Behavioral, Humanistic-Existential, and Psychodynamic Approaches to Couples Counseling

Michael D. Reiter, Ronald J. Chenail, Michael D. Reiter, Ronald J. Chenail

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317386445
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Couples counseling is distinct from individual and family therapy and, while ideas from these other formats may be overlapping, applying theoretical concepts to couples has distinctive challenges. Behavioral, Humanistic-Existential, and Psychodynamic Approaches to Couples Counseling is unique in that it addresses how to conceptualize various theories around a single case. By discussing only one case, the reader is more readily able to compare and contrast the theoretical ideas of each theory, as well as the pragmatics of techniques. Five theories are discussed around four consistent parts: history, theory of problem formation, theory of problem resolution, and case transcript.

1

COUPLES COUNSELING

Michael D. Reiter

When two people enter into a romantic relationship, they usually do so with hopes that they will have a positive and enriching relationship. However, as we know, all relationships are fraught with periodic disagreements, difficulties, and problems. Sometimes the members of the dyad are able to resolve these conflicts in a mutually satisfying manner. However, sometimes they are not and seek outside pathways for resolution. One means of resolution is through couples counseling.

Couples

This book, and its companion (see Reiter & Chenail, 2017), are about conducting psychotherapy with two people who are in a romantic relationship. While we can conduct couples therapy with just one member of the couple (using a systemic perspective), in this book we will be exploring what occurs when they both come together—what was classically called conjoint therapy. There are many terms that can be used for the dyad that is coming for change as well as the change process. The two people in therapy may be called spouses, marital partners, partners, significant others, boyfriend/girlfriend, or other such terms. They may be of different sexes, the same sex, different or same religion, race, educational background, socioeconomic background or may vary in age.

According to the US Census, in 2010, there were approximately 60 million married couples in the United States. This does not take into account the amount of unmarried cohabitating couples as well as noncohabitating couples. These couples may have recently come together or have been together for many decades. However, couples have been changing in various ways over the last century—with the Supreme Court’s ruling that anti-miscegenation laws were unconstitutional in 1967, the Supreme Court ruling in 2015 that same-sex marriage is a right, the influx of immigrants interculturally marrying, as well as people altering the timing of relationship formation and marriage. As an example, for married couples, both men and women are marrying for the first time later in life than in previous generations, with the median age for women at first marriage being 25.8 and 28.3 for men (Copen, Daniels, Vespa, & Mosher, 2012).

One of the reasons for the later age of first marriage is the increase in cohabitation (Copen et al., 2012). For instance, in 1982, approximately 3 percent of women cohabitated while 11 percent of women cohabitated in 2006–2010. This increase in cohabitation is related to an inverse trend in marriage. The marriage rate in the Western world has been decreasing in the last part of the twentieth century and into the twenty-first century (Pinsof, 2002). Sixty years ago, cohabitation was not as prominent as it is today, but has now become either a pathway toward marriage or an alternative to marriage. Between 2006 and 2010, for first premarital cohabitation for women, 40 percent transitioned into marriage by three years, 32 percent continued to cohabitate, and 27 percent of the couples ended their relationship (Copen, Daniels, & Mosher, 2013). While primarily utilized as a union of choice for younger couples, older couples—especially those who had previously been married to someone else—are deciding to cohabitate rather than marry (Noack, Bernhardt, & Wiik, 2014). The type of residence coupling is important as it may impact relationship happiness. For instance, married couples tend to be with one another for longer periods of time and stay together at higher levels, even in instances of couple distress (Moore, McCabe, & Brink, 2001).

It is important for therapists to be cognizant of the changing trends in couplehood as this impacts the internal and external dynamics of the couple. For instance, a cohabiting couple who come from one or more very religious families may experience social disapproval for their living situation. Or a same-sex couple or a couple with one or more transgendered members may experience discrimination from friends, family, or others in society.

A couple can be considered a family—even if there are no children involved (Del Rio & Mieling, 2010). While most people consider a family to be at least one parent and one child, couples, especially those that are married or in long-term committed relationships, function as the spousal subsystem of families. But the couple is also a subsystem of at least two larger families—that of each partner’s extended family. As such, the couple attempts to distinguish itself as separate but still connected to each partner’s family-of-origin. This is where the dyad has developed some type of boundary to demarcate itself from these larger families. It is a dynamic push and pull to say that, “We are a part of you, but we are separate.” While being an adult and perhaps not living at home makes it seem as if the person is distinct from their family, the influence of the family on the person—and the couple—is still present. Bertoni and Bodenmann (2010) found that satisfied couples had better relationships with their families-of-origin than did dissatisfied couples or couples who were in therapy. These authors highlighted that one aspect of marital quality was this intergenerational dimension.

Young and Long (1998) identified several characteristics of couples. These include the relationship being voluntary, having both stability and growth/change, having a past, present, and future, merging two perspectives, giving and receiving support, and having a separate identity while also being respectful of the other person’s identity. So while we may use the word “couple” in this book to refer to the unit, we understand that within that unit are two separate individuals. These distinct entities, however, are intimately connected in a process of mutuality—they create the other person in the relationship. For instance, a partner who frequently says negative things to her partner is helping to create a partner who may be quite defensive. Or a partner who does not engage the other emotionally helps to create a partner who more actively seeks out this emotionality.

As we’ve explored, all couples have problems; some more than others. Even couples who are very satisfied with their relationship have areas of their relationship they find as negative. Yet, those who are dissatisfied in their relationship will tend to have higher levels of negative behaviors (Bertoni & Bodenmann, 2010). These authors found that there were distinctions between satisfied and dissatisfied couples as well as those that seek therapy. Satisfied couples had more positive than negative behaviors, dissatisfied couples had more negative behaviors than positive, and couples in therapy had about equal amounts of positive and negative behaviors.

The couples that come to see you will come in all shapes and sizes and with a wide variety of presenting complaints. It is important for you to recognize that regardless of the configuration between the two members (i.e. their gender, sexual orientation, age, religion, culture, race, etc.) as well as the length of time they have been a couple, they are seeking something very important: change. The various specific issues that couples come to counseling for are beyond the scope of this book, which is more focused on operating from a specific model rather than focusing on the presenting complaint. However, having an understanding of some of the main reasons couples come to counseling can be quite important. For instance, problematic communication and lack of emotional affection are the most common reasons couples say they seek therapy (Boisvert, Writght, Tremblay, & McDuff, 2011; Doss, Simpson, & Christensen, 2004). Other prominent reasons for couples to go to therapy include making the couple relationship better for the children, lack of physical affection and sex, as well as trying to increase positive feelings between the partners. Therapists may also need to know how long a couple has been together and where they are in their developmental stage of couplehood (Henry & Miller, 2004; Miller, Yorgason, Sandberg, & White, 2003). While the problems that couples report tend to be the same whether they are newly together, are at the having children stage, or have been together for a long time, how these problems play themselves out in the relationship may be different.

However, the two members of the couple are often not in agreement as to what the agenda is for therapy—sometimes having two very different goals for the process (Goldberg, 1992). For example, one partner may come to couples therapy in hopes of salvaging the relationship while the other partner wants to use it as justification for the relationship not working and thus needing to end. Or one partner may come to therapy hoping for increased sexual intimacy while the other partner desires emotional connection rather than physical connection. This difference in agenda may be, for heterosexual couples, based on gender, as women tend to report more problems about their relationship than do men (Miller et al., 2003). Given that there are two separate individuals coming to therapy, it is important for the therapist to distinguish where the members’ goals and intents for therapy overlap, as this will be the foundation for moving toward a mutually satisfying outcome.

Couples Counseling

As for what we might call what is happening when the couple comes to see you, this might be referred to as psychotherapy, therapy, marital counseling, relational counseling, couples therapy, etc. We are not going to distinguish between these sorts of terms (i.e. what might be the differences between “therapy” and “counseling”). However, in this book, we use the phrase “couples counseling” as a broad overview of what occurs when at least one person who is in a romantic relationship comes to a professional for some type of change in their relationship.

Couples counseling can be done with one person as it is not the amount of people in the therapy room that distinguishes it as couples counseling but the focus of the therapy—a focus on what is occurring between two people. As such, there are several types or forms of couples therapy (Sholevar, 2003); individual therapy, concurrent couples therapy, conjoint couples therapy, combined couples therapy, and couple group therapy. Individual therapy for couples occurs when just one member of the couple comes to sessions, but the focus is on improving the relationship. The other partner may not come for a variety of reasons including they are seeking a divorce, have a mental health issue, or do not believe in therapy. Concurrent couples therapy is when both partners are attending therapy, but doing so individually with the same therapist. Conjoint couples therapy, which is the most frequently used type, occurs when both partners attend the same sessions. Combined couples therapy is an integration of concurrent and conjoint when some sessions are held individually with each partner and some sessions both partners participate. Lastly, couple group therapy occurs when multiple couples are seen together in a group format. In this book we will be focusing on conjoint couples therapy.

We believe the term couples counseling encompasses the vast array of couples who come to therapy: people who are married, divorced, dating, engaged, as well as other configurations and allows room for one or more people to be in the therapy room. The important idea here is that regardless of how many people are present and regardless of the stage of relational development, the focus of the sessions is on the relationship. However, this focus may not always be the maintenance of the relationship as some couples come to therapy to seek ways of having a more amiable separation.

This decision to utilize the term couples counseling instead of marriage counseling is significant as it is inclusive rather than exclusive. The use of the term “marriage” may imply a more heterosexual dyad rather than nonheterosexual or nonmarried (Del Rio & Mieling, 2010). For some couples, laws and societal demands have not allowed them to formally marry. Other couples may not believe in the purpose of marriage or may see it as an institution. Thus, marriage is just one option for couples. Given the negative climate surrounding homosexual couples and recently transgendered couples, where a formal and legal marriage was mainly unattainable and even unsafe (by people outside of the couple threatening those within it), we believe the word “couple” is much more respectful than “marriage.”

For many years the fields of couples counseling and family therapy have overlapped and were perhaps viewed as one and the same. This can be seen in associations such as the American Association of Marriage and Family Therapy. While many of the ideas between couples and family therapy are similar (i.e. that problems that people have are relational), we can distinguish between these fields. However, within this joint presentation, couple therapy was presented as of secondary importance to family therapy—which could be seen in the scarcity of presentation in family therapy textbooks (Gurman & Fraenkel, 2002). This secondary status can be placed in historical perspective.

What was considered as marital therapy (now couple therapy) is approximately 80 years old (Sperry, Carlson, & Peluso, 2006). Couple therapy may be viewed to have developed in four phases—some of which overlap (Gurman & Fraenkel, 2002; Gurman, 2015). These include “Atheoretical Marriage Counseling Formation” (1930–1963), “Psychoanalytic Experimentation (and Reemergence)” (1931–1966 and 1985–current), “Family Therapy Incorporation” (1963–1985), and “Refinement, Extension, Diversification, and Integration (1986–).”

The “Atheoretical Marriage Counseling Formation” phase was a time in which “marriage counseling” developed but was practiced by people who were not counselors as we know today, but rather doctors, family life educators, and clergy. Much of the counseling was about teaching the individuals in the couple about family life/roles rather than addressing “problems” as is current. It was during this time that marital therapy became a profession, which was seen in the establishment of the American Association of Marriage Counselors in 1942. This organization later changed its name to the American Association of Marriage and Family Counselors and is currently called the American Association for Marriage and Family Therapy.

The “Psychoanalytic Experimentation” was a time in which the marriage counseling of the previous stage, which did not really have a theoretical base, found a home in the psychoanalytic paradigm. In this phase the practice of conjoint therapy—working with more than one person in the room at the same time—emerged as a common practice. This was a major shift in the practice of therapy as traditional psychoanalysis was predicated on a one-on-one analyst and patient relationship.

The third phase, “Family Therapy Incorporation,” contrasted the psychoanalytic influence on marriage counseling. Since many of the early family therapy founders had their roots in psychoanalysis, but had rejected that model and began to adopt a more systems-focused lens, they brought a brand new epistemology to work with couples. It was in this stage that family therapy, in many ways, devoured marriage counseling, leading the two fields to be virtually one and the same.

In the last stage, “Refinement, Extension, Diversification, and Integration,” a greater focus on research into couples counseling emerged, such as emotionally focused couples counseling, the Gottman method, as well as behavioral couples counseling. This stage utilized “diversification” by bringing in ideas from feminism, multiculturalism, and postmodernism. Also, clinical models and techniques became more formali...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• About the Editors
• About the Chapter Contributors
• Preface
• 1 Couples Counseling
• 2 The Case: David and Natalie Johnson
• 3 Psychodynamic Couples Counseling
• 4 Adlerian Couples Therapy
• 5 Cognitive Behavioral Couple Therapy
• 6 Gottman Method Couples Therapy
• 7 Imago Relationship Therapy
• Index