The Needs ABC Therapeutic Model for Couples and Families

A Guide for Practitioners

Tom Caplan

• Publisher: Routledge
• Year: 2011
• eBook ISBN: 9781135234164
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The Needs ABC Therapeutic Model for Couples and Families: A Guide for Practitioners shows readers how to successfully tailor a therapeutic approach to meet the needs of couples and families. Beginning clinicians will come away from this book with concrete, practical skills and expanded theoretical base for their practice. They will be able to apply their new knowledge directly and in ways that will help them create long-lasting change in clients who present with difficult behaviors. The book explains the concepts and theories behind the Needs ABC approach and provides tangible methods with which to integrate aspects of the Needs ABC approach into the therapists' own therapeutic techniques. Practitioners will find that the Needs ABC model is an invaluable complement to cognitive-behavioral, integrative, and other therapeutic models, as well as a general guide to couples and family therapy.

1
INTRODUCING THE NEEDS ABC MODEL

The Needs Acquisition and Behavior Change (Needs ABC) model, an integrative model within the broader school of cognitive behavioral therapy, focuses on client relational needs and the emotions predicted by them rather than on specific client behaviors. The model assumes the following:

1. The need described in the themes embedded in clients’ narratives
2. These emotions drive behavior.
3. Meeting needs through appropriate behavior results in eliminating the inappropriate behavior.

In addition, three important goals govern the Needs ABC model:

1. Safety: Allying with clients around their relational needs will help clients to feel understood and to trust the process of therapy. This helps participants to begin experiencing a sense of safety that can lead to greater participation and selfdisclosure.
2. Ownership: Once a sense of security has been developed, the next goal is for clients to take responsibility for their part in the problem and to collaborate with the therapist and other family members in the development of appropriate restorative strategies.
3. Understanding: The facilitator should assess and illuminate clients’ relational needs and emotional states during the therapeutic process and do the following:
   1. Help clients to understand the evolution and reason for having these important relational needs that color their functioning.
   2. Help clients to understand how these needs predict how they feel.
   3. Help clients to understand why they behave in the dysfunctional ways that they do.

In its development, the Needs ABC model was influenced by the work I carried out in other clinical settings with substance abuse, gambling, and other behavioral problems. Needs ABC was designed to minimize clienttherapist contextual resistance and to form, as quickly as possible, a positive therapeutic alliance with those in attendance (Henry & Strupp, 1994, pp. 5184; Nichols, 1987, pp. 272296). Joining with the client sooner rather than later would help engage the client in the collaborative problem-solving process earlier in the course of therapy, allowing more opportunity for the “practicing” and refining of strategies while maintaining client engagement (Warzak, William, Parish, & Handen, 1987).

Our focus here is on couples. By extension, we will also be discussing adolescents in the context of their relationship with their parents, the impact of couples’ problems on their adolescent children, and how the same adolescents can be assisted in engaging in the therapeutic process and supported on their journey toward becoming mature adults who will, in turn, be able to form healthy couples. We will refer to a large number of case studies, which are fictional accounts of therapy based closely on my clinical experience and on the very real problems that my clients have brought into therapy. For brevity, the actual time frame involved is not necessarily represented. It should also be understood that, in the real world, some clients do not manage to remain in therapy for long enough to resolve all their presenting issues.

In addition to my book Needs ABC: A Needs Acquisition and Behavior Change Model for Group Work and Other Psychotherapies (Caplan, 2008b), you might want to explore Doel and Sawdon (1999) and Yalom (2005).

In this book I have tailored an application of this approach to couples and families as a unit and to adolescents as individuals who are reluctant to present for therapy in general. As we are aware, for parents, children approaching adolescence can be a difficult period which can even signal the onset of serious relational difficulties in parental couples and families that, up until that point, have experienced relatively straight-forward, happy relationships.

In general, couples and family therapy first emerged in the 1950s as positive, proactive methods of helping clients build on their personal strengths and on their strengths as a family unit or as couples (Nichols, 2007, pp. 734). Continually over the course of the intervening years since, new and adapted models of family therapy have emerged, such as structural family therapy, with a focus on creating change, and narrative therapy, with a focus on the way people tell their life stories. All couples therapy models seek to provide couples having difficulties in their relationships with the ability to access more functional behavior and a happier interpersonal situation, although the methods used can vary considerably.

For obvious reasons, couples and family therapy are closely interlinked. Like couples therapy, family therapy seeks to help the people involved to improve their interpersonal relationships by working on dysfunctional behaviors and, generally, by understanding better the reasons behind these behaviors (Nichols, 1987, pp. 6572). It usually does not attempt to blame or scapegoat any individual in particular but instead explores the patterns of behavior that have emerged from the group that is the family.

Distinguishing the Needs ABC Model

Therapy has, over the course of its relatively short history, been offered to couples by practitioners from quite a wide range of theoretical backgrounds. No therapeutic approach arises out of thin air. Instead, therapists learn and build on work that has already been carried out by their predecessors by adapting their style and approach to their own personalities, to the specific needs of their clients, and to their cultural and temporal environment. Different styles of therapy can all work, given certain circumstances and the willingness on the part of clients and therapist alike to engage with each other and to commit to therapy. However, the peculiar flexibility of the Needs ABC model, which combines concepts also found in the teachings of various wellknown practitioners of group, individual, and couples therapy (the more important of which we will shortly discuss) with the author’s own approach and therapeutic innovations derived from experience in all of the aforementioned modalities, makes it especially adaptable to a wide range of situations and circumstances.

The Needs ABC approach focuses on isolating and putting into practice useful, pragmatic solutions to the problems facing the individual. As in the case of Teyber’s (1997) approach, “A primary working goal for the therapist is to provide validation throughout each session by grasping the client’s core messages and affirming the central meaning in what the client says” (p. 44). Needs ABC therapists also believe that without an understanding of the unmet needs that lie behind dysfunctional behaviors and the emotions they predict, it is difficult to create lasting change. At the same time, one must also work hard at choosing new reactions, new ways of behaving, while re-creating one’s personal narrative and, in the context of couples therapy, one’s relationship with one’s partner.

The Needs ABC model uses an integrated therapeutic approach combining observation and elucidation of a client’s relational process and incorporates some concepts also described in cognitive-behavioral, motivational, solution-focused, narrative, and emotion-focused models. The overriding premise of this model is that a client’s unmet relational needs—in this case, in the context of them as one element of a couple—will predict a more or less useful emotion and that a less useful emotion will predict a less functional problem-solving strategy. If the relational need is defined and a more productive emotion is determined, treatment planning can be done around a more appropriate acquisition of the need. Once the need has been acquired with a more useful emotional approach, clients will no longer experience the emotional need to exchange in the destructive behaviors that brought them to therapy; a functional relationship will ensue, and more appropriate problem-solving techniques will be assimilated.

But what makes the Needs ABC approach different from the many other models available to therapists? While it draws on the wisdom and experience of many therapists and therapeutic writers, acknowledging a considerable debt to clinicians working with a range of models, the Needs ABC model is distinguished by its emphasis on the relational needs behind maladaptive behaviors and the emotions they provoke rather than on the behaviors themselves and by its flexibility in terms of application to clients in a range of personal and therapeutic settings. In the context of providing therapy, it provides a unique approach that helps clients understand the origins of their problematic behaviors individually and in the context of their presenting problems and formulate more constructive ways to react to stress. By deemphasizing behavior and emphasizing emotion and need, it becomes easier for clients to access the reasons that lie behind their problems and to work constructively toward solutions. All of this is very important when it comes to counseling people on how to heal the way they interact with the most important people in their lives.

For example, a man may consistently present with “anger” and express himself using angry words; self-exploration may reveal the more strongly felt sentiment lying beneath the anger as a deeply felt sense of hurt because he cannot get as close as he would like to the people he cares for, particularly his life partner. The way he reacts to this anger (hurt) is likely to be problematic and may relate to the way he reacted as a child when he attempted to have his relational needs met in the context of his family of origin. Similarly, a woman might present with “sadness” and express herself using sad words but might discover that the underlying emotion is really anger at a lack of validation in her personal relationship. Accessing her anger may then help her to assert herself, whereas feeling sad only might maintain her position of perceived impotence and victimhood. Of course, while anger and sadness are, respectively, stereotypical expressions of emotion by men and women, these examples could equally well be reversed.

Throughout this book, we will be looking in detail at how the Needs Acquisition and Behavior Change model can be employed in a range of contexts. However, to set the scene, let’s have a quick look at how the basic model translates into therapy. Please consider that the following is only a brief overview and that we will be looking more deeply into how to use the model effectively as we progress. The following story shows how one woman’s frustration with her father’s forgetfulness can be related to what we will refer to as the universal themes—those easily described and understood and to which

I find it useful to use a nonstereotypical emotion, or scenario, when I sense that a stereotype is extant and inhibiting problem resolution. For example, if a woman tearfully relates her concern that her partner does not feel she can contribute financially to the household, I might say, “I guess it’s infuriating to think that you might make a larger contribution that he does now.” This will highlight her relational need to feel competent in the eyes of her partner while suggesting a more active or motivating emotion, which could help her to become more assertive with regard to the acquisition of her relational needs.

people can easily relate—of betrayal, abandonment, and powerlessness. Although her partner has not experienced the same specific problem as she, he can relate to the universal themes embedded in her narrative. As you read the following, please bear in mind that only her relational needs will be highlighted to more clearly understand how to develop and articulate an appropriate therapeutic statement:

Janette was a 35-year-old mother of three who had married Will, her “childhood sweetheart,” right after she graduated from high school. She had been going out with Will since the age of 14 and decided to “go all the way” at the age of 17 when she was in her last year of high school. She and Will had enrolled in separate colleges, each some distance away from their home town, and it was not clear if they would be able to remain together. At the time, Janette felt that she was offering Will “a gift.”

Shortly after graduation, Janette was dismayed to discover that she had become pregnant, since she had originally wanted to go to law school. Despite some misgivings, she decided to keep the child with a promise from Will that he would do his utmost to support her financially as well as share in the parenting. Janette’s parents had been against her keeping the child and had told her emphatically, “If you decide to keep the child you will have to take care of it! Don’t expect anything from us.”

Though disappointed that she would have to put her education on hold, Janette took her parents’ words as a challenge. They had never been that supportive and had divorced around the time that she began to date Will. In the meantime, Will seemed to work longer hours and become less involved with both Janette and their infant. Because the young couple did not have much financial support from their parents, Will had also forgone college and instead worked in a series of blue-collar jobs he felt were beneath him as someone who had graduated high school with grades high enough to attend “any college he wanted.”

Janette convinced Will to have another child and gave birth to their second just after their first child turned 2. Janette always had always wanted a “large family” (she was an only child) and felt that taking care of two would be as easy as caring for one and that, since she had decided to be a mother, she might as well “do it properly.”

In the meantime, Will became less and less available, using the financial commitment of providing for his family as an excuse, and when Janette became pregnant with their third, against her husband’s wishes, Will admitted to being unfaithful with one of his co-workers and asked for a divorce [loyalty].

Janette was devastated. She had been so busy with her children that she had lost all contact with her friends. In fact, part of her secretly feared that if she did not attend to her children she might “lose” them as well [reliability]. Her mother had moved to Europe and remarried, and her father had never been reliable because of his drinking and partying—especially since his wife had left. Janette also began to drink, and it was only a matter of time before child protection services were called in and she was given an ultimatum to get help for her drinking or lose custody of her children. Janette sought help at a government-funded substance abuse treatment facility close to her home town, in their outpatient department, so she could continue to be with her children while dealing with her substance abuse problem.

Since Will continued to distance himself from his role as “father” and to remain absent from his children’s lives [reliability], Janette tried to enlist her father for some emotional and practical support. In fact, Janette’s dad had been able to babysit on several occasions without incident. However, there were also several occasions when he was unavailable because of his drinking [loyalty].

During one of Janette’s and Will’s therapy sessions she recounted her devastation [power] at her father letting her down once again [loyalty].

Averting her eyes from the gaze of her partner and their therapist, Janette began to talk:

“My father said he was going to go shopping with me yesterday but called at the last minute to tell me he was having ‘just one more drink with the boys.’ He never made it. I have decided that I don’t have a father anymore” [power]. As she finished speaking, her voice began to break but she bit her lip to avoid crying.

On hearing the story, Will muttered that Janette’s father is “no good” and that she is “better off without him” [loyalty].

Far from being reassuring, these comments seemed to make Janette feel worse. She sank into a morose silence and contemplated her feet on the carpet, apparently reluctant to say any more or to engage further with the discussion.

On listening to Janette’s story, and knowing something of her background, the therapist could rely on the following schematic to formulate a process-oriented intervention for the couple, focusing for now on Janette’s needs.

The therapist listens to Janette’s story and tries to think about how she is feeling about what is being said (putting herself in the client’s shoes, so to speak). In this case, the therapist’s initial reaction concurs with Will’s—that Janette’s father is extremely selfish in choosing his friends over his daughter [loyalty]:

• The therapist then thinks about what Janette actually wants (client need) or does not yet have (needs-deficit). For example, the show of frustration could represent her anger at feeling that no matter what she says, she will never be able to trust her father [loyalty]—or for that matter, Will.
• Or the statement might also represent Janette’s frustration with other important relationships in her life, such as her relationship with her mother, in which she felt abandoned [reliability].
• The therapist constructs a hypothesis about what she perceives as Janette’s relational need and its emotional component. Janette is afraid of completely losing Will the way she lost her father, emotionally and concretely.
• Or Janette perceives herself as never being able to have a reliable relationship with anybody. The therapist formulates a needs-based, emotion-focused, statement reflecting the process in Janette’s story, taking into consideration her stage of development in therapy. There are least three possibilities for what Janette is missing in her relationship(s): feeli...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Preface: The Evolution of the Needs Acquisition and Behavior Change Model
• Acknowledgments
• 1: Introducing the Needs ABC Model
• 2: Couples Therapy
• 3: Introducing the Needs ABC Relational Needs and Emotion-Focused Components
• 4: Expectations for an Optimal Therapeutic Setting
• 5: Using the Needs ABC Model In Couples and Family Therapy
• 6: Unconscious Factors and Relational Needs
• 7: Power and Control In Couples Therapy
• 8: Life Stages and Couples
• 9: Additional Techniques
• 10: After Treatment
• 11: Conclusion
• References