July 8, 2010

The Dynamics of Marital therapy

This paper will look at the major dynamics of marital therapy. First, will present a definition of marital therapy; second the nature of the dynamics of marital therapy as distinct from individual therapy will be examined; thirdly, consideration will be given to how a marital therapist’s knowledge of intimacy can have a bearing on marital therapy dynamics and to assist this an example will be presented. Fourth, the importance of marital therapist’s knowledge of paradox in communication will be addressed. Finally a summary will be presented.

Definition of Marital Therapy

Marital therapy is a “relatively short-term, structured approach that is consistent with managed-care demands for specific treatment plans and assessment of defined therapeutic goal attainment” (Epstein and Baucom, 2002, p. 37). Various approaches are utilized in marital counseling by contemporary therapists, including behavioural, insight-oriented and cognitive-behavioral and solutions focused models (Snyder, Wills, & Grady-Fletcher, 1991). Epstein and Baucom (2002, page 37) have stated that, “Research has documented how couples’ behavioral interaction patterns, cognitions, and emotional responses have important impacts upon the quality of their intimate relationships.”

The nature of Marital Therapy as distinct from Individual Therapy

The dynamics of marital therapy are considerably more complex than individual therapy. Instead of a one-to-one set of dynamics between the therapist and the client (A [Therapist] influences B [client] and B influences A), there are now three participants involving the therapist and two clients (A [Marital Therapist] influences B [spouse 1] and C [spouse 2]; B influences A and C; C influences A and B). From the marital therapist’s viewpoint, he or she must use a greater range of skills than those required of an individual therapist. The basic therapist skills identified by Carkhuff (1983) such as skilled attending, facilitating, help exploring, personalizing – facilitating understanding, initiating – facilitating acting, and helping – facilitating processing may be valuable in marital therapy in establishing rapport with clients and perhaps giving them confidence that you have some understanding of their issues. But skills like these are only a small part of the marital therapist’s approach because much more is required. For example, the marital therapist needs to watch how the spouses communicate with each other – especially non-verbally as the non-verbal communication may contain more clues as to how each spouse regards the partner’s communication than the verbal content. This is not to say an individual therapist does not watch non-verbal skills. It’s just that in marital therapy these are often important because they provide vital information about how spouses respond/behave towards each other that the therapist needs to be aware of if he or she wants to be effective.

In the USA, Doherty (1999), a veteran marriage and family therapist at the University of Minnesota, points out the need for more directiveness and clear guidelines for marital therapy or he says there may be no progress whatsoever. At the end of a stormy session the marital therapist who says, “We’ve clarified some of the issues, haven’t we?” (i.e. they’ve put in psychological terms the problems that the couple knew they had) may not generate any positive change in the couple’s dynamics at home because there is typically much more work to be done by the couple than just clarifying issues.

Marital therapists who are stuck on the individualistic model of one-to-one therapy may be inclined to challenge one or both of the partners instead of challenging the marital relationship. The marital therapist might ask “And how do you feel about Mary speaking in the tone of voice to you Joe?” Joe says “Well, I’m just here to save my marriage.” “No, Joe, that’s not a feeling.” “Well, I think it’s important that we…” “No, no, that’s a thought, Joe, that’s not a feeling.” While it may be true that Joe would benefit from individual help, in general this approach within marital therapy is not as likely to produce effective outcomes as a more dynamic approach that recognizes and embodies the interpersonal relationships of the marriage and challenges both husband and wife to sort out their problems themselves (rather than the marital therapist helping each individual sort out their problems with him/her). Example: The marital therapist tells Joe; “OK Joe, tell Mary how you feel when she speaks to you in that way.” Joes talks to the marital therapist, “Well, I think it’s important that we…” The marital therapist interjects, “No, Joe, tell Mary, don’t tell me.” Joe looks at Mary and says, “Well I just want to save our marriage.” The marital therapist commands, “Come on Joe, tell her what you feel when she talks to you in that sarcastic tone of voice.” Joe (tearfully), “It hurts me Mary, I just want you to love me again. I want the old Mary back…” This direct approach of demanding spouses communicate with each other rather than through the therapist is more likely in my experience to produce positive outcomes and, again in my experience, much more likely to bring up emotions in one or both parties. These emotions are important, as they reveal the deeper intimacy/lack of intimacy issues I need to focus on for breakthroughs to be made in old deadlocked patterns. As mentioned above, challenging the marital relationship rather than individuals, is an important focus. Hence, the marital therapist asks, “What are you going to do about this problem of …?” while looking from husband to wife and back, instead of focusing on the individual. This approach demands the couple sort out their issue with each other rather than through the marital therapist. Thus generalization of desirable behaviour to the extra-therapy situation is promoted.

The nature of marital therapy dynamics demands that the therapist is equipped with a range of skills to deal with the in-session conflict which can be intense and at times overwhelming. For this reason respected writers such as Haley (1996) state that marital therapy is the most difficult form of therapy. A couple may express a wide range of emotions/behaviour such as anger, frustration, tears and love followed by tender terms of endearment all within a few minutes. The marital therapist who works on the assumption that there is a lot of individual pathology that needs addressing and does not focus on the interpersonal relationship between spouses may cause more harm than good. For example, he or she might send spouses off to their individual therapists, focus on the wife who says she’s depressed a lot, that she’s read a lot of self-help books and knows she is co-dependent so the therapist and the husband become co-therapists to help her with her problems.

Marital Therapist’s Knowledge of Intimacy

In order for the dynamics of marital therapy to have the better chance of positive outcomes that help the couple which may mean they stay together, separate for a time, or even divorce in some instances, marital therapists need a practical understanding of the nature of intimacy and how this ebbs and flows within ongoing relationships between spouses. According to Schnarch (1997), this understanding is not well developed at this stage by enough practicing marital therapists. Understanding the nature of paradox within human communication is of considerable importance. For example, one of the reasons for a couple having difficulties may not be simply “lack of communication”. In fact, the silence of couples may reflect “good” communication because each spouse knows the other doesn’t want to hear what is on his or her mind. This means that just because a couple is not communicating does not necessarily mean that they are “insensitive” or “thoughtless” or something of this nature that is regarded as negative. The need to differentiate between intimacy – in the form of emotional closeness and communication – in the form of an exchange of personal information, is apparent because one does not necessarily imply or guarantee the other.

Example: Bill and Joan approach marital therapy afraid that their relationship is fast approaching divorce. Joan says, “But you never listen to me. You used to share about your thoughts and feelings when we first went out, but now you won’t. (This is clear communication). Joan pauses, looking at Bill as if waiting for him to reply. Bill says nothing. He looks dejected. He knows Joan is right. To agree with her is to admit he is “wrong” he believes, so he is silent. But he is aware that Joan has become increasingly upset that he has withdrawn from her over the six years they have been together. At first in their relationship’s honeymoon phase he loved the way Joan expressed herself so openly. He himself was reserved in this way, and he hoped as time went by he would become more like Joan. But despite a reasonable beginning, over time the more he tried to share the more he felt inadequate and inferior. Lacking self-confidence, and needing validation from Joan (that he did not get), he stopped talking and along with that he stopped listening to her. Joan accused Bill of being “afraid of intimacy”, while he accused her of being “dependent and smothering.”

Having a practical understanding of the nature of intimacy and how its nature changes over time within relationships enables the marital therapist to approach Joan and Bill’s problems as a relationship issue rather than as Joan having a problem (Joan tells the therapist about her issues) and Bill having a problem (Bill talking to the therapist). But there is also a lot of understanding that the therapist needs to have in order to help couples resolve their issues without blame. Thus Schnarch (1997) maintains that marital therapists need to know the difference between self-validated intimacy and other-validated intimacy. The former “relies on a person’s maintaining his or her own sense of identity and self-worth when disclosing, with no expectation of acceptance or reciprocity from the partner,” while the latter “involves the expectation of acceptance, empathy, validation, or reciprocal disclosure from one’s partner” (Schnarch, 1997, page 106).

The implications of Schnarch’s views for understanding the nature of marital therapy dynamics are many, and only a few points can be made here in terms of the above example of Joan and Bill. In general terms, the therapist needs to understand the unfolding relationship dynamics in the above terms or risk being several steps behind what is really going on and thus in effect, becoming redundant or even harmful. Specifically, Schnarch (1997) advises that the marital therapist needs to:

1. Help the couple explore the ways that Joan’s over-reliance on other-validated intimacy makes her vulnerable to losing her personal power to Bill. Because Bill has the least desire for intimacy, he has more control over the relationship than Joan.

2. Help Bill explore how his lack of self-disclosure may cause him to “win the relationship battle”. Since he really wants the relationship to prosper (and thus be happy), his silence could cause him to “lose the war” and face a divorce that he doesn’t want.

3. Help both spouses take risks to show their vulnerability and thus be known while appreciating that there is no guarantee of acceptance and validation from their partner.

4. Help Bill and Joan to focus on becoming more differentiated and value their partner doing this rather than resisting. Differentiation is the ability to maintain a sense of self even while in close contact with the partner (Schnarch, 1997, page 87).

As can be seen, the personal and theoretical extent of marital therapist’s knowledge about other or self-validated intimacy, and differentiation (Schnarch, 1997) has much influence on marital therapy dynamics, making major contributions to the success or otherwise of the therapeutic outcomes. Other topics such as conflict (Finchan & Beach, 1999), self-regulation (Halford, Sanders & Behrens, 1995), and forgiveness (Gordon & Baucom, 1999) should be added to the list and there are many more as well. Marital relations are very complex requiring that marital therapists are knowledgeable about many of the various areas of interaction so they can guide couples in appropriate ways. As professionals they need to show they are competent and lead from the front rather than take their cues from the clients as tends to happen with many of the insight-oriented approaches to individual therapy. One reason this is important is because research suggests that marital therapy is not nearly as successful as it would be hoped. Two years after ending counselling, studies find, 25 per cent of couples are worse off than they were when they started, and after approximately four years, up to 38 per cent are divorced according to Johnson (2003), Professor of Psychology at the University of Ottawa. However, it might be accurate to say that many couples may have left it too long before they sought marital therapy and thus reduced their chances of success (Bray & Jouriles, 1995).

Marital Therapist’s Knowledge of paradox

A naïve marital therapist will fail to recognize the complexity of couple dynamics and may be less effective than one who understands this complexity. Much of this complexity arises because of the paradoxical nature of communication between intimates (Blanton & Vandergriff-Avery, 2001). The knowledgeable marital therapist understands that just because a spouse tells their partner they “hate” them “with a vengeance”, doesn’t mean that they don’t also “love” them equally, and they are just needing to get their anger off their chest before they can clear the air and go back to loving again. Thus, the therapist has to understand that not everything between couples is as it seems and look for meanings of behaviors rather than take everything literally. The knowledgeable marital therapist is aware of how words can be used to uplift or destroy and of the subtleties employed to do this. Again, this can reflect paradox. For example the wife looks at her husband and says, “you’re such a stupid dork!” but he sees her feint smile and knows she is playing with him and it’s OK. Yet with another couple the marital therapist sees the husband read the same types of behaviour negatively, and knows it is important to be aware of this couple’s “codes” which are typically subtle and secret and may take a lot of observation and questioning to unravel.

Other Issues

My first encounter in couple counselling came in 1990. I attended an excellent therapist with my second wife to try and sort out our relationship issues. Unfortunately after the first 2 hour session my wife would not return.

I have received training in working with couples since 1996 when I attended the American Family Therapists Association 5 day intensive on Working with Couples. I continue to enhance my work with couples having trained with David Schnarch on Resurrecting Sex: Solving sexual problems and revolutionizing your relationship and Imago Relationship counselling.

Cultural diversity will present different issues within presenting couples and care and sensitivity needs to be addressed when culture or gender difference occurs.

I have the premise that in couples I practice what I teach. So the basic principles of differentiation, self soothing techniques and dealing with the issues that arise in a relationship are paramount in my personal life and how I work with others. Transference and counter transference issues need to be dealt with as they arise in supervision.

Summary

The dynamics of marital therapy are very complex requiring that marital therapists have a wide range of diverse knowledge and skills in order to be effective. This assignment concentrated on some just a section of this knowledge and skill base, recognizing that this section/part is far from complete. Examples were given to illustrate practical applications from the marital therapist’s point of view.

Academic, cultural, and personal issues are important considerations in couple counselling.

References

Blanton, P. W. & Vandergriff-Avery, M. (2001). Marital Therapy and Marital Power: Constructing Narratives of Sharing Relational and Positional Power. Contemporary Family Therapy, Vol 23, No 3, 294-308

Bray, J. H., & Jouriles, E. N. (1995). Treatment of marital conflict and prevention of divorce. Journal of Marital and Family Therapy, 21(4), 461-473.

Carkhuff, R. R. (1983). The Art of Helping. [5th ed.]. Amherst, Massachusetts: Human Resource Development Press.

Dardaneau, M. L. & Johnson, S. M. (1994). Facilitating intimacy: Interventions and effects. Journal of Marital and FamilyTherapy, 20(1), 17-33.

Doherty, W. J. (1999) How therapy can be hazardous to your marital health. Smart Marriages Conference, July 3. www.smartmarriages.com/hazardous.html

Epstein, N., & Baucom, D.H. (2002). Enhanced cognitive-behavioral therapy for couples: A contextual approach. Washington, DC.: American Psychological Association.

Fincham, F.D., & Beach, S.R.H. (1999). Conflict in marriage: Implications for working with couples. Annual Review of Psychology, 50, 47-77.

Gordon, K. C., & Baucom, D. H. (1999). A forgiveness-based intervention for addressing extramarital affairs. Clinical Psychology: Science and Practice, 6, 382-399.

Halford, W.K., Sanders, M. R., & Behrens, B. C. (1995). Self-regulation in behavioral couples therapy. Behavior Therapy, 25(3), 431-452.

Hayley, J. (1996). Learning and Teaching Therapy. [1st ed.]. The Guilford Press.

Johnson, S (2003). The mind’s eye – married couples. Psychology Today. March-April.

Kurdek, L. A. (1999). The nature and predictors of the trajectory of change in marital quality for husbands and wives over the first 10 years of marriage. Developmental Psychology, 35(5), 1283-1296.

Schnarch, D. (1997). Passionate Marriage: Keeping Love and Intimacy Alive in Committed Relationships. New York: Henry Holt.

Snyder, D.K., Wills, R. M., & Grady-Fletcher, A. (1991). Long-term effectiveness of behavioral versus insight-oriented marital therapy: A 4 year follow-up study. Journal of Consulting and Clinical Psychology, 59(1), 138-141.

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