Master Conflict Therapy

A New Model for Practicing Couples and Sex Therapy

Stephen J. Betchen, Heather L. Davidson

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351751094
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Illustrated with case studies, this book teaches couples and sex therapists the comprehensive, integrative treatment approach of master conflict therapy (MCT), which combines psychoanalytic conflict theory and Bowen Theory with the basic principles and practice of sex therapy. MCT suggests that each partner has an internal conflict born out of their experiences from their respective families of origin. Partners then choose one another based on these conflicts, and it is only when they are out of balance that the couple experiences symptoms. The authors help clinicians treat couples through providing them with a solid theoretical foundation, a practical assessment procedure, and highly effective treatment techniques to re-balance a couple and, in turn, alleviate their sexual symptoms.

Section II

Assessment and Treatment

Chapter 4

Assessment

Structuring the Therapy

When a couple presents for treatment, each partner tends to blame the other for any relationship problems. This dynamic allows both to avoid taking individual responsibility for contributing to their symptoms. Some partners take turns playing offense and defense; one attacks and the other defends. Rabin (2014) wrote: “In most cases the blame is squarely on the partner. The partner is at fault and the partner is supposed to change” (p. 110). For example, a wife might scold her husband for failing to initiate sex with her; she might proceed to accuse him of having lost physical attraction for her, having an affair, or even being gay. Her husband might deny every accusation yet claim to be at a loss for his low libido. If he has enough courage, he might confront her about her spending habits. The point being that couples bring the fight that they experience at home into the session and show it to the therapist. This may be demonstrated even before the therapist asks what the chief complaint is.

Partners may waste hours complaining about one another, thus preventing the therapist from intervening appropriately. In this sense, it might be a diversion to keep the therapist from succeeding in helping them change. Therefore, the first step in the assessment process is to structure the treatment (Gurman, 2010; Weeks & Fife, 2014). When supervisees first present cases to us, we always ask questions about the couple; and oftentimes the supervisees do not have the answers, in part because they claim the couple wouldn’t allow them to take a history. The supervisees are allowing the couple to overwhelm them with interactional dynamics and endless symptoms. One intervention we use with a couple is to point out that we appreciate their pain, but to help them, we must carry out our assessment. We believe that the sooner an understanding of the couple’s conflict is obtained, the more quickly the therapist will be able to intervene appropriately.

Many couples therapists have countered that they prefer to take several sessions to “join” (Weeks & Fife, 2014) with a couple before asking probing questions, especially those regarding sex (Gambescia, personal communication, November 9, 2016). We believe that it is more difficult to collect personal information in the middle of treatment, when the therapist and couple are fully engaged in the interactional dynamic. This is considered a regression, even though we acknowledge that some data gathering takes place throughout the treatment process. We have witnessed therapists of all developmental levels focus so intently on joining that they know little about the couple after several months of treatment. While this is to be expected for those following an ahistorical bent, we also see this phenomenon in psychodynamic approaches.

If the therapist expects both partners for a conjoint session and one is much earlier than the other, it is best to wait for the tardy partner before beginning the therapeutic process. This shows a commitment to the partners as a couple and prevents the perception of favoritism. For couples that are on the verge of separating, or for those in which one partner is highly anxious, jealous, or paranoid, it is safer if the therapist were perceived as balanced. Reluctantly, Howie allowed the couples therapist to see he and his wife, Jana, in separate individual sessions following their initial conjoint evaluation. Even though Jana made it clear that she was considering divorce, Howie expressed the belief that in her individual session, the therapist convinced Jana to leave him.

In MCT, the “couple” is to present for treatment unless extraordinary circumstances make it impossible. For example, some clients have been suddenly called away on business or are needed to care for a sick child. In other cases, one partner may have taken ill. Nevertheless, the evaluation will go on even with one party present—to be followed by an individual session with the other mate. They are then brought back together for the third session, so the therapist can begin to observe the couple’s interactional style.

Not exclusively, but perhaps more exceptional to couples with sexual difficulty, we have noticed that one partner may force the other to begin treatment alone. It seems to be particularly convenient to blame the sexual-symptom-bearer for the relationship problems, in part because sex is tied to one’s self-worth. McCarthy (1999) wrote: “When sexuality is dysfunctional or nonexistent, it plays an inordinately powerful role, 50 to 75%, draining the marriage of intimacy and vitality” (p. 297). One woman claimed that she had prodded her husband to attend couples therapy with her for years to address his low libido, but to no avail. Under the threat of divorce, his punishment was to go alone for a time to be decided by his wife.

The absent partner may have no intention of attending treatment. Some of these individuals are hoping that their partner will do the work; others are biding time until they can divorce. Doherty and Harris (2017) refers to couples in which one partner is “leaning out” and the other is “leaning in” as mixed-agenda couples (p. 3). For example, Bart came to therapy at the behest of his wife for the treatment of his premature ejaculation (PE). He was very cooperative and said that he would do anything to save his marriage. While his wife, Jane, claimed that she wanted her husband to “fix his problem,” she was uncooperative in the treatment process and flatly refused to attend sessions. With the help of psychotherapy, solo stop-start exercises (Kaplan, 1989), and medication for anxiety, Bart was ready to have sex with Jane. To his dismay, however, Jane refused all sexual contact. It was soon discovered that while Bart was in treatment, Jane was having an affair and preparing to leave him. When Bart discovered this, he was devastated. He said that he felt duped.

It is the job of the couple’s therapist to discern whether a couple’s sexual dynamics mimic their relational dynamics and to what extent. If one partner relentlessly pursues a procrastinating partner to seek treatment for a sexual disorder, we do not consider it a stretch if they pursued and distanced in other contexts as well. For example, the pursuing partner may seek affection or time spent together, while the distancing partner may move further away (Betchen, 2005).

In MCT, we follow the initial session by holding one individual session with each partner. We tell the couple that we reserve the right to incorporate individual sessions as we see fit. In tune with Weeks and Fife (2014), individual sessions, if balanced between partners, can be useful in the context of couples therapy. We find these particularly helpful in dealing with therapeutic blocks such as: (1) Secrets (e.g., affair) that one or both partners may be keeping; (2) A sexual issue that neither partner wants to address out of embarrassment; (3) When countertransference issues need to be processed; and (4) When internalized conflicts result in a rigid system.

It is deemed important that the therapist charge the couple for missed sessions unless a valid reason for the failure to attend is presented. There are more cancellations in couple’s therapy because of the nature of the work: two people must show for treatment, and then the odds of something going wrong are far greater, especially if they have careers and children. After years of practicing, it is not hard to make an educated guess as to who will show for the first session and who will appreciate the structure of the treatment process. When it takes weeks to schedule a couple because they fail to make an appointment or because they keep changing their appointment time—there is a good chance further trouble is awaiting the therapist. Others make trouble from the very first contact. If there is too much resistance, we do not take the case but remain polite and offer a referral. The therapist must show the couple that they must take the couple’s therapy and the outcome of the treatment very seriously. If the therapist fails to maintain therapeutic structure, the integrity of the treatment process will suffer, and with it, the couple.

Using the Genogram as an Assessment Tool

The formal assessment commences once the proper paperwork is filled out, the rules of treatment discussed, and a few pleasantries exchanged. The therapist then takes charge by asking the couple why they saw fit to seek treatment. It is recommended that the therapist begin to pay close attention to the couple’s interactional dynamic, including where they choose to sit in the office. Those partners that sit relatively close may not be in as much trouble as those that sit farther away. But in our experience, those that choose to sit on top of one another or hold each other throughout the therapeutic process may be experiencing quite a bit of anxiety and may be in much deeper trouble than it appears. Attention should be given to eye rolling, sighing, or any other expressions of frustration or pain, which may help the therapist to better decipher the relational dynamic.

The question regarding the chief complaint is not aimed at any one partner. We do not decide who will speak first; that is decided by the couple, and it may convey something about their dynamic, such as: Who is the dominant partner? Who is most anxious? Who is the initiator in the therapeutic process? Who is most invested in the treatment? It is usually the initiator of the treatment or the most dominant mate that speaks first. Once the first speaker is finished, the therapist turns to the other mate for their version. Most of the time, the couple agree on the problem. What they disagree on is who is at fault. For example, they may each agree that they have communication issues but not necessarily who is responsible. By giving each partner a say, the couple’s therapist is beginning to put the couple on notice that balance is important. As mentioned earlier, it is important not to let the couple take up the therapist’s assessment time with fighting or long-winded answers. The primary complainer may attempt to take over the treatment, but the therapist must stop this immediately. To calm initiators, we often tell them that while we have the ...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Dedication
• Dedication
• Preface
• Contents
• Acknowledgements
• SECTION I Understanding Master Conflict Therapy (MCT)
• SECTION II Assessment and Treatment
• SECTION II Assessment and Treatment
• Epilogue
• Index