On March 22, I will be presenting a webinar is titled A Roadmap for Couple Therapy: Integrating Systemic, Psychodynamic, and Behavioral Approaches, based on my recent book of the same name. This webinar is hosted by the Couples and Intimate Relationships Topical Interest Network.
Here are a few of the practical ideas and takeaways that I’ll be discussing in more detail in the webinar.
First, we can view conjoint couple meetings as like lessons. Just as when you take music, dance or sports lessons, it’s not sufficient to talk about what you do, it’s essential to show your teacher or coach what you’re doing so that he or she can help. This metaphor works for couples when I encourage them to talk to each other, rather than to me (something they find far easier as they try to convince me that they are right and their partner is wrong!). But what to do when couples really get into it and spin out of control? A first move is to halt this sampling of their process, calling “time,” and have the partners again talk to you which also allows you to talk to them empathically and supportively. This is basic but is key to survival and is a major reason many individual therapists dread working with couples—they are simply too passive and don’t know how to move in and out, alternating between having the couple “talk to each other” and talk to the therapist.
The next crucial thing to do is to focus on the details of the couples’ maladaptive dance, their “vulnerability cycle.” All schools of couple therapy do this, though they do it in different ways which we will discuss. The key is not to get bogged down in weekly discussions of “the problem du jour.” In most cases, problem solving will have to wait. In placing the focus on the couple “process” rather than the “content,” we are making that process the “shared enemy.” While this makes logical sense to many clients, most humans have trouble with the idea that a “system” has “emergent properties” (here destructive and amplifying ones) that can’t be blamed entirely on one or the other partner. Three metaphors help make this clear to clients:
- The chemical reaction metaphor. The partners are likened to two colorless reagents in separate beakers that, when mixed, become drastically altered: perhaps becoming explosively hot, ice cold, or foul smelling. One of the reagents might think, “I was just fine before: not hot, cold, or smelly. This sudden change, in which I don’t even recognize myself, must be due to that other damn chemical!” This metaphor powerfully illustrates how group process is not reducible to individual behavior and is experience-near for individuals who are feeling blamelessly victimized by their partners.
- Drowning swimmers to normalize off-putting demands: Escalation commonly consists of one or both partners speaking increasingly loudly, impatiently, and aggressively, perhaps while nagging, guilt-tripping, or swearing. These ineffective attempts to influence a partner tend to occur and intensify when the partner appears unresponsive. Therapists can normalize these counterproductive behaviors by explaining them in systemic terms. One metaphor I use is of a drowning swimmer calling for help. The more the swimmer fears drowning, and the longer the lifeguard fails to respond, the louder the swimmer screams. Often, it is more accurate to characterize both partners as drowning swimmers, even though one may superficially appear to be an unresponsive lifeguard.
- Firefighters battling forest fires to normalize flight: Just as escalating pursuit can seem appropriate in some situations, so can flight. Withdrawal becomes more comprehensible and acceptable if one remembers that firefighters facing a raging forest fire must sometimes retreat temporarily.
I hope this has given you a taste of what the webinar will cover, which is designed to benefit couple therapists, from beginning students to skilled clinicians.
Arthur Nielsen, M.D. is a full-time, practicing psychiatrist, psychoanalyst and couple therapist. He is a Clinical Associate Professor of Psychiatry at Northwestern’s Feinberg School of Medicine, a faculty member at Northwestern's Family Institute in Evanston, and a faculty member of the Chicago Institute for Psychoanalysis. For many years and until recently, he was the coordinator of a popular for-credit course he developed for Northwestern undergraduates, “Marriage 101: Building Loving and Lasting Relationships.” He is the author of forty-some published professional papers in the fields of psychiatry, psychoanalysis, and couple therapy. His recent textbook, A Roadmap for Couple Therapy: Integrating Systemic, Psychodynamic, and Behavioral Approaches, forms the backbone for this webinar.