Saturday, August 27, 2011

Couples Therapy 2

When doing couples therapy avoid going over old territory.  Couples  are like jail house lawyers. These are criminals who with just a little bit of law training 'make their case'.  To this end they invariably show themselves in a good light, forget all their own negatives, and focus wholly on the error of the other even if it's minor. So don't "make their case'.
Couples commonly come in to session wanting to 'make their case'.  Don't let them.  In contrast to some of the wishy washy, pink vanilla laissez faire individual therapies, where the therapist is an 'observer to the individual' , the couples therapist is very active and interventionist.  Note how mediation, a form of couples therapy, models itself after a parent with two squabbling children bringing their fight to mommy or daddy.  This is what is supposed to happen, but the therapist must remain 'neutral' in a the way the United Nations with it's Security Council remains neutral.  The therapist avoids taking sides at all costs and probably should discuss their desire to take sides with an outside therapist before doing so.  Taking sides is like 'invading' a foreign country.  The United Nations can do it but only if it has a majority vote in the Security Council.  However hearing the dispute and identifying the components of the dispute does not involve taking sides. To this end a therapist is 'reframing' from the 'get go' in couples therapy whereas 'reframing' in individual therapy might wait days or weeks.
For example:  "My wife is a bitch who won't put out and all she wants to do is watch tv and read her fashion magazines. She won't clean up the place either. I do everything and I don't get any reward so I'm leaving her. I wouldn't be here if it weren't for my mom either."
Reframed:  "It sounds to me like you want to get laid and you want your wife to clean up the place a bit."
The therapist would in this case ask the wife to comment and she'd say something like.
"Ask him what he was doing with my sister at the party last year. You just ask him.  Ask the little shit."
Now, boys and girls, isn't couples therapy fun?  To a "trained' therapist this would be seen as a potential 'derailment".  Note that the therapist has an 'agenda'.  THe therapist 'agenda' is to avoid a blood shed in the office.  If a therapist goes.
"Well, Henry just what were you doing with her sister,"  this would be 'taking sides' and getting into 'blaming and shaming'.  Couples love using 'blaming and shaming' but therapists should at least make a half hearted attempt to stay above this particularly attractive entertainment.  Couples also like to be defensive so that they can get into a better position to take pot shots from.
Ideally the therapist should also be registering the underlying message. This is usually happening at light speed while what is being said "for the recording' and "and the court" ( since some invidiuals bring hidden tape recorders into the sessions so they can give them to their lawyers to help their case ') occuring in real time.  The couple is also trying to 'score points'. They are individually trying to make an ally or an enemy of the therapist so they can together beat up the other or have a further excuse to get out of dodge.
The therapist isn't a 'referee' and couples therapy isn't a sporting match.  Junior therapists love to take sides and play referee. This is what high school girls do when their friends argue.  These are often the ones who come in and say 'everyone thinks I should be a therapist'.  Somewhere someone with a great sense of humor has already made a cartoon "so you want to be a couples therapist' with this starring 'peacemaker' coming from a dysfunctional family with her own dysfunctional relationships wanting to make everyone love her like she was some kind of Sister Teresa.
So keeping on track, not taking sides, not losing control of the interview (it's your office, you're paying the rent, they can fight on their own time and they'd done this bad sitcom segment - from the wife's account for a year - a good therapist would have already registered this couple has real 'strengths' because they both sound like real losers as everyone does when they argue with their spouse, so one should be trying to keep the couple together and the room undamaged long enough to find out what do these two love about each other and how is this 'glue' so crazy that's its stuck this couple together.'
"That's a very interesting question, Mrs. Woods, but I'd like to save that question for later."
Right now I'd ask you what you want from him?
He said "He wants to make love to you and he wants to live in clean surroundings.  Personally I can relate to his wanting to live in clean surroundings and most couples get together for sexual relationships so what would make this relationship work better for you.?"
Note how we too want to castrate the little shit for doing whatever with her sister.  Even going there at this point would let this guy have his excuse for saying screw the wife and screw the mother. But at this point we really don't know why this girl puts up with this guy and yet I probably have heard of a hundred relationships broken up in the first session of counselling by untrained inexeperienced individual counsellors.  I see individuals coming into my individual practice routinely telling me they had one session with a couples therapist.. I ask what happened and one or the other 'walked out'.
This can happen to an experienced therapist.  Several times  I havehad  a man 'drop off his wife' and say' you fix her', like she was a broken weed eater.  I thanked my teachers and 30 years experience to getting them to stay.  I knew intuitively that if I let him leave and the dejected defeated woman stayed he'd go to the family and friends and make up a glorious story about 'her being mentally ill', the psychiatrist not needing to see him, and that he's suffered long enough so he can leave and find another woman to make her life miserable.  Recently I had a powerful and famous pant wearing wife drop off her husband and the best I could do with this new twist on an old story was to insist if I saw him she'd see my colleague. She certainly didn't need any therapy because she was making all the money and he wasn't pulling his weight in the relationship.
In couples therapy neither individual is well.  In alcoholics anonymous with the obvious bad woman or bad man drinker it was recognised in the 30's that there was a need for Al Anon the organizatin for those people who are attracted to or stay with sick people.  The whole issue of co - dependency and 'sado-masochism' is core to couples therapy. I personally belive like most people "I"m okay and you're not".  I really like it when a therapist says "you're right' and then we can both get together and put the nazi boots to the person who if they take it really revels in self loathing and if they don't is showing the world they are healthy to leave a sick person and their sick therapist.  No healthy person would multiply their abuse unless perhaps they clearly understand why the increased 'pain' as with cancer therapy will have the much wanted gain.  In this case a therapist has to lay out up front why they and the spouse are asking this person to be flogged publicly and what the reward of humiliation is.  Personally I've not seen this approach work and what I've seen is punitive therapists getting their rocks off instead. Theoretically though I can see there might be some benefit and I've utilized techiniques to get a couple back in which we all agree to where  the man, usually, needs to do something terrible, like live in ahotel for a few months before he's going to be welcomed back into the home because the wife needs some space. In recent years this has had to be documented with a lawyer or notary as a strategy or the absence from the marital home is used by her conniving psychopathic lawyer as 'evidence' she was 'abandoned' and therefy he 'forfeited' his million dollar home and now he wants to kill the therapist.  Strong survival instincts help couples therapists immensely.
Ultimately what you want to find out is a) what does she want b) what does he want for 'today and tomorrow'. The whole aim in couples therapy is to shift from 'past focus' to 'future focus'.
At the same time there will need to be a discussion about what he and the sister did a year ago.  Further we will probably want to know what she did in retaliation because he doesn't know this at this point or we all would have heard about it.  This information is usually best arrived at in the session which is scheduled for meeting with each person as an individual.  Scheduling then returns to couples therapy .  Individual sessions are scheduled and I usually only have one in the course of couples therapy. I want this to hear about the woman's affairs.  I want this to hear about the man's affairs.   i want to hear about the previous sexual relationships from each so that I can learn which pattern is being re enacted in this relationship and further to find out what each person learned from their parents.  The error which so commonly occurs for individual therapists doing couples therapy is that once they see the individuals they want to go back to doing individual therapy.  Give a boy a hammer and everything becomes a nail. So de facto the therapist starts seeing them, especially the sexy young wife who is either attractive to a male therapist or is sympatico with a female therapist.  This sends the message that the 'couple' is really 2 individuals and that their individuality is being celebrated. The individuals see the benefit of being individuals and that whole hard and tedious and really advanced thing called being a 'couple' is scrapped like any hard work might be.  If  I were to suggest my colleagues at student mental health faced with individuals having trouble with university and study take their clients to the bar and party they'd laugh at me but no one questions individual therapists doing couples therapy and turnig it  into easy highly lucrative individual therapy.
Couples therapy is hard work. It's like being a Canadian soldier on a UN mission in Bosnia Serbia.  These people aren't nice people. They are at war and it's the couples therapist job to change ghenghis khans and mata haris  into gandhis and saint theresa.  I am always amazed when I meet junior therapsts and they talk blithely about how easy couples therapy is. I first wonder what they're smoking and then try not to think about the menage e trois that this person must be indulging in.  The truth usually comes out in the stats and can usually be gleaned when the therapist speasks glowlingly of their helping facilitated couples who are separating.
Trained couples therapists are like great obstetricians who love mothers and babies. The first baby of a couple is their relationship,  It is a glorious dream. I took no pleasure when I was delivering babies saving a mother but looking down at a dead baby.  The only time for great celebration as couple therapist is when the relationship and the individuals survive. I don't feel good about calling in the UN Security Council because I think the couple is going to literally kill each other themselves or their kids if they stay together.  On those rare occasions I have felt the best thing was for the couple to break up. Then I 'm just sad looking at the death of their glorious dream.  .
No surprise couples therapy fails as often because of the couples therapist, as because of the couple. In fact if a couple gets to a couples therapist it's a pretty good indication there's still a whole lot of love "glue" left in the relationship.  Love isn't something that should ever be squandered.

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