Saturday, May 5, 2012

Pamela's reflection

One the most useful things about the workshop on FPS for relationship problems was the realisation that there are many possible strategies and approaches that involve behavioural and cognitive change. It seems to me that working with a couple when both people are in the room is more dynamic and complex than working with one member of the couple.

It seems that listening and reflecting in an attentive and mindful way is a great place to start and I often find that this works well with many of the couples I have seen. Upon reflection I realise that these couples were probably the healthier ones and were not so entrenched in the negative cascade described by Gottman.

Recently I saw a couple, Donald and Rachael who were really struggling together and the contempt from Donald was palpable. They both seemed stuck in the rightness of their own individual positions and moving from this was sadly, not possible. This couple has not stayed together.  In order for this couple to stay together and work on their relationship I would have needed to be able to engage them in a therapeutic process in order to move their relationship to a new position.  Upon reflection, providing psychoeducation about the negative cascade and the impact that this may have had on their relationship and then actively seeking ways to interrupt the cycle.

As a beginning couple therapist there appears to be a bewildering array of strategies and ideas about what to do in the therapy room and deciding so, I thought I’d read William J Doherty article about bad therapy. I like his comment about a “laid-back or timid therapist can doom a marriage” as some relationships require a “quick CPR” to keep it alive. It is useful to remember that developing hope and finding a purpose is incredibly important for some one recovering from depression, the same can be said of relationships. Most couples would like the therapist to demonstrate a sense of hope for moving forward.  Without this maybe the therapist will join the couple in their spiral down the negative cascade.

So, developing the idea of a sense of hope many of Gottman and Doherty ideas would be helpful: creating structure within the session, focussing on relationship goals, reducing/eliminating criticism, naming specific arguments as perpetual and creating a “pet” name for it and focussing on solvable problems that help the couple recognise the futility of gridlocked positions.  The starting point for this is encouraging the couple to listen more attentively to each other with an attitude of interest and mindfulness of the present moment.

I will be seeing a couple next week who have many complex difficulties including alcohol use and mental illness and I am planning to put some of the above into action.

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