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Chapter: Essentials of Psychiatry: Couples Therapy

Couples Therapy: Strategies and Techniques of Intervention

Sometimes, couples present with chronic histories of un-resolved and unrelenting conflict.

Strategies and Techniques of Intervention


Couples therapy utilizes strategies for imparting new infor-mation, opening up new and expanded individual and mari-tal experiences, psychodynamic strategies for individual and interactional insight, communication and problem-solving strat-egies, and strategies for restructuring the repetitive interactions between the spouses or partners.


Sometimes, couples present with chronic histories of un-resolved and unrelenting conflict. Other couples are in a state of transition, perhaps moving from the initial expansion stage of their marriage to the inevitable crisis related to the reevaluation of the contraction stage. In either case, clarifying the couples’ process and their reoccurring patterns of behavior represents the starting place for couples therapy.


The focus should be primarily on the interpersonal distor-tions between husband and wife, and not on the couple–therapist transference. However, negative transference distortions toward the therapist must be addressed quickly and overtly.


There are three strategies in this focused, active treatment of marital discord:


·   The therapist interrupts collusive processes between the spouses. The interaction may involve either spouse failing to perceive positive or negative aspects of the other that are clear to an outsider (e.g., cruelty or alternately generosity) or when either spouse behaves in a way aimed at protecting the other from experiences that are inconsistent with the spouse’s self-perception, (e.g., husband working part time views himself as breadwinner, whereas wife works full time and manages checkbook to shield husband from reality of their income and finances).


·   The therapist links individual experience, including past ex-perience and inner thoughts, to the marital relationships


·   The therapist creates and allocates tasks that are constructed to (a) encourage the spouses to differentiate between the im-pact of the other’s behavior versus (the other’s) intent, (b) to bring into awareness the concrete behavior of the partner that contradicts (anachronistic) past perceptions of that partner, and (c) to encourage each spouse to acknowledge his/her own behavior changes that are incompatible with the maladaptive ways each sees himself/herself and is seen by the marital part-ner. These tasks also help reconstruct the couple’s narrative to make it more positive.


The last (c) is most important. In fact, in the initial stage of marital treatment the authors ask that each partner focus on what they want to change in themselves, not how they want the other spouse to be different.


In an integrative model of couples therapy, the focus is on three related domains: the functional relationships between the antecedents and consequences of discrete interactional se-quences; the recurrent patterns of interaction including their im-plicit rules; and each spouse’s individual schemata for intimate relationships. In the initial stage, alliances must be developed between the therapist and each marital partner, with the thera-pist offering empathy, warmth and understanding. The therapist must also ally with the couple as a whole and learn their shared language as well as their different problem-solving styles and attitudes.


Behavioral techniques, including giving between-session homework, in-session tasks, communication skills and problem-solving training, can facilitate the process of helping marital part-ners reintegrate denied aspects of themselves and of each other. However, the focus is not on behavioral change alone, as overt behavior is seen as reflecting the interlocking feelings and per-ceptions of each spouse. Ideally, the process of treatment should be one where each partner can consider what they want to change in themselves as opposed to how they want the other spouse to be different; safely explores new beliefs, feelings and behaviors; and experiments with new patterns of interaction that are unfamiliar and even anxiety-provoking.


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Essentials of Psychiatry: Couples Therapy : Couples Therapy: Strategies and Techniques of Intervention |

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