Couple Therapy Issues - Case Study Example

Introduction Couples therapy has been representing something paradoxical---meaning that we have been witnessing couples therapy largely in the shadow of myths with regard to the low success rates of couple therapies. Such has been making distressed couples feel that therapy makes the situation worse. For instance, New York Times columnist Elizabeth Weil questioned the workability of couple therapy. She concludes that even with most effective methods, all types of therapies are well structured and results are always well documented, at least in follow-ups few years later. However, she strongly believes that the entire aspect of couple therapy faces a systematic setback. With Elizabeth’s views at stake, American Association of Marriage and Family Therapy, (2012) disputes such claims by suggesting successful methods needed for interventions. Such approaches boil down massive research to show within major theoretical orientations, how couples can benefit through a well structured therapy model. Elizabeth and American Association of Marriage and Family Therapy’s claims can only be integrated and valid stance found if there is direct contact with therapist working with a couple. This paper therefore intends to present my critical analysis with a therapist working with a couple over three sessions so as to assess its interventions, appropriateness and effectiveness. Such will also include legal and ethical issues arising from the sessions. First session During the first session, Professor Hedrick began his therapeutic process by changing views of the couple regarding situation at hand. He was attempting to help both partners see their relationship in a more objective manner. This was done by making them stop “blame games” and instead, looks at their financial misunderstandings as a process involving each of them. Much of the shifting blame was a data collected by the professor based on how the couples were interacting. The next step was formulation of hypotheses why couples were interacting that way. Based on this approach, it is important to mention that in my view point, professor’s approach is just but one of the available theoretical orientations that therapists can use. For instance, Gottman (2002) adds that there are empirical supports that can guarantee variety of approaches from insight-oriented to behavioral. Giving credit to Professor’s approach to collecting data regarding the situation at hand, it is worth mentioning that appropriateness of such approach lies on the premise that it is a clear application of behavioral and attachment perspectives. Basing my argument on principle of reinforcement, his perspective tended to conceptualise distress between both partners as a function of the ratio of punishing versus rewarding behaviors that were exchanged by these partners before seeking his interventions. It is also worth mentioning that the effectiveness of this approach made the first session have couples change the way they behave with each other. In simple words, Hedrick conducted careful assessment that determined success in ensuring that his clients did not engage in actions that could cause psychological, physical or economic harm. Again, behavioral theory as an intervention taken by the therapist during the first session was designed to understand reason behind their discontinued communication and whether such resided within their individual differences or within their relational processes. The second aspect that was witnessed during the first session was decreased emotional avoidance. Through application of attachment-based couple therapy, partners felt less afraid of expressing their feelings. Just like (Grant, 2002) has it; behaviorally oriented therapists assume that sometimes partners fear expressing their actual feelings because, initially, such did not receive reinforcement; an aspect Hedrick integrated as an intervention. And as an indication of effectiveness of Hedrick’s choice of using attachment theory during the first session, (Fonagy, 2001b) explains that there are three ways in which attachment theory is able to inform behaviorally designed models of relationships and therapies for couples. The three ways Fonagy refers to are: why couples behave the way they do, who is at high risk as a result and shedding light on why we have problems in relationships. Second session The second session was more of a therapeutic relationship whereby Hedrick was trying to secure base and safe haven for the couples and himself. The therapists spent much time with his clients trying to create a warm relationship, handling of any protests, creating firm boundaries, reliability and firm emotional responsiveness that he explains were necessary for affect regulation. From my observation, Hedrick was trying to provide his clients with a base from which they could explore the so obvious painful and unhappy aspects brought by their financial mistrusts. And in so doing, he went ahead in exploring ruptures that seemed to have been created by what seemed to me as previous therapeutic errors and misunderstanding between who was right and wrong regarding financial decisions Mr. and Mrs. White were making. Schore (2003a) mentions something about the approach the therapists took during the second session. In his work, Schore traces the neurobiology of attachment applied by Hedrick and in so doing, integrates attachment theory with couple relationship. In what seems to be something that Hedrick was trying to find out during the second session, Shore suggests that there are four prototypic attachment systems or patters in a marriage situation: secure, preoccupied, fearful and dismissing attachment. And therefore what I was able to observe engaged in second session was a leeway in making Hedrick realise that in his clients, with insecure attachment as was witnessed here, the couples were fixed in a single position, both unable to seek help or support from one another in a mutually enhancing way. Effectiveness of using a therapeutic relationship to secure base and safe haven for the couples was able to be realised towards the end of this session. It was during the last thirty minutes of the consultative talk that there were strengths and resilience build between Mr. and Mrs. White. Professor was promoting strength with an aim of helping couple derive more enjoyment out of their marriage life. As researched by Holmes, (2001), we understand that behaviorally-oriented therapists should suggest that at one point, either of the client do something that can arouse or please the other. And in so saying, Hedrick was playing his cards right by avoiding attempts to put his spin on what could constitute a strength or resilience, instead, left this to be defined by the couple. Third session The third session was lengthy with Professor focusing on partial resolution of the internal conflict involving his clients. It was evidenced that partners were making partial expression of their inward desired experiences. I realised that by nature, they were seeking cognitive consonance in their quest to do so. The first fifteen minutes of their engagement with the professor could make me see couples beginning to alter their sense of what their value and possibilities of achieving a lot in the relationship. As a matter of fact, emotionally focused therapy suggests that a slight alteration of feelings about the other person is needed in cases where couple seemed to have fallen out completely. Explaining about emotionally focused therapy, (Johnson, 2008) suggests that such alteration enables therapist in his/her clients create respect, intimacy, sensitivity or joy that had been previously unavailable to the preexisting limitations. And this is the point where attachment theory is effectively applied by the professor. In the first twenty minutes of his third session, he avails an environment where ultimately or at the broadest level, goals of attachment for the couples are met; that is to feel secured. Above is my suggestion owing to the fact that what I witnessed during the first session was more of a relationship in a complete distress as a manifestation of a failure to feel that attachment needs were being met by either of the partners. Appropriateness of this theory and intervention was even effective to the client when the professor gave a typical example of a woman who left home while a teenager with learned ability to block her emotional expressions for support to an extent that the husband had no idea how to respond to her in the required manner. The professor added that this teenage lady did not “hook” her proper nurturing responses to what was to be her emotional desire that now fuelled her motivation for her marriage. The professor suggested that in this situation, the teenager in question needed a simple intervention. And that was to be made to visualise the teenager she had been when she was leaving home. In so doing, the teenager was recognised the feelings of sadness and desire during that time. Then she could identify with the help of images she had of the times she was having tender emotions. As a result, she owned the ability to engage her husband. Back to his clients, Hedrick embarked on emphasis of positives. At this stage, he was trying to help the clients express and recognise aspects possessed by their partner what attracts him/her in the marriage. In this case, the professor jokingly asked his clients to express the way they felt when they first met each other. And in my opinion, this intervention was not only cognitive or intellectual but trying to make Mr. and Mrs. White believe that they are still in contact with the value they first encountered seventeen years ago. Alternative approaches and a counseling plan Having participated in the three eventful sessions, it is worth mentioning that no matter whichever way it is looked at, the ability of the professor to integrate theoretical and factual approaches in solving the issue is something we both admire to achieve. However, there are instances where if the session was to go longer, other alternative approaches and counseling plans would have been included. To begin with, as an additional approach, I would have emphasised support skills in addition to conflict resolution skills that were evidenced in the second session. Anchoring my other plan to what research says, (Cook, 2000) argues that traditional focus in behavioral treatments should be on helping Mr. and Mrs. White communicate effectively so as to solve the conflict. Therefore integrating an attachment viewpoint into behavioral treatment, I will seek to focus on helping the couples become more support providers and support seekers. I would have included this approach during the second session. For instance, as education is oriented towards conflict resolution, I will educate the couples about supporting each other. And in general, be done from the perspective of attachment. Secondly, I would have had fourth session which is geared towards reduction of abandonment fears but increase comfort with intimacy as suggested by Wampold (2010). As research has it, abandonment fears is likely to be associated with chronic marital distress while discomfort is coupled with intimacy which again is associated with divorce (Amoto, 2000). Incorporating this during the fourth session, I will address this issue from a more emotional standpoint where the clients will have an in-session interaction which is geared towards disconfirmation of fears but increase of intimacy. For instance, discouraging blame games and promoting soft emotion will top my agenda. Related to this, in his last session, professor embarked on positivity and partial resolution of the internal conflict. As a step already in progress, fourth session should now include partial resolutions of the conflict that encompass family sculpting, role enactment, alteration of ego psychodrama (something which I witnessed during the first session) and exercising Gestalt awareness which can yield gentle supportive confrontations (Greenberg and Johnson, 2007). Legal issues arising from the therapeutic process As licensed professional couple therapist, there are legal systems that during the observation of the three sessions, the professor should have considered. Looking at this situation, there are legal prescriptions that have been set and such define the welfare of individual that takes precedence over issues that the couples faces. During the first session, Mrs. White described a case involving physical abuse to the third borne, a thirteen year old Clara. This is a clear situation which can culminate to legal issues where in accordance with child abuse reporting laws and for this case, Cal. Penal Code, §11161.5, 1976, before proceeding with the session or in the process of the sessions, professor was supposed to inform authorities regarding the abuse of Clara. Clara was hit severally with a blunt object at one point when she tried to intervene in what Mrs. White described as “unforgiveable verbal utterances.” More generally, Hedrick should understand that as a therapist, it is his responsibility to advocate of the couples who seem not to be aware of their rights. And as a result, legal issue on the abuse of the minor should arise. Ethical issues arising from the therapeutic process As the situation presented itself during the three sessions, confidentiality is an ethical issue the therapist may be forced to deal with. Based on the suggestions that clients are willing to give confidential information only if they are sure that such will not only yield expectation but remain under the control (Coren, 2001), what we are witnessing in this case is that the confidentiality is gradually expanded from the couples to other professionals like priest who the three agreed to meet. When such happens, am focusing a situation where confidentiality obligations will be compromised. Professor is concealing existence of sexually transmitted disease that Mrs. White confessed in absence of the husband and am afraid if the matter goes to the priest, such will be shared with the husband thus emergence of ethical issues. Reference Lists American Association of Marriage and Family Therapy. (2012). AAMFT Code of Ethics. Washington: Author. Amoto, P.R. (2000). The consequences of divorce for adults and children. Journal of Marriage and the Family, 62, 1269-1287. Cook, W. L. (2000). Understanding attachment security in family context. Journal of Personality and Social Psychology, 78, 285-194. Coren, A., 2001. Short-Term Psychotherapy. A Psychodynamic approach, Houndmills, UK, Palgrave. Fonagy, P., 2001b. Attachment Theory and Psychoanalysis, NY, Other Press. Gottman, John (2002). Marital Therapy: A Research Based Approach: Clinician's Manual, Seattle: The Gottman Institute, Inc. Grant, J., 2002. The Therapeutic Alliance in Counselling and Psychotherapy, Counselling and Psychotherapy Association Newsletter, June: 13–15. Greenberg, L. S., & Johnson, S. M. (2007). Emotionally focused therapy for couples. New York: Guilford. Holmes, J., 2001. The Search for the Secure Base. Attachment Theory and Psychotherapy, Hove, East Sussex, Brunner-Routledge. Johnson, S., 2008. The Practice of Emotionally Focused Marital Therapy: Creating Connection, NY, Brunner/Mazel. Schore, A. N., 2003a. Affect Regulation and the Repair of the Self, NY and London, Norton. Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Erlbaum. Read More