Relationship
Counselling
Neil Harris CCAA Seminar 2010
Neil Harris CCAA Seminar 2010 Neil Harris CCAA Seminar 2010
Neil Harris CCAA Seminar 2010
[email protected]
[email protected] [email protected]
[email protected]
[email protected]
[email protected] [email protected]
[email protected]
Lambert’s (2009) research presentation at the PACFA conference confirmed that therapy is considered a legitimate form of intervention for mental health issues.
Couple therapy is showing great promise not only for normal relationship distress, but also as a valid form of treatment for what has traditionally been seen as the realm of individual therapies.
Specifically with such issues as anxiety, depression, and trauma.
Johnson (2002, Trauma in Relationship therapy) Greenburg (2010, EFT conference papers, Sydney)
Psychotherapy is Effective
It is about four times as effective as no
treatment
It is about twice as effective as placebo
Lambert (2009) PACFA conference
All Have Won, So All Must Have Prizes
The most controversial conclusion as we enter the new
century is that practice should be limited to empirically
supported psychotherapies.
The claim of superior outcomes for one treatment over
another has created a schism between therapist and
researcher as well as within the research community.
It is surprising to see so much made of so little!!
Lambert (2009) PACFA conference
Implications for Practice
We can be confident that we have an overall positive
effect on client functioning.
Our treatments are efficient and lead to lasting
changes in a variety of important areas.
Outcome is largely due to client capacities.
Specific techniques are not the most important
avenue to getting good results.
Lambert (2009) PACFA conference
WHAT WORKS IN
COUNSELLING
COMMON FACTORS
Support Learning Action
Empathy Advice
Catharsis Affective Learning Taking Risks
Positive Relationship Change Expectations Mastery Efforts
Reassurance Feedback Facing Fears
Structure Insight Reality Testing
Expertness Corrective Emotional Experience Exposure
Acceptance Modeling Behavior Regulation
Warmth
There are many different models of couple therapy currently operating.
In vogue at the moment is the EFCT model, Attachment models, Gottman Sound House model, CBT Models, Systemic Models, Strategic models, etc….
What ever model a person wishes to use, what's important is the therapist’s ability to operate across three paradigms…
1 :Theory (What informs me as to how to conceptualize a problem)
2: Model (What specific framework I am operating from)
3: Technique (What intervention skill I am using in that moment)
From this perspective I suggest to you that each one of us will end up with an individually expressed model, this is not eclecticism, instead I suggest that we naturally integrate when using this three tier application.
E.g. 5 different couples with 5 different models, or parts of models)
COUPLE AS
ATTACHMENT
P0SITIVE MODEL OF OTHER
NEGATIVE MODEL OF OTHER P
O S I T I V E M O D E L O F SELF
N E G A T I V E M O D E L O F SELF SECURE PREOCCUPIED
DISMISSING FEARFUL
Comfortable with intimacy and autonomy in close relationships
Preoccupied with close relationships Overly dependent on others for self esteem and support
Down - plays importance of close relationships Compulsive self reliance
Needing yet fearful of intimacy due to fear of rejection Socially avoidant
FOUR CATEGORY MODEL OF ADULT ATTACHMENT
C. Culow Ed. (2001) Adult Attachment and Couple Psychotherapy
AMBIVALENT
COUPLE AS
SYSTEM
Systemic Concepts
Recall that systems theory holds
that many problems are a product
of the relationships that surround
them.
The family is a system with
characteristics of its own.
The focus of investigation is on the
interaction within and among
systems and individuals.
Copyright © Allyn & Bacon 2003
Systemic Concepts cont.
Circular causality
We mutually influence each other
via–
Patterns of Interaction
Family members’ characteristic ways
of behaving.
Centrality of Communication
Patterns of interaction expressed are
both verbal and nonverbal.
“One cannot not communicate.”
Copyright © Allyn & Bacon 2003
Other helpful models
Communication Models
Developmental models
Contract models
Object relation models
Narrative models
Structural-Strategic models
Cognitive models
Behavioral models
Couple therapy
Whilst theory is important, in couple therapy it
runs secondary to couple focus/presence. Theory
can in fact hinder couple process, stop the
therapist listening and cause the therapist to miss
important information/ process.
The idea is to create a safe enough holding space
where the couple can face themselves and their
partner within the context of their relationship.
Couple therapy
“ Most psychotherapy approaches press clients into
conceptual frameworks created by individuals
often generated generations before current clients
are treated” Fisher 2002.
“ In trying to define psychotherapy as a natural
science, many approaches inadvertently seek
refuge in monocausal etiology of mental distress,
thereby ignoring that people, different to
laboratory rats, live in complex social and natural
environments” Sattman-Frese 2008
Couple therapy
Within this comes the gate keeping skills. This
allows me to invite each person to become more
aware of themselves in the context of their
relationship as they hear and relate to each other.
Gate keeping allows me to keep a couple focus, so
that from this technique, emerges the unique
couple relationship sitting in front of me. From
this experience comes the process/interventions
that hopefully fits best the couple.
Gate
Gate Gate
Gate
Keeping
Keeping Keeping
Keeping
The couple bring the RELATIONSHIP to counselling The RELATIONSHIP is the CLIENT THE REALTIONSHIP the “BETWEEN” has a reality of
its own
An effective working relationship requires two people who are able to be comfortable with their own embodiment
REMEMBER
THE RELATIONSHIP
IS THE CLIENT
THINK
“SYSTEMIC”
BEWARE OF FOCUSING ON OR JUDGING ANY
INDIVIDAUL
THE CORE
THE CORE THE CORE
THE CORE
MODEL
MODEL MODEL
MODEL
The basic core of the model is the
work in the “between” of the
therapeutic relationship. Therefore
the primary goal is the creation of a
relational space where clients can re-
experience and re-own their sense of
and agency for an embodied self in
relationship.
Doug Sotheren.
GATE KEEPING
ITS PURPOSE
1. ASSIST EACH PARTNER TO CLARIFY AND
HEAR THEIR OWN AND THE PARTNER’S
POSITION AT ALL LEVELS POSSIBLE.
2. RESPECT AND MAINTAIN THE COUPLE
BOUNDARY
3. KEEP A FOCUS ON IMMEDIACY IN THIS
RELATIONSHIP.
4. EFFECTIVELY SLOW THE PROCESS IN
CONFLICTUAL COMMUNICATION AND
ALLOW REFRAME OF DESTRUCTIVE
STATEMENTS.
5. MAINTAIN THE COUNSELLOR'S CONTROL OF
THE INTERVIEW PROCESS.
6. ALLOW A SUBTLE MOVING INTO DEEPER
LAYERS OF EMOTIONAL EXPERIENCE (OR
REGRESSION TO CHILDHOOD)
7. PROVIDE, IF APPROPRIATE, A SUBTLE
CHANNEL OF INFLUENCE THROUGH RE-
FRAMES, EMBEDDED COMMANDS AND
IMPLIED REALITIES.
STAGE 1
Connecting with the couple in terms of one partner and then the other.
Watch who speaks first, usually the initiator. Using basic empathy skills simply respond as you would to an individual client, in doing so you let each partner know that you have heard and understood their core material and experience at that point.
It is important to make the distinction between when a client is using their story to cover material, avoid emotion or control and when it may be important to hear the story in order to make contact.
STAGE 2
After empathically establishing each partner’s position the counsellor now changes their language to take on the words of the speaker and expresses what the client would like to say.
i.e. The counsellor changes tense to speak as if he were the client, making the statement that is needing to be expressed to the other partner whilst looking at the speaker.
STAGE 3
The counsellor continues to be the channel through i.e., The counsellor expresses the desired statement to the other partner.
STAGE 4
At this stage, the counsellor needs to be sure that he has connected well with both partners so that the holding and supporting in this stage will be received and not resisted.
The counsellor will begin to invite the speaker to look at their partner and make their statement.
This is often more difficult than it appears. Clients often feel inadequate and fearful to really be able to say what they think, feel and want.
Sensitive support will be necessary on the part of the counsellor.
Care will need to be taken that both partners feel they are being supported and heard often for the first time. A particularly dominant or aggressive partner will need to be firmly held whilst the other partner is given support to make their statement.
STAGE 5
As the counsellor becomes more fully in the “shoes of the client”
they are able to listen to one partner and without checking turn, face and address the other partner.
This can be very powerful. Unless good empathic connection has been made, resistance and power struggles between counsellor and one partner may emerge at this point.
However, it does allow for both sensitive and tender material or powerful hurt and angry material to be stated with clarity.
Follow this stage by an empathic Stage 1 response to hold and support the client.
You may or may not be able to proceed to the next stage at this point.
STAGE 6
The counsellor invites the couple to turn and look at one another (eye contact is very important) and begin their process of speaking, hearing and responding.
The goal of couple counselling is to assist couple to speak openly, honestly and directly to each other about their thoughts, feeling, wants, etc.
Here the counsellor keeps a guiding hand on the interaction by taking more a monitoring/checking role that assists understanding, expression of feelings and deals with couples’ process.
STAGE 7
This stage runs somewhat parallel to the other stages and addresses, at various point the relationship between the couple as a real and tangible entity.
The counsellor makes a statement to the relationship that identifies the relationship issue in terms of content, experience and feelings, and assists both partners to discover and own the way they each contribute to the relationship and its distress.
E.g. “Anne, your involvement and attachment to the children leaves you little time for Bob, and Bob, because or your work and other interests you really pay little attention to Anne. There is a distance between you and the relationship feels quite empty.”
