Couples therapy (in class notes)

Question 1

What are three factors driving the prominence (importance) of couples therapy?

Answer 1

1. the prevalence of couple distress in community and clinical samples
2. the distress on both mental and physical well-being of the couple and their offspring
3. increased evidence of the effectiveness of couple therapy for both the relationship distress but also to treat a variety of individual disorders

Question 2

what are three negative correlates of relationship distress?

Answer 2

1. increased emotional disorders like depression
2. Negative communication has direct adverse effects on cardiovascular, endocrine, immune and neurosensory and other physiological symptoms
3. wide range of deleterious effects on children including depression, withdrawal, poor social competence, health problems…etc…

Question 3

what is the efficacy of couples therapy?

Answer 3

effect sizes across 6 meta analyses range from 0.50 to 1.30

overall mean effect size is 0.84

the average person receiving treatment was better off than 80% of people who did not receive treatment

Question 4

What are two EBT’s for couples that have the most research?

Answer 4

1. behavioural couple therapy

2. emotion focused couple therapy

Question 5

what is Nielson (2016)’s Talk to Each Other (TTEO) Model? (3)

Answer 5

Believes that therapy is:

1. a scheduled occasion to talk
2. safety, containment and hope
3. mediation, translation and coaching

Question 6

What are the 7 basic steps that the therapist must engage in during the course of the therapy?

Answer 6

1. let the couple choose the problem topics and attempt to work them out
2. observe and interrogate (query) the silent partner
3. assist clients who don’t want to talk to each other
4. manage the emotional temperature of the room (calm things down by putting yourself in the middle and heat things up by moving out of the middle)
5. work to stay neutral
6. take sides when necessary
7. side with the least likeable partner first (helps push counter transference of how the other partner might feel towards them)

Question 7

What are the 11 systems/interpersonal perspective of how fights escalate in couples (negative interaction cycle)

Answer 7

1. poor starts –> problem is raised abruptly, in a hostile or unsympathetic way
2. defensive responses (rebuttal, self justification and defence)
3. Escalation and polarization –> exaggerations, digging in, no one is listening, neither is able to stop
4. collapse of the interpersonal space –> partners stop seeing each other as individuals and it starts getting impossible to workout the differences
5. Escalation of attack (5 levels)
6. Worst fears are confirmed –> partner behaves like exactly how they feared
7. vengeful motive emerge –> strike back to restore a sense of agency or self-esteem after partner has emotional hurt you
8. lack of resolution leaves things worse than they were
9. alienation, hopelessness, sensitization and negative sentiment prevail
10. longer term adaptation and deterioration
11. trying something different and turning things around

Question 8

what are the 5 escalation to attack in the negative interaction cycle?

Answer 8

LEVEL 1: criticizing behaviour
level 2: criticizing feelings
level 3 criticizing character
L4 accusatory interpretations
L5 criticizing intentions

Question 9

what are 6 ways that the therapist can address the negative interaction cycle?

Answer 9

1. focus on it and label IT (the cycle and its processes) as the problem
2. be cautious about your words
3. use metaphors to normalize demands (hungry diner and unresponsive waiter)
4. use metaphors to normalize fight (fireman and forest fire)
5. Use cogwheel metaphor (when one cog moves, so does the other)

Question 10

what are 12 behavioural techniques in teaching emotion regulation in couples?

Answer 10

1. become aware of feelings and name them and consider where they might be coming from
2. learn to regulate your physiological responses (relaxation and breathing)
3. learn to redeploy your attention away from what is distressing you and back again (take time to step back)
4. learn how to soothe the other person (shift to empathetic listening, compassionate concern)
5. consider the possibility of a ‘hot button’
6. refocus on goals and core values
7. minimize being distracted by emotions
8. remember past coping
9. remember the normality of the situation
10. when your attempts to self soothe fail - ask your partner for help
11. monitor your partner’s emotional state
12. when nothing is working suggest a time out

Question 11

what are 6 ways to reinforce positive interactions and to minimize the bad and foster the good?

Answer 11

1. planning enjoyable experiences
2. noticing enjoyable experience
3. turning towards each other
4. hand holding, hugging and sex
5. compliments and loving actions
6. positive couple identity (recognize yourselves as a unit and not two separate people)