Increasing constructive communication patterns

• promoting strenghts and reinforcing gains

IS couple therapy most effective when problems are less severe or more severe

less but is does have a considerable impact in the most distressed couples

Two major problem in which couple therapy is contradicted?

1. domestic terrorism: the danger is that improving the surface of the relationship without sufficiently addressing the violence places the abused partner at risk

2. When one partner wants to preserve the relationship and the other has made a final decision to exit the relation