The Anatomy of a Couples Therapy Session

The 50 Minute Hour in Eight Stages

Judith P. Leavitt

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781351655408
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

How does a couples' therapist actually run a 50–minute session? What needs to happen? What must happen? Managing this time and knowing how to guide a couple through what can be a rocky roller coaster ride is a critical skill. This volume breaks down the entire 50 minutes of a couple's therapy session from beginning to end. It divides the 50 minutes into eight time period stages that may overlap. The distinctive characteristics and challenges of each time period are examined. Numerous case examples are given throughout the book. The couples therapist is addressed directly with many suggestions given for handling the situations that can arise in each period. In addition, the couples therapist's own experiences during the session are explored.

SECTION V
FULL STEAM AHEAD: 15–40 MINUTES

10
INTRODUCTION

Now is the time! This is the meat of the session. This is the time to dig in and do meaningful work. This is the time to roll up your sleeves and commit to the work. For the therapist it is often the most exciting and rewarding time. Something can get done. New outcomes can emerge. This is the period in which something definite happens. The direction has been set, the work has been established and now you and the couple can sink your teeth into the work. In the best of sessions the couple is clear about the work they are doing: looking at the pros and cons of sending their child to a special school, working on how to be more physically intimate, understanding what went wrong in an argument. As the couples therapist, you need to be clear about the type of session you are running. Then you can guide the couple through territory that is likely to be familiar to you. You know options and can envision possible outcomes. All couples therapists have had the experience of not knowing even at this point what the work is about, yet this is not preferred and not the norm for an experienced couples therapist. For the couple this can be the most intense, scary, and unnerving time. The boat has left port and is out in the middle of the ocean. Land is not yet in sight. The couple must trust that you as the therapist know how to keep the engine going and how to steer the ship.

Full Steam Ahead occurs during the time period of 15–40 minutes. Thus, you often have about 25 minutes to really work the issues with the couple. Not much time! It shows how much pressure there can be to accomplish some helpful work during a single session.

However, this 15–40-minute time frame can vary greatly. For example, occasionally a session can jump right into the work and be Full Steam Ahead within minutes. This happens when there is a compelling issue, the couple is fully engaged, and you as the therapist see a clear direction. On the other end of the spectrum, a floundering session may not move into the Full Steam Ahead period until 30 minutes into the session or even not until the end. Part of what makes doing couples therapy so stimulating and at times exasperating is how the unknown can emerge at any point. Many couples therapy sessions, however, go through the stages being outlined: Beginning, Finding Direction, Establishing the Work, and now Full Steam Ahead.

What happens during this Full Steam Ahead period? This Chapter 10 will look at four important aspects of this period of the session: unfolding of the work, disruptions to the work, types of sessions, and roles of the couples therapist. Four categories of types of couples therapy sessions will be covered in Chapters 11–14. Chapter 11 will discuss seven types of Difficult Couples Therapy Sessions. Chapter 12 will present seven types of Classic Couples Therapy Sessions. Chapter 13 will present seven Special Types of Couples Therapy Sessions. Chapter 14 will present five Deeper Couples Therapy Sessions. Chapter 15 will examine how to use intervention exercises as part of the Full Steam Ahead period of the session.

UNFOLDING OF THE WORK

Once into the body of the session, how do you guide the session so that the work unfolds productively? Much depends on you and your therapeutic approach. There are, however, some truisms that hold in many sessions.

1 You gauge what type of session this is becoming in order to guide it successfully in that direction (see below for types of sessions).

2 You anticipate the steps that are necessary to get from point A to point B.

3 You “listen” for what disruptions might occur in order to be prepared for how they might derail the session.

4 You are alert for how you may get caught in the web of the unfolding session. You look for issues of your own that could get activated and remember how to deal with them. You anticipate the limits of your abilities and knowledge.

5 You remember prior sessions like this: what may have worked and what may have gone wrong.

6 You look for how to find a new direction if this session becomes a repetition of past sessions.

7 You choose when to show reactions of your own that may facilitate the work. You may at some point decide to show shock, sadness, surprise, etc.

8 You become invested in the piece of work, but are ready to let it go, if need be.

9 You are ready for what may happen. Couples therapy sessions can turn on a dime.

10 You look for what the couple will/can take away from the session.

11 You anticipate what may happen after the session in order to possibly handle it during the session.

12 In other words, you become a wise person capable of handling any twists and turns, any catastrophes, any challenges. You are a rock, a juggler, a supporter, a cop, etc. No pressure! This is a workout of creativity, love, and endurance.

DISRUPTIONS TO THE WORK

RESISTING

The work of the session is well underway. The couple seems to be making progress. Then one partner doesn’t want to talk about the issue any longer. Then one partner becomes evasive or attacking. Then one partner who has been pushing the other partner gets scared and acts strangely. There are many ways in which partners can resist the work and prevent it from becoming productive, and there are many reasons for resisting.

In this section resisting refers to blocking the work in progress. The term “resisting” is used here rather than “resistance” because resisting is an active behavior that is going on right in the room. Resisting may also be a manifestation of a larger resistance in the couples therapy. The larger resistance may need to be addressed at some point, but not now when the work is underway. At this point in the session you look for resisting if it blocks the work from being able to continue.

What can you do when you encounter resisting during the session?

1Allow the resisting to continue such that (a) it becomes clear that it is there, (b) it plays out and the individual or couple lets it go, (c) it provides material for the work in progress.

2Observe what is happening and ask about it. For example, “I see that you have become quiet. What is happening?”

3Ask the partner who seems to be resisting about the underlying feelings. For example, “What are you feeling right now?” Or, “Are you feeling uncomfortable (scared, nervous, vulnerable)?”

4Come at the issue from a different direction, one that is not as likely to elicit the resisting. Go around the resisting by finding ways for the partner to save face or become more vulnerable.

5Give support to the resisting partner so that he/she can feel heard and feel more a part of the process.

6Ask the resisting partner to put aside his/her resisting for now, with your assurance that you will come back to these concerns.

The risk of some of these approaches is that the direction of the session becomes derailed and the resisting becomes the focus. This may be inevitable and it may be better to make it explicit. If this does happen, it would be important for you to acknowledge the change in direction. The hope is that these techniques will allow the work underway to, in fact, continue. If the work does change direction, it is important that at some point you tie the work that had been underway back with the new direction.

BECOMING STUCK

In any of the types of sessions presented below, the work can become stuck. Becoming stuck can take various forms: nothing is happening, the couple is repeating issues and viewpoints, the energy for doing the work is low, suggestions by the therapist are not leading anywhere, or the couple stays in blaming mode. The therapist needs to consider whether he/she or the couple will take the responsibility for getting unstuck. When the work becomes stuck, the therapist might reflect this back to the couple and ask them what would help them get unstuck or what they could do to get unstuck. The session then might be diverted into a discussion of “stuckness.” This may be an important direction for facing a chronic pattern in the couple’s dynamics. This may be the time for the therapist to initiate an intervention to shake things up.

TYPES OF SESSIONS

What territory are you in? The Rockies, New York City, the desert? A couples therapy session can feel like any of these terrains. One important aspect of this period is that you develop a clear view of what type of session this particular session is becoming or what type of session you want it to become. Knowing what type of session is underway helps to guide you through the work. You can develop a plan and see the steps ahead. You can see the pitfalls and the advantages of the direction of the work. For example, the goal of a crisis session is usually to stabilize the couple. However, the goal of a problem-solving session is to find a solution. The goal of a feelings session may be to break open emotions. The divisions given below are to help identify and clarify what may be the main focus of a session. In each type of session there is a discussion of when that type of session is appropriate. There are also guidelines about handling this type of session, pitfalls that can occur, challenges for the therapist, and the therapist’s experience.

And just when you thought you knew what type of session you were in, the session can change into quite a different type of session. When this happens, you need to determine if you think it best (or possible) to go back to the type of session that had been underway or to let the session shift.

A session can be and often is more than one type of session at a time. Thus, even as a couple is developing communication skills, they may also be working on expressing certain feelings. Sometimes two or more types of sessions at a time work together and sometimes they do not. For example, a crisis session in which the goal may be to stabilize and a feelings session in which the goal may be to shake things up would be at odds.

References to case examples of couples therapy are given in any number of the types below. Many published case studies describe the overall case or phases of the therapy without describing specific sessions. These examples are not helpful to this book. Thus, for the case examples used, the authors give descriptions of specific sessions (session 3 or 4, etc.), sometimes with actual dialogue.

Many case studies are written to illustrate a specific overall approach to couples therapy, such as emotionally focused therapy or structural therapy. When a session is described, it is to illustrate some principle or technique from that approach. The goal here is different. Written case sessions are presented to illustrate a type of session, not a particular approach to couples therapy.

Many of the specific sessions in published case studies show the bread-and-butter types of couple sessions; sessions such as Processing sessions and Teaching sessions that are described below. It is considerably harder to find examples of less common sessions, such as Therapist as Cop or even a Celebration session. In addition, many of the published case examples show positive results. It is difficult to find cases that show sessions that do not work. Also, the case examples tend not to show the very difficult sessions, such as Therapist Under Fire and A Session Gone Wrong; two types of sessions that will be described. Thus, therapists get less help with handling these particularly difficult sessions. There are exceptions, such as Addison and Thomas’s (2010) case that describes very challenging sessions.

Twenty-six types of sessions are presented here. The 26 different types of sessions are divided into four groups: Difficult Couples Therapy Sessions, Classic Couples Therapy Sessions, Special Types of Couples Therapy Sessions, and Deeper Couples Therapy Sessions. These divisions do not mean that a basic session such as a processing session cannot go deep or become difficult. As discussed and as couples therapists know all too well, any type of session can become mixed with any other type of session. You can be experiencing a quiet teaching session and suddenly be in the middle of a crisis session or an emotive session. The therapist’s experiences will be discussed during the specific type of session.

ROLES OF THE THERAPIST DURING DIFFERENT TYPES OF SESSIONS

Most of the different types of sessions call for you as the therapist to play a variety of roles. Some types call on certain roles more than others. As the session unfolds and you become aware of what type of session it is becoming, you also need to consider what role you need to play during the session. In a crisis session an important role you play is grounding the couple. In a Therapist as Cop session you play a directive role. The importance of the particular role you take in a session cannot be emphasized enough. The role you take may determine the success or lack of success of the session.

To be an effective couples therapist you need to be able to assume a variety of different roles. It is not enough for you to be a supportive reflective therapist or a directive take-charge therapist. Being a couples therapist will require you to stretch your natural style and develop other styles. You also need to be ready to switch roles in a flash as the session unfolds. Suppose you are being the cop because the couple is yelling at each other and paying no attention to you. Then suppose that one of the partners starts shaking and breaks down in tears. Suddenly ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgements
• Introduction
• Section I: The Lead -In
• Section II: Beginning: The First 5 Minutes
• Section III: Finding Direction: 5–10 Minutes
• Section IV:. Establishing The Work: 10–20 Minutes
• Section V: Full Steam Ahead: 15–40 Minutes
• Section VI: Pulling It Together: 35–45 Minutes
• Section VII: Ending: 45–50 Minutes
• Section VIII: Leaving
• Section IX: Summary Case Study
• Bibliography
• Index