Working with Attachment in Couples Therapy

A Four-Step Model for Clinical Practice

Jim Donovan

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9781000721775
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Through an exploration of extensive case studies, this book demonstrates how the discovery and examination of original childhood attachment wounds is crucial to couples therapy.

As many as half of all mental health referrals involve interpersonal issues and these very often relate to marital problems. Yet, after a half a century of couples therapy, we still lack a widely accepted treatment model for couples and there are relatively few training programs or graduate courses dedicated to the field. Why does an effective general approach to marital therapy remain so elusive? Working with Attachment in Couples Therapy: A Four-Step Model for Clinical Practice presents a series of in-depth case studies, which illustrate the seeking of the primary wound for each participant as it unfolds session by session and traces improvement in each couple while exploring past injuries.

This book represents essential reading for any mental health professional working with couples, as well as those in training.

1 The four-step model

Step 1 – the resurrection of safety

We’re about to discover that whatever treatment approach we introduce, couple counseling will probably represent a sequential, four-stage process. 1) Provide the necessary safety; 2) Separate the primary, one-person wound, for example, a lifelong fear of abandonment, from the secondary, the reactive feelings that we find in the two-person “fight”; 3) Rekindle intimacy within the couple; 4) Promote long-term personality change in each of the pair and in their couple.

We’ll discover that these four operations represent the core of a generic couple therapy model. If counselors, new to the field or more experienced, can begin to master these four steps, they’ll quite quickly increase the impact of their marital work, to say nothing of their own sense of competence. They will no longer fear sinking into confusion themselves or need to assume responsibility for a couple about to unravel. Philip Ringstrom (2014) proposes a somewhat similar six-stage approach, and I discuss more about his model in Chapter 2.

Here in Chapter 1, we’ll meet several experienced couple therapists and begin to discover, in action, how they start a treatment.

Two initial points of reference: 1) As we begin this exploration, we’ll find that psychotherapy across schools comprises much more than a verbal exchange. We’ve found that the tones of voice, body language and facial expressions, particularly smiles or lack thereof, from both counselor and couple, convey crucial information about the interaction. (See Donovan et al., 2017, Para-verbal Communication in Psychotherapy: Beyond the Words.) This is why we include many descriptions of those para-verbal data in observations about our case material.

We use the word “para-verbal” versus “non-verbal,” because most of this communication behavior accompanies and modifies, but does not replace, the spoken word. For example “I love you” in a neutral tone, shorn of facial expression, conveys much less than “I love you,” spoken gently with a warm inviting smile. We usually sense that the para-verbal communication represents the most authentic part of the exchange. Therapists often find that deep, important feeling is almost invariably accompanied by this para-verbal emphasis (Wachtel, 2011, Inside the Session, p. 121).

2) Our second early finding is that when a couple does not feel rapidly safe in the office, this may often quickly translate into a failed therapy.

We now introduce Step 1 of our model.

The resurrection of safety

For example, Jim begins his communication with Dick and Renee, from the introduction, in gentle tones, offering steady eye contact with each, demonstrating that he understands, for both of them, that their sense of self feels crushed. They’re bewildered about their next move. Jim communicates that he knows something about that next move. He suggests that, taking turns, each can explain to their partner and to him, their anguish and their quandary of what to do. They provisionally agree and begin talking. Jim actively supports the speaker and adds for example, “Renee, you feel completely devalued because he seems indifferent to your hurt, and he often seems to use a sarcastic tone towards you.”

“Dick, you don’t understand why she’s so hurt, but also you don’t want to repeat whatever oversight you’ve made. Can you turn to her ask about her terrible pain and then listen to what she says?”

Gradually, the two gather some calm, possibly in response to Jim’s gentle tone, the prosody of his delivery, his friendly grin and the fact that he’s familiar to them from their original therapy. Jim’s strong activity level also may make them feel more at home. “In couple therapy the therapist’s passivity is poison” (Gurman and Burton, 2014, p. 473).

We will return to Renee and Dick at length in Chapter 3 and beyond, and follow their therapy over several months. Every mystery has its answer. It turns out that Renee has endured life-long rejection from her mother, who clearly prefers her siblings to her. Dick has never understood this, in depth, and frequently stumbles along, inadvertently hurting her feelings. This pattern represents the central problematic one in Renee and Dick’s therapy, as we’ll discover in Chapter 4. The beginning of their treatment, then, presents our first example of re-establishing security for a highly distressed couple.

Step 1 – resurrecting safety: vignettes from several therapists

Let’s begin with another example from Jim Donovan et al. (2017).

In subsequent chapters, we will explain Steps 2, 3 and 4 of our model in much more detail, but we cannot begin any treatment while the couple feels raw and scared. Effective marital therapists behave in a very engaged fashion, in ways authentic to their individual personalities, particularly in these opening sessions. Their behavior, at first, has only one goal: re-establish safety in the room so that the clients can begin to hear and deeply understand each other. As it may turn out, for the first time.

Now, Jim meets with a 54-year-old Caucasian couple, Nancy and Ed, married for 35 years, who have bickered, argued and sometimes physically fought, during the whole of their relationship. Jim serves as a consultant to them and to their regular therapist, Linda, also present at the meeting. The foursome will try to decide whether additional couple treatment can be effective, or if the pair might wisely consider a final ending to their marriage, since conflict within it seems so ubiquitous. The meeting has high stakes.

The couple have separated once, for one year. However, in the past few months, they’ve moved back together. Their acute discomfort seems abated for now, but frequent disagreements apparently remain a major issue. The stability and closeness, that they probably crave, may never be possible in this conflicted relationship. They’re scared. I feel it.

Jim’s couple sits at the end of a large conference room table. He’s seated close to them, at kitty corner. Jim leans forward, keeps steady eye contact and smiles broadly and gently. Steadily, in a soft respectful voice, he asks, “Could you tell me a little bit about the arguments that you get into with each other?”

Jim has already begun to phrase his comments carefully and specifically. He has noticed that Nancy smiles invitingly and inclines her posture toward him. Her husband Ed, however, has almost no facial expression and slumps in his chair with a notebook placed in front of him, possibly as a protective psychological barrier? Jim approaches Ed first, feeling him as the more problematic of the two, but he does so in a quiet, modest fashion. Engaging with Ed, Jim ends an early tentative observation with, “If I can get something right …” Taking this tack, he shows Ed that he’s no competitor, no intruder, that Ed has nothing to fear from this therapist. Perhaps Ed can relax his guard a little?

We’ll return to this couple and to their complex psychological and para-verbal presentations in later chapters. Why do they fight so often, but also, what holds them together so strongly? We’ll eventually find out how this initially awkward interview played through. For now, we’ll note that Jim, in his physical presentation and in his tone of voice, minute by minute, tries to allay the mistrust that Ed clearly feels. Jim is well aware that if Ed doesn’t gain a sense of safety, the consultation will probably go nowhere. Nancy feels more relaxed and present than he.

I’m far from the only therapist who operates in this easily approachable fashion. Now, we meet Susan Johnson (2015). Sue almost certainly opens her meeting with her warm demeanor and her eagerness to commit to a relationship with her new couple. (I’ve studied YouTube videos of Susan at work.) She knows that her patients, Trevor and Mandy, a young couple in their early 30s, are a traumatized pair, following her discovery of Trevor’s recent affair with an office associate.

Susan leans forward, possibly touching Mandy on the arm. Her face, very probably, communicates interest, empathy and welcome. She engages with high energy and a gentle, but firm voice. She addresses each member of the couple with equal concern. She enlarges upon their responses. They’ve lost connection with each other, and they need to re-find it, through Susan Johnson as the attachment conduit.

She offers to Mandy, “So in these moments, when you sense that Trevor is in any way disappointed in you, you feel terror … and you tell him I am so afraid that I am not enough for you – so scared.”

MANDY: Yes that’s right I am scared so I go into my shell.

SUSAN: Trevor can you hear your wife? What happens to you when she says this?

TREVOR: I feel sad … (turns to Mandy) but when you blow me off like I don’t matter, when you just go silent. I can’t handle that.

(Johnson, 2015, p. 122)

Susan is rapidly introducing herself into the emotional life of each of the couple, through her rapport. She has them sit close to each other, and close to her, in the arrangement of the chairs. They’re in a small intimate circle. They all can maintain direct, consistent eye contact. They can probably feel Susan’s reassuring warmth, an invitation to the couple to join in and share with her, at deeper levels.

In a third case, on video (Recovering from an Affair, 2000, Psychotherapy.net), Richard Schwartz meets Dennis and Irene, a Caucasian couple in their early 40s with two young teenage sons. Dennis and Irene are reeling from the new knowledge of Dennis’ recent affair. We quickly learn that Irene feels understandably shattered, lost and furious. Even before this affair, she already had a history of sexual abuse as a child – her safety betrayed by a “family friend.” She tells us, she’s had to work hard to build attachment trust in her adult life generally, and with her husband Dennis, in particular.

This latest violation of her security has set her far back. She feels that she’s not only lost faith in her husband, but that she’s also lost her belief in her own personal strength and in her ability to accurately judge people. Irene is going to have to re-find her sense of self and recapture her hope, for this therapy to succeed.

We observe in the video that Richard Schwartz seems more low key than Susan, or even Jim. He’s simply dressed, no tie, and he quietly, kindly, gently, humbly approaches the pair. He offers steady eye contact, a serious, responsive demeanor and an active invitation for the couple to participate. He has the calm, concerned presence of someone who well understands the upheaval caused by the crisis under which this couple stumbles. As he welcomes Dennis and Irene, he’s soft spoken but active, verbally and para-verbally.

The affair came to light a few weeks ago. In his first words, Schwartz speaks very slowly, quietly and seriously. He offers,

Thank you for agreeing to work with me and to make this tape. I hope you’ll tell me how you feel with me, and if there is anything I can do to help. I want you to feel as safe as possible. If I ask a question, and you don’t feel comfortable, just say that.

Then he turns to Irene, understandably the more vulnerable of the two, and asks, “What’s it been like in the past month?”

In his third sentence Schwartz introduces the word “safe.” His responsive soft manner beckons this couple toward him. It’s hard to imagine a less frightening, more understanding verbal, and particularly para-verbal, overture to a new pair than Schwartz has just offered.

Finally, Dr. Pat Love (2001), a senior counselor connected with Harville Hendrix’s Imago group, again on video (Love, 2013), meets a young couple, Cathy and Dave, in their early 30s. They are newly married, have different styles of emotional relating and often misunderstand each other. The three sit close together and start a verbal, and particularly a para-verbal, mutual overture. Dr. Love leans toward Dave, after he’s offered his first few words: “I just don’t understand what Cathy wants.” Dr. Love asks “Let me see if I got it?” and she repeats Dave’s description. She’s calling for a deeper interaction right away, and she’s modeling communicative dialogue, checking with Dave, her therapy partner, if she’s grasped his point.

She smiles warmly, inclines toward the couple, with strong eye contact and often gestures with her hands, as she delivers her observations. Her voice is responsive, and she changes amplitude to emphasize each idea. She also mixes in personal anecdotes to enlarge on her grasp of the situation. The clients can have no doubt that Dr. Love is interested, encouraging, enthusiastic and a good listener who really wants to understand. On the video, we can watch this couple join in with Dr. Love’s body language after a few minutes. They smile; they speak more and more easily. They lean in toward her with an increasingly relaxed posture. They feel safer.

It will turn out that these four experienced counselors, and others whom we’ll meet later, work from apparently very different models of treatment. Susan Johnson (2015) has developed Emotionally Focused Therapy (EFT); Richard Schwartz (2004) and Toni Herbine-Blank et al. (2016), Internal Family Systems therapy; Jim Donovan et al., Relational/Para-verbal interventions (2017) and Harville Hendrix (2008) and Pat Love (2001), Imago Therapy.

Consequently, the later treatments that they offer will quite possibly take differing roads, as we’ll see. However, the opening few minutes of the first session that each therapist orchestrates, seem nearly identical. The couple’s attachment bond has undergone severe threat. The counselor quickly moves to close this breach as much as possible. If husband, wife or both remain disoriented, detached or in a furious state, no treatment, no matter how ingenious the model, will gain any traction.

Right away, the therapist offers himself/herself as a warm bridging attachment figure and strongly begins to build a close atmosphere in the room, reaching out, sometimes literally, to both partners. The couple will continue to test the credibility of their therapist, but if at least one member, preferably both, responds to these intimate offers by the counselor, a constructive second session becomes likely. Attachment with the therapist arrives first, and then secondly, between the partners, now in serious conflict.

The issues of security continue

It is one thing to say “I want you to feel safe in this room,” but another to para-verbally communicate with a client that you’re i...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• Acknowledgements
• Introduction: which path to follow?
• 1. The four-step model: Step 1 – the resurrection of safety
• 2. The four-step model: Step 2 – pursuing the attachment wound: excerpts from Jim Donovan and other senior authors
• 3. After identifying the wound: starting the healing
• 4. The four-step model: Step 3 – treating the wound and rekindling the intimacy
• 5. The middle stages of the treatment: the challenge
• 6. The four-step model: Step 4 – The later stages of couple treatment: long term personality development
• 7. Final words: for now
• Index