Assessment in Couple Therapy

Navigating the 7 Cs of Relationships

Lee Williams

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9780367752996
• eBook ISBN: 9781000512090
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This innovative text offers a simple but comprehensive framework for couple assessment that integrates research and information on couples from a wide range of models.

Using the 7 Cs as a basis for guiding assessment, chapters move through key areas of couple functioning including communication, conflict resolution, culture, commitment, caring and sex, contract, and character. An additional chapter on children also offers insights into assessment of couples who parent. Offering a broad and accessible framework that can be applied to a variety of theoretical perspectives, the book highlights how the 7 Cs can be used to inform both assessment and treatment of couples. Numerous case examples are interwoven throughout the text to demonstrate how therapists may utilize this approach to work with a diverse client base.

Written in an accessible style, Assessment in Couple Therapy is an essential tool for students of marriage and family therapy and beginning therapists, as well as seasoned mental health professionals working with couples in a range of settings.

1

INTRODUCTION

Assessing Couples Using The 7 Cs

DOI: 10.4324/9781003161967-1

Do you remember your experience of learning how to drive a car? You had to learn the rules of the road before you were given a permit to get behind the wheel. You then had to develop several new skills for operating the vehicle, including learning how to properly accelerate a car, how to stop it, and how to park. Once you had mastered these basic skills on a driving course or quiet street, you then ventured out into the real world where you encountered more complex situations. Now you were on the road with other drivers, sometimes in heavy traffic. Or you were learning to drive at much higher speeds on a highway or interstate, which sometimes required merging onto a lane with fast moving traffic. Not only did you have to pay attention to what you were doing, but you also had to be aware of what other drivers on the road were doing. Some have said that learning to drive is one of the most complex activities that we regularly engage in.

If the divorce rate in our society is any indicator, then building a successful marriage or committed intimate relationship is an equally if not more challenging endeavor than driving. Human beings are psychologically complex, which can make a relationship between two of them all the more complicated. In fact, some have questioned why it is easier to get a marriage license than a driver’s license. As a couple therapist, you will have to confront this complexity when working with couples. Fortunately, couple therapists and marital researchers have accumulated a wealth of knowledge on what it takes to build a successful relationship. This book was written to help you access some of the best ideas in the field to guide your work with couples.

To organize all of these concepts or ideas into a coherent picture, you will be learning the 7 Cs framework (Birchler et al., 1999). Gary Birchler, who was director of the couple clinic at the San Diego Veteran’s Administration Hospital, was the originator of the 7 Cs. As a training site, Gary taught all the therapists to use the 7 Cs during their internship. I learned of the 7 Cs when I began to volunteer as a therapist with Gary at the VA. I was immediately drawn to the framework due to its simplicity, as well as its ability to integrate ideas from a number of different sources into a coherent framework. It soon became my mental file cabinet for organizing the wealth of information I was accumulating from various models I learned, from research, and from my own clinical experience.

If you are new to working with couples, you may be asking yourself some of the following questions:

“Where do I start in my assessment?”

“What is important to focus on when assessing couples?”

“How do I know I am doing a thorough assessment and that I am not missing anything important?”

“How do I translate what I am learning about the couple through assessment into an effective treatment plan?”

“How will I know if the treatment I chose is working?”

This book will attempt to answer these and other questions for you.

I have made the decision to focus this book primarily on assessment for two reasons. First, it became apparent in reading the literature that there are no contemporary books that focus on couple assessment. Current books on assessment in the family therapy field combine family and couple assessment. In fact, I am co-author of one of these books, Essential Assessment Skills for Couples and Family Therapists (Williams et al., 2011). Unfortunately, books like this only devote a chapter or two on how to do an assessment that focuses specifically on couples. Because assessing couple functioning is very different from assessing individual or family functioning, it would be helpful to have a book that provides a more comprehensive description on how to do couple assessment.

Although an older book on couple assessment exists (Karpel, 1994), it makes no reference to current evidence-based approaches like emotionally focused therapy or integrative behavioral couple therapy. Furthermore, John Gottman’s research, which has profoundly shaped our understanding of intimate relationships in marriage, is not addressed either. Therefore, this book fulfills a need for a contemporary guide on how to assess couples that reflects our current understanding of couples and how to treat them.

Second, this book focuses on assessment because it is the key to effectively treating couples. Without a proper understanding of a couple and their dynamics, your treatment interventions are likely to be misguided or ineffective (J. S. Gottman & J. M. Gottman, 2015). Think of assessment as the foundation for treatment. You can’t build a 3,000 square foot house on a foundation that can only support a 1,500 square foot house. Much like the foundation of a house, assessment dictates what can and can’t be done in treatment. If you don’t include certain areas of a couple’s functioning into your assessment, then you won’t know if these areas need attention or repair. This book will help you feel more confident that you have an adequate understanding of a couple upon which to build your treatment.

Before describing the 7 Cs framework in more detail and how to use the book, I would like to make explicit some of the philosophies that have informed how the book was written. First, although the book primarily focuses on assessment, it was also written with treatment in mind. Assessment and treatment are closely linked, like two sides of the same coin. Despite its focus on assessment, the book is written in such a way that implications for treatment will be clearly evident.

Second, the book emphasizes a strength-based approach to assessment. As you go through the book, you will be encouraged to examine not only areas where the couple may be struggling, but also areas where the couple is doing well or has strengths. For example, some chapters include a discussion of protective factors that can be assessed. These strengths should be celebrated and built upon.

Third, the book emphasizes an integrative perspective rather than promoting one particular model over another. Offering an integrative perspective is not unique to this book. However, what makes the 7 Cs unique as an integrative framework is its simplicity. In the couple therapy course that I teach, beginning therapists like how easy the framework is to grasp and how quickly it orients them on what to look for in a couple’s functioning. At the same time, more experienced clinicians will appreciate the elegance and flexibility of the framework to integrate and organize a wealth of information for working with couples. You will find that the 7 Cs framework can expand and grow to accommodate the new knowledge you will accumulate as you gain more experience working with couples.

Fourth, the book primarily focuses on how evidence-based approaches and research can inform our understanding of couples. In their book 10 Principles for Doing Effective Couples Therapy, Julie Gottman and John Gottman (2015) state that the first principle is to use research-based methods to treat couples. Consistent with this recommendation, the concepts described in this book have been drawn primarily from the leading couple therapy models with strong research support for their effectiveness. This includes models like emotionally focused therapy (EFT), the Gottman approach to couple therapy, integrative behavioral couple therapy (IBCT), and the Prevention and Relationship Enhancement Program (PREP). Although the emphasis in this book is on concepts from empirically supported models, you can also integrate ideas from other family systems models (e.g., narrative, Bowen, structural) using the framework. The 7 Cs framework allows one to assemble the best ideas that each of these models has to offer in understanding couples, much like a compilation of the best hits from various artists. In addition, insights from research or your own clinical experience can be integrated into the 7 Cs.

Each C within the framework has at least one chapter devoted to it (one of the Cs has two chapters). The first C is communication. Communication is not only the basis for intimacy, but it also helps couples handle the inevitable problems that arise in any intimate relationship. Good communication skills help couples discuss these issues in an effective manner, thereby reducing the likelihood that conflict will escalate as couples try to address their issues. This chapter will help you evaluate a couple’s ability to effectively communicate in terms of discussing issues and building intimacy.

Couples will also benefit from having effective conflict resolution skills when addressing issues, the focus of the next C. This chapter will help you assess a couple’s ability to handle conflict in relationships, including learning how to identify problematic interactional cycles that create dissatisfaction in relationships.

The third C is devoted to examining culture. Culture is broadly defined to include not just race or ethnicity, but also religion, sexual orientation, socioeconomic background, and nationality, among other factors. The chapter will look at how culture can impact couples in a variety of ways. The chapter will first explore how cultural differences between partners can impact relationships, as well as how intercultural couples attempt to manage these differences. The second section will discuss the need to assess sociocultural factors for all couples to determine the role that larger social systems have upon couples, including the potential to influence power dynamics within relationships. Cultural factors can also play a role in the level of acceptance that couples experience, which is addressed in the last section. For example, intercultural couples or same-sex couples may experience a lack of acceptance from family, friends, or others, which can impact social support and create minority stress.

Commitment, the fourth C, is essential to sustaining a relationship through difficult times. This chapter will focus on assessing a couple’s level of commitment, as well as various factors that can impact their level of commitment. This assessment will also inform how you might nurture or strengthen commitment in a couple’s relationship.

Love is the cornerstone of intimate relationships. The expression of love through caring behaviors will be the next C. This chapter will emphasize the importance of assessing the couple’s love languages for expressing love. It will also consider other aspects of caring, such as offering emotional support and nurturing a strong connection in the relationship.

Sex is another important element of caring that can enhance a couple’s relationship. Due to its importance and complexity, a separate chapter is devoted to assessing a couple’s sexual relationship. This chapter will review important principles to guide assessment, common causes of sexual problems, and specific considerations for various sexual disorders. A section is also devoted to assessing issues related to pornography use, which is an increasingly common concern.

All relationships carry expectations between partners. These expectations form the basis of a couple’s contract, the sixth C. This chapter will explore how to assess four common contract issues that occur in relationships. This will include assessing the extent to which a couple has been able to repair their relationship after a serious violation of the contract (e.g., infidelity) by working through important tasks (the 6 As).

Individual attributes can impact relationships in both positive and negative ways. For example, each person’s personality can influence the relationship, including creating the potential for conflict. Similarly, mental illness and physical illness can also impact a couple’s relationship. Therefore, this chapter will focus on the seventh C, exploring how individual attributes or character are important to assess in relationships.

The 7 Cs above apply across all couples. However, for couples with children, I recommend that this be considered as a possible eighth C due to the significant role of parenting in a couple’s relationship. Therefore, this chapter will explore potential relationship challenges couples face while parenting. It will also include unique challenges that couples may face if they bring children from previous relationships into their current one.

The book will conclude with how to take the information learned from each of the Cs to organize feedback for a couple and develop a treatment plan. It will also describe how you can use the 7 Cs framework to integrate interventions from various treatment models if you so desire.

Although separate chapters are devoted to each of the Cs, you will quickly notice that the various Cs are connected. For example, cultural factors can shape a number of the other Cs, including how couples communicate or the expectations they have for each other (contract). Likewise, a couple’s effectiveness in communicating may impact their ability to resolve issues in the other Cs. Therefore, it can be helpful to be aware of the possible interconnections between the Cs during your assessment.

Before delving into each of the Cs, the next chapter discusses how therapists might structure their assessment to collect information for each of the Cs. This chapter begins by describing a five-session model for conducting a couple assessment. This is followed by a discussion of various assessment techniques that can be used to collect information during an assessment.

2

GETTING STARTED – STRUCTURING ASSESSMENT

DOI: 10.4324/9781003161967-2

Holly and Ross, both 38, are sitting in your office for their initial therapy session. You know from the intake phone call that they have been married for 10 years, and that they have two sons ages 6 and 4. The couple complains of “communication problems” and ar...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Contents
• List of Tables
• Foreword
• Acknowledgments
• 1 Introduction: Assessing Couples Using The 7 Cs
• 2 Getting Started – Structuring Assessment
• 3 Communication
• 4 Conflict Resolution
• 5 Culture
• 6 Commitment
• 7 Caring
• 8 Assessing a Couple’s Sexual Relationship
• 9 Contract
• 10 Character
• 11 Children: An Eighth C?
• 12 Moving Beyond the Initial Assessment
• References
• Index