Treating Marital Stress

Support-Based Approaches

Robert P Rugel

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780789016317
• eBook ISBN: 9781317788263
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Help your marital therapy clients become more supportive of their partners!

As a therapist, you see many unhappy couples who long for the loving support that used to be the touchstone of their relationship. Treating Marital Stress: Support-Based Approaches helps you restore that support, beginning with detailed descriptions of the five major patterns of marital distress and continuing with a comprehensive training manual that includes figures, case studies, and samples of possible dialogues between clients and therapists. Step-by-step discussion of the first five sessions with a hypothetical couple provide you with the tools you'll need to help your clients learn to work together as a team, manage their anger, and communicate effectively with each other.

Treating Marital Stress shows you the best ways to:

• work with a reluctant spouse
• use empathic probing to make a connection with each client
• design homework assignments so spouses can work on individual improvements
• point out problematic behaviors within sessions through 'here and now' interventions
• reframe conflicts to reduce defensiveness
• help clients accept responsibility for themselves and avoid placing blame

Other chapters discuss how you can assign behavioral tasks, get the couple to focus on their objectives, and predict and move beyond emotional obstacles to healing. This helpful volume also explores the outcome data from a study on support-focused marital theory conducted in a university setting.

Author Robert Rugel, PhD writes: A spouse who is on the receiving end of support will feel loved and valued by the partner. That spouse will also know that the partner can be counted on to be there when help is needed. As a result, security and trust develop in the relationship. You can be there to help spouses look at each other differently and learn to trust and support each other once more.

The Treatment Manual

Chapter 2

Session One: Using Empathy and Probes to Understand the Perspective of Each Partner

The Therapist’s Goals

The therapist’s goals for the first session are to

1. elicit from the spouses their experiences of the relationship and their concerns about the relationship;
2. allow each to feel that the therapist understands his or her experience and considers it to be important;
3. ascertain what the spouses’ goals are in coming for treatment; and
4. convey an understanding of how the therapist and couple will work together.

What are Your Concerns? Working Empathically with One Spouse and then the Other

Empathy and empathic probing are the therapist’s primary tools in session one. The therapist will begin by asking each spouse to describe his or her concerns in the marriage. The therapist’s role is to work first with one spouse and then the other in order to elicit each spouse’s perspective regarding the problems in the relationship. Usually, as the therapist begins to work with the spouse who initiates the discussion, the other will be content to wait his or her turn. If the other spouse is not so self-contained and begins to interrupt, the therapist must structure the therapy to stop the interruptions by clearly telling the interrupting spouse that his or her point of view will be heard as well. Indicate that little will be accomplished with interruptions. Explain that you will need to work first with the initiating partner and that you will certainly return to the other spouse to get his or her perspective.

Marital therapy, at this point, takes on the appearance of individual therapy in a conjoint setting. The therapist works individually with one, with the other observing, and then reverses the process. Taking the empathic position and delving into the perspective of each spouse will be the primary therapist task throughout the course of therapy. During the first session this means exploring the concerns that are raised initially. After the first session it also means empathic probing with regard to the concerns the couple raise about their relationship during the week preceding the therapy session.

As each new session begins, the therapist will ask, “How have things been between the two of you this past week?” When a spouse raises a concern about the relationship, the therapist will begin anew the task of working to gain an understanding of the issue from the perspective of each.

Therapist empathy serves many important purposes: (1) It is the means by which the therapist acquires an understanding of each spouse’s subjective experience of the marriage. (2) It allows the partner to learn more about the inner life of the spouse, since the information disclosed through empathic probing is often information the spouse would withhold outside of the therapy room. (3) It is a means by which the therapist establishes an emotional connection with each spouse.

The value of empathy and perspective taking cannot be overemphasized. The therapist begins with empathic probing and will repeatedly return to the empathic position after other interventions.

Asking for Concrete Examples

Once the initiating spouse begins to describe a concern, the therapist will use empathic summarizing to communicate back to the spouse what is heard. For example, “So you are feeling overwhelmed and you feel that you are not getting any help,” or “This project is really important to you and you feel she isn’t supporting you.” If the issue that is introduced remains at an abstract level, ask for a concrete example. For example, if the wife complains that the husband does not help, the therapist can say, “Can you think of examples of when you wanted help and didn’t get it?”

Probing the Concrete Example Through Outward Questions

Using the example the spouse provides, the therapist can then use empathic probing to elaborate on the specific complaint. Outward questions are intended to achieve greater specificity, to broaden the context, and to learn more about the pattern. By getting the spouse to describe the events before, during, and after a problematic interaction, the therapist can begin to put together the pieces of the interactional puzzle. The therapist can assume a position of ignorance and try to fill in the missing details about who said what to whom. As the therapist listens to the material, questions will occur regarding the circumstances. For example:

Support

THERAPIST: Did you ask him to help? [Spouse replies.]

THERAPIST: So what happened then?

THERAPIST: So when he said ____________, what happened next?

THERAPIST: Let’s talk about who does what. What is the morning routine like? Who gets the kids ready? Who makes breakfast? What about dinner? Who gets home first?

Derogation

THERAPIST: You said she made hurtful comments. What did she say?

THERAPIST: She called you a ____________ and a ____________. Was there anything else?

THERAPIST: So what happened then?

Triangulation

THERAPIST: What do you mean he avoids you? What does he do?

THERAPIST: She is complaining to her mother about you. I am not sure I understand. Were they having a conversation on the phone? What did she say?

Communication Avoidance

THERAPIST: She said she wanted to do ____________. You didn’t want to, but didn’t say anything. Then what happened?

Intimacy Avoidance

THERAPIST: So one of you goes to bed early and the other goes to bed late. Tell me how that evolved.

THERAPIST: So you sleep on the sofa and you sleep in the bedroom. Tell me how that came about.

These questions may feel intrusive; however, your job is, with sensitivity, to be intrusive in order to derive a complete picture of the circumstances surrounding the situation being discussed. Probing the concrete example will help flesh out the various issues that may be involved.

Probing Through Downward Questions

Downward questioning is intended to bring out more of the spouses’ emotional experience, particularly painful affects associated with the troublesome interaction. Downward probing can broaden and deepen the way a spouse understands his or her own inner experience. It can also deepen the way the partner, who hopefully is listening, understands the spouse. For example, seeing the pain that lies behind a spouse’s anger will allow the partner to see the spouse as human and vulnerable, as opposed to attacking and threatening.

Support

THERAPIST: So you ask for help and you are ignored. What does that feel like?

SPOUSE: Like I don’t matter. [The therapist probes.]

Derogation

THERAPIST: What was that like for you when he said ____________?

SPOUSE: I felt like he was treating me like a stupid child. [The therapist probes.]

Triangulation

THERAPIST: Tell me more about what it is like for you when you hear them talking about you.

SPOUSE: It makes me angry. [The therapist probes.]

Communication Avoidance

THERAPIST: You didn’t like the idea, but you didn’t say anything. What were you feeling?

SPOUSE: I didn’t want to make her mad. [The therapist probes.]

Intimacy Avoidance

THERAPIST: What is it like for you sleeping on the sofa at night?

SPOUSE: It is not where I want to be. [The therapist probes.]

Conveying the Initiating Spouse’s Experience to the Partner

After working with the initiating spouse, the therapist will have some understanding of what that spouse is feeling with regard to the issue at hand. It is then time to turn to the partner. In the first session, the therapist is seeking the partner’s perspective on the problem the initiating spouse has presented and has not yet elicited the partner’s own concerns about the problems in the relationship. The therapist might say:

THERAPIST: So in these situations she feels like she is getting no help. What is your experience in that situation?

THERAPIST: So she feels that you prefer computer games to spending time with her. What is your experience in that situation?

Eliciting and Demonstrating Equal Respect for the Spouse’s Point of View

The therapist should be prepared to be immersed in the partner’s perspective, and should assume that the partner’s experience of the situation will be quite different. The therapist’s position, which should be both explicitly stated and demonstrated, is that each spouse is equally important and each must have an equal opportunity to describe the problem from his or her own point of view. For example, a husband may reply, “I do help. She just won’t admit it” or “She always asks when I am in the middle of something and then gets mad when I don’t do it immediately.”

The method of outward and downward questioning will proceed until the therapist is satisfied that he or she has an understanding of the partner’s perspective regarding the issue. The therapist will then reflect back to the initiating spouse the therapist’s understanding of the problem from the partner’s perspective.

Therapist As Gatekeeper

If the spouses continue objecting to their partners’ characterization of the problem and continue to interrupt, the therapist’s role as gate-keeper may increase and the therapist may structure the session by talking to one and then the other. For example, a spouse may respond defensively to what is heard and interrupt with, “That is not true; you are wrong.” Functioning as gatekeeper means not letting them interrupt each other and escalate their disagreement. The therapist can say:

THERAPIST: Let him finish. Then I would like to get your perspective.

When one has finished, the therapist can then turn to the other and say:

THERAPIST: How do you see this? What is your experience of this situation?

Clarifying and Holding Their Incompatible Viewpoints: Tolerating Confusion

The therapist should assume that each spouse’s description of the problem will be narrow, self-serving, and full of distortions. This is human nature. More specifically, it is the result of the negative schemas, self-protective processes, a...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• About the Author
• Table of Contents
• Acknowledgments
• The Importance of Support
• The Treatment Manual
• A Case History
• The Outcome Study
• Afterword
• References
• Index