Fundamental Concepts in Marital and Family Therapy

September 12, 2011

Paper – 20% -Last class of December: could be by email –  

Class 1 

Introduction to John Gottman’s Marital Therapy: A Research-Based Approach 

Gottman’s CV

Gottman is not a relationship expert but an expert at researching relationships

He is what I refer to as the Mathematician who meets psychology 

 

From his perspective the problem in marital therapy is that many of its theories and models are not “based on solid empirical knowledge of what real couples do to keep their marriages happy and stable”

 

“The field of marital interventions has desperately needed a theory, one with a strong empirical basis, rather than…most which are based on myths that have little or no empirical support” 
 

His 30 years of research experience have included research projects such as:

 

The Love Lab 

 

            Example:

            respiration,

            electrocardiogram,

            blood velocity,

            skin conductance,

            gross motor movement,

            urinary stress hormones,

            blood samples to test immunology 

To test his hypothesis he used non-linear mathematical models that he devised with a mathematician and biologist, James Murray.  
 
 

Based on his research he suggests the following hypothesis:

“Lasting effects in marital therapy are the most likely when interventions are designed with three prongs; 

 

In his laboratory he has developed a scientifically-based theory of marriage that represents a systematic approach to these three prongs for producing lasting effects in marital therapy.  

He calls his theory:

“The Sound Marital House Theory” 

It is an integrative approach that includes aspects of:

 

It answers the questions;

 

The model is based on Six Basic Assumptions; 

  1. The therapy is primarily Dyadic-goal is to move therapy from triadic context to dyadic context in which therapist acts primarily as a coach.  You’re really trying to promote couple interaction and empowering the  couple to make changes
 
  1. Couples need to be in Emotional States to learn how to cope with and Change their Emotions-  It is only by permitting spouses to do what they normally do and then working with them in these emotional states that transfer of learning becomes possible. In this therapy it is important for the therapist to adopt the view that all emotions and all wishes are acceptable and need to be expressed and understood
 

      eight basic emotions (happiness, fear, sadness, anger, disgust, contempt,  interest, and surprise) that are not in any hierarchical relationship to one  another. (Contrary to EFT, anger is not always masking another emotion.)   Each emotion can vary in intensity  

  1. The therapist should not do the soothing- The therapist ought to allow the couple to get very upset, and then have them self-soothe or soothe one another.  You want to avoid “therapist irreplaceability”
 
  1. Interventions should have low psychological cost- Interventions should seem easy to do
 
  1. Marital therapy should primarily be a positive experience- Marital therapy has a bad rap. Like individual therapy, couple therapy should be a positive growth experience, an island of time and space that is special, where the client is central. You want to avoid being in an adversarial position with the couple.  He also acknowledges that there is a need to develop methods of therapy that are more appealing to men.  (less than one percent)
 
 
  1. I am not idealistic about Marriage and its potential- The good enough marriage, not an elitist or perfectionist
 

      Other points of consideration in his methodology 

 

I think these will provide good visuals for you as you listen to Gottman’s video introducing you to his concepts.  At first, you may feel overwhelmed with all the new conceptts and terminology.  Please do not worry, we will revisit all these concepts several times over before the end of the class.   

During the video pay special attention to

 
 

-using the clinician’s checklist – (3 page document) – and complete a case conceptualization and plan –knowledge of major Gottman concepts – recommendations: adequate treatment plan. Rethink assessment in Gottman terms. Assessment inventory. 2/20 case description . 5 marks for assessment. 7/20 conceptualization: theory and concepts. 5 marks for treatment plan + intervention. 1/20 for organization. 5-7 pages. 

Gottman: researched relationships. University of Washington + established the Gottman Institute.

  1. Marital therapy is not based on empirical stuff
  2. theories are based on myths and not empirical
    1. emotionally focused therapy -EFT -(sue Johnson) is an exception
 
 

He looked at what makes couplehood work. “Love Lab” –Gottman’s lab, where couples spend 24 hours and are videotaped and physiology measured [i.e. immunology and blood pressure] 

Lasting effects of marital therapy = increasing every day positive affect:

  1. love maps
  2. fondness/admiration system
  3. turning towards versus turning away [emotional bank account]
 

-reduce negative emotional affect =repair [as opposed to EFT’s approach] 

The Sound Relationship House

  1. create shared meaning: legacy, value and rituals of connection
  2. make life dreams come true
  3. managing conflict: six skills for managing conflict
  4. the positive perspective
  5. turn towards
  6. shared fondness and admiration
  7. build love maps
 

gottman is based on:

-existential, behavioural, cognitive, affective, systems, psychodynamics  

Gottman assumptions

  1. change couple only occur when they are at an experiencing the affect
  2. unlike EFT: 8 basic emotions: no hierarchy in Gottman, unlike EFT
  3. therapist is not to soothe the couple: the couples should
  4. low psychological cost of change – i.e. not getting too heavy, to the point that any of the couple will not be able to handle it.
  5. Marital therapy should be a growth, positive experience [as opposed to rehashing/ganging up/arbitration]
  6. Gottman is not looking for a perfect relationship, but rather a “good enough marriage” = realistic expectations.

Gottman is against “Swinging relationships” i.e. open relationships. It is a sign of cracks in the foundation. 

-using Gottman’s model can predict divorce and when.

-what predicts divorce?

1) ratio of positive vs. Negative issues during conflict: 5/1 will ensure positive. Divorce: 0.8/1

Positive over negative in an argument will help heal a negative situation. Negativity is a marker to be addressed, not suppressed. Courtship is needed after negativity. Some negative things are more corrosive than others: “4 horsemen”:

  1. Criticism [of personality vs. Complaining – i.e. taking of the complainer’s needs]
  2. Defensiveness: righteous indignation [counter-complaint] or innocent [say “but I did”] – all of this versus taking ownership.
  3. Disrespect/contempt –single best predictor of divorce. Calling names/insulting. Opposite: respect, proud of people we love. Thanking for small things we/they do: scan environment for things you can appreciate – same thing with parenting children.
  4. Stonewalling: emotional withdrawal from conflict: i.e. not giving cues of listening. The speaker increases their force.
 

4 useful principles for building a relationship

  1. Friendship: maintaining intimacy. Includes 3 measured things
    1. Enhance love-maps [internal road-map about the partner’s inner world – interest in one another – this includes asking more questions, instead of statements] + updating them sometimes
  2. Fondness/admiration: communication affection and respect: culture of appreciation. It has to be expressed, and not only thought
  3. Intimacy is built in small bids [i.e. for attention] + successful turning-towards responses to it. Re-bidding does not succeed so much, and nil for those who will likely divorce.
 

-Positive sentiment over-ride: when the above work well

- negative sentiment over-ride –helps towards running into problems: thus, cognitive stand-alone interventions are bullshit for anything else except symptom relief. 

Sept 19, 2011 

-69% of couple’s conflicts are unresolvable and perpetual. In divorce-bound couples, those conflicts become gridlocked – never moves anywhere. Move from gridlock to dialogue is key to successful relationship. In the 31% resolvable conflicts, the successful couple member starts in a softening start and not a conflicting start. Accepting influence of spouse, especially men, is important for good relationship. Men’s refusal to consider of spouse [rejecting of influence] is key to a successful relationship. Women tend to accept influence more easily than men. 

-Lasting effects of marital therapy = increasing every day positive affect:

  1. love maps
  2. fondness/admiration system
  3. turning towards versus turning away [emotionally] – bids for connection

àif 1x big positive event w/o the above, then the event will be seen negatively. 

Instead of calling one side immature, personality disordered, etc., you will want to find the theme behind the person’s quest. This reduces conflict and increases intimacy.

Calming down, physiologically, is important to conflict resolution [it is good for fight-or-flight, but not negotiation]. Calming down time before resolution discussion may be needed. Some aggressive partners will not let the other step aside for some time to calm down.

 àall of this helps repair conflict 

-shared meaning – the feeling that they are building something – has purpose – beyond the individuals. Doesn’t have to be explicitly spoken about 
 

 

Gottman:

Emphasizes formal assessment and not intuitive assessment tools. Before that, you need a plan of procedure. Throughout the assessment and interventions, respect of both couple-members  are needed. Examples include:

 

Clinician checklist

 

Gottman – his model is not for high conflict stuff. High conflict couples have other models. 

The Gottman model tries to move from the cognitive to the emotional. 

The assessment is not reserved for the initial

sessions.  It can be revisited at any phase of

treatment!!!!!

1. Overall, where are they each in the marriage?

2. What is the nature of the marital friendship?

3. What is the nature of sentiment override? Is it positive or negative?

4. What is the nature of conflict and it’s regulation? (Note regulation, not resolution?)

5. What is the nature of their life dreams and shared meaning systems?

          6.   What potential resistances exist

      He use both the Locke-Wallace Scale to assess Marital Satisfaction and the Weiss-Cerretto Scale to assess divorce potential.

According to Gottman:

Oral History

      (discrepancies)

Distinguish between two kinds of conflict

Solvable vs Perpetual

Use part of the Oral history Interview and part of the Meanings Interview

 

      It only takes one unhappily married person to make an unhappy marriage 

Sept 26th, 2011 

      These couples tend to have a fair amount of stereotypical sex roles in their marriage.

      Rather than resolve conflict, avoidant couples appeal to their basic shared philosophy of marriage. 

       

All three types is quite good

1. Validator with Avoider- the validator is constantly pursuing the avoider and feeling shut out emotionally.  The avoider starts feeling flooded

2.Validator with Volatile-the validator starts feeling not listened to and flooded, like he or she is doing combat duty all the time.  The volatile feels that the validator is cold and unemotional, distant and disengaged.  There seems to be no passion in the marriage.

3.Avoider with Volatile- This is the worst of the pursuer-distancer combinations.  The avoider quickly feels that he or she has married an out of control crazy person.  The volatile believes that he or she has married a cold fish and feels unloved, rejected, and unappreciated. 

      Refers to the sense that each partner feels that their partner is worthy of being respected, liked and honored.  

Three kinds of couples:

 

All three of them could work, as long as 5/1 good to bad bids/exchanges. i.e. turn towards, 4 horsemen. As clinicians: always have to ask: how happy are they with their exchange. Is there love and respect counters contempt. You can have hybrid in the relationship within each. It can’t be that one is one and one is something else. Mismatches are often what we see in counselling. validator vs. avoider: pursuer vs. avoidant. Gottman: since the avoidant is flooded, you got to calm him down first. Therapist must first be the regulator – i.e. address physiology. 

Avoider vs. volatile –  worst off. Avoider feels unloved. 

Love maps

In clinical setting: -increasing positive affect while reducing negative affect.

Step one: build and increase the love-maps: the more detailed it is, the better that stressors/transitions of life are. There are assessments for this part [p. 51-2 of Gottman book]. If it is a strength, stick to other issues. If the love maps need working on, there is a game of love-map cards where you have to ask and answer questions. “opportunity cards” things that you can do for the couple. Important to highlight the positive parts of the relationships. In the bible, sexual intimacy = “knowledge”. 

Three prongs of intervention:

  1. Positive affect every day [non conflict situations]
  2. Positive affect during conflict.
  3. Reducing negative affect during conflict
 

Therapist is directive. Almost like a coach.

Couples who score low of love maps: this should be part of the treatment plan: working on positive affect- important to teach the couple about positive affects, feeling known as this helps build intimacy. Sexual dissatisfaction is often related to thin love maps. 

-if the couple is not ready to build a love map, build the relationship before you do the love-map questions. 

For love-maps, do some positive things for each other – in session, establish rituals. 

 

October 3rd, 2011

“who am I exercise”  -building friendship – quite intimate – page 56 in the book. 

Fondness and admiration

Above “love maps”  in the Gottman hierarchy.

-this is how a person would like to be respected and liked. Without this element, the relationship will not last. This part is the antidote to contempt. When you have contempt, you need to work on this part of the relationship (fondness and admiration).

-contempt is the most corrosive of the “four horsemen”. “culture of appreciation”  must be built in a relationship. Looking at history of couple will assess the “culture of appreciation” – i.e. if the couple “re-wrote”  their past in negative terms, the couple is headed for rough relationship. Therefore, one must work on “culture of appreciation” urgently. If none of it is possible, you can ask what their goals are given the volatility –process the volatility. If unable, one must help them figure their next options, etc.... i.e. not be unrealistic and push for them to stay together. 

Page 66 of Gottman: fondness and admiration questionnaire. Low score on this questionnaire: work on reframing negativity. Building fondness and admiration through also countering distress-maintaining thoughts.

Interventions:

 
Problem Solution
criticism Softening
Defensiveness Taking responsibility
contempt Fondness and admiration
Stonewalling [reaction to being flooded] Self-soothing [physiological]
 

Transition to parenthood – a major crisis for the relationship

-women: more marital satisfaction =love maps + fondness and admiration

-men: more marital satisfaction = only love-maps 

-bids couple be part of: building love maps, shared fondness and admiration, or turning towards [especially the respond part] 

Emotional Connection

Bids:

-expression of “wanting to connect to you” – it is a request for attachment, connection. Could be negative or positive, etc...

 

How do we connect emotionally?

Bids

   the fundamental unit of emotional communication. It is any single expression that says, “I want to feel connected to you” People make bids because of their natural desire to feel connected with other people (need for attachment) 

What do Bids look like?

      Verbal or non-verbal

  Highly physical or totally intellectual

  Sexual or nonsexual

  High or low energy

  Funny or serious

  Questions

  Statements

  Comments

       

What do Bids look like?

***They can contain our thoughts, feelings, observations, opinions, or an invitation 
 

What causes Fuzzy Bidding?

 

Types of Responses to Bids

      A positive or negative answer to somebody’s request for emotional connection.

                        -Turning away

                        -Turning against 

                        -Turning towards

 

Turning away

      is what happens when you fail to pay attention to another’s bid for attention.

                  Preoccupied responses

                  Disregarding responses

                  Interrupting responses

-this could be a problem: when there is negative sentiment over-ride (not when there is positive sentiment override.

 
 
Are they being intentionally disregarding or are they simply being mindless?

Gottman’s research shows that people in general tend to turn away usually because they are operating on automatic pilot and are unaware of how their behavior is affecting those around them. 

Regardless of intent: The Bidder may still feel:

 

Two interesting observations

-Interrupting [you’re still engaged!] does not seem to be as harmful to a relationship as being preoccupied, or ignoring the other person

 -Wives that turn away because they are preoccupied with other tasks tend to be more dissatisfied with their marriages than husbands that respond in this way. Men tend to do so regardless of dissatisfaction. Turning away in women are more symptomatic of hostility àgender differences!!!! 

 

Turning Against

responding to a bid in a negative way

à4 horse-men + flooding

àthe above are more hurtful than the ignoring!

 

Turning Towards: brief exchanges that communication value/connection – people are left feeling heard –very validating-It is the brief exchanges that happen between partners that communicate to one another that each partner is valued, loved, respected…..

 

According to Gottman: turning towards is the basis for emotional connection, romance, passion, and good sex.   

Exercise: page 81 of Gottman: “is your marriage primed for romance”

Masters:

 

Emotional Bank Account

-Metaphor he uses to help couples become aware of the ratio of turning towards and turning away responses. People cannot survive in relational debt. 

Deposits and withdrawals

Idea of building a nest egg or cushion to help couple thru the tough times

Helps couple become aware of the everyday moments rather than focus on the fireworks that do not often come around.  Makes romance more attainable, reduces the pressure to create wow moments. Page 83 of Gottman: what can you do to improve the marriage (vs. what your spouse is or is not doing). “emotional bank account” exercise on page 83 of gottman. This exercise in not good for competitive couples.

-unhappy people: undermine partner’s good intentions by 50%.

-another exercise: “stress reducing conversation” – p. 87 of gottman.  

Accepting Influence

-Accepting influence is an attitude, but it’s also a skill that you can learn if you pay attention to how you relate with your partner.  When you have a conflict, the key is to be willing to compromise  

Research has shown

-When a man is not willing to share power with his partner, there is an 81% chance that the marriage will self-destruct

-Women are more likely to let their husbands influence their decision making by taking their opinions and feelings into account whether they are in a happy or unhappy marriage.  Men do not show the same tendency

-Women (even when angered or feeling negative emotions) tend to rarely respond to their husbands by increasing the negativity in the interaction.  They either meet his level of negativity or they attempt to tone it down.

-65% of men responded to their wives by escalating their wives negativity and responding with the four horsemen. Using one of the four horsemen to escalate a conflict usually a sign that a man is resisting his wife’s influence. 

-When a woman uses the four horsemen in the same way, it is not as destructive to their marriage.  The data does not provide an explanation as to why?

-“More than 80% of the time it’s the wife who brings up sticky marital issues, while the husband tries to avoid discussing them.  This isn’t a symptom of a troubled marriage- it’s true in most happy marriages as well”

-men’s stress systems kick in stronger and calms down slower 

Accepting Influence - does not mean never expressing negative emotions towards your partner.  A relationship can survive with a reasonable level of anger, complaints and even criticism.  Suppressing your emotions is not the goal.  Accepting Influence allows you a greater chance of reaching a compromise 

-85% chance of hurt in interactions.

-gay/lesbians: better at start up.

  

-gottman idea: coach the couple about how to talk: hopefully helping them generalize the “turning towards” 

October 17th, 2011 Conflict Regulation: Part I “Solving what is Solvable” Marital conflicts

Important to remember that our goal is to help couple’s learn to cope with their conflicts rather than solve them….because 69% of conflicts are not solvable, they are perpetual problems that will be a part of their lives forever, in some form or another

Solvable Problems are

 

Two Key Ideas in Conflict Regulation

It is important to communicate a basic acceptance of your partner (treat him/her with the same respect you show your guests). There is no absolute reality in marital conflict, only two subjective realities  

Helping clients resolve what can be resolved…..

Gottman has the couple identify an “easy problem” that they don’t feel is gridlocked (not always easy to do because every problem has the potential of being a perpetual problem.)

Couple can use Gottman’s list to help them identify a solvable problem.  

Follow the five steps of conflict regulation

Step 1: Softened Start-up

Help the client change the way that they begin their conflict discussion, so that it is softened rather than harsh. Important to convey to client that research has shown that the way an argument starts determines how it will end. Therefore, softened start-up is crucial to conflict regulation. Need to take the criticism and blame out of the couple`s discussions. It only leads to feelings of being attacked. 

Softened start-up

 
 

Softened start-up intervention 

Present and practice the suggestions for softened start-up p.164-165  

Step 2: Repair attempts

-Formalize the repair process by helping the couple identify ways to stop a discussion that has not started on the right track

-Gottman suggests using the repair checklist (p.173-175) and helping clients internalize these statements so they do not feel phony or awkward.

-The formality of the script helps ensure that the client uses a set of words that will be reparative rather than continue to escalate the conflict

-Working on this process in a structured way also helps clients be more receptive to repair attempts made by their partner

-It is important to help the receiver “accept influence” for this step to be effective 

Step 3:Flooding and self-soothing

Help couples recognize when one of them is feeling flooded

Educate clients that flooding (high levels of physical arousal) has an impact of conflict regulation 

Flooding impacts;

 

Interventions

 

Step 4: Compromise

Important belief: The only solution in marriage is compromise. Negotiation is only possible after you’ve followed the steps above. i.e. can’t compromise when you’re flooded. “Accepting influence” is paramount in this step. An inability to be open-minded is a real liability when it comes to conflict resolution. No fondness and admiration = no conflict resolution whatsoever. 

Help couples work together on a compromise by discussing the following questions;

 

Step 5:Be tolerant of each other’s faults

Help clients avoid getting bogged down in “if only” thinking. As long as this pattern of thinking prevails, conflicts will be very difficult to resolve. Acceptance of the other person’s flaws is crucial for successful compromise. 

October 24th, 2011

Conflict Resolution Part 2: Overcoming Gridlock

The Signs of Gridlock

 

Interventions For Gridlock

The first part of the intervention is to break up the couple’s gridlock by uncovering the dreams that underlie each person’s entrenchment in an uncompromising position.

-Help the couple express the metaphors, stories, hopes, and dreams in each of their positions in a safe context by using the Dreams within Conflict intervention

-The second part of the intervention is to change the influence patterns in the marriage so that both people proceed to honor one another’s dreams with the Honoring One Another’s Dreams intervention 

The Dreams-Within-Conflict

  1. Couple identifies a core marital issue (gridlock) to discuss, not to solve!!!!!
  2. One partner starts as the speaker and the other as the listener
  3. After 20 minutes they switch roles
 

Speaker’s Job

 

Listener’s job

 

Therapist’s job

-Provide a lot of support to the client and work on symbolic meanings. Help them expand their understanding.

-you want to see if it is the interaction or history that is flooding them

-10-20% -this intervention brings up anger as they gave up their dream. The client will blame the other for that. Bring responsibility for their part in it and that they are empowered to get to those dreams. 

 

Change the influence process so that the couple moves towards honoring (respecting, supporting, participating in) both person’s life dreams;

  1. Define the core areas that you cannot yield on
  2. Define areas of greater flexibility that are not so “hot” emotionally
  3. Come up with a temporary compromise and a plan

      10-20% of couples in his workshops run into trouble with the Dreams-Within Conflict exercise.

      Help partner take responsibility for their decision to not pursue their dreams rather than get stuck in the blame game. This is not an exercise about airing resentments.

      Some couples struggle with changing the influence pattern. Recast them as

      By using the same protocol as the Dreams Within Conflict intervention, help the couple get to the potential catastrophe in their mind 

-make a differentiation between reactivity [i.e. flooding] and emotion – reduce the reactivity and then deal with the emotions. No heightening in Gottman’s approach. 

October 31st, 2011

Dreams within a conflict –  compromise –movie 

Aftermath of a fight: fights are normal within a marriage. Sub-goals are:

  1. Process the fight without starting all over again – i.e. name the emotions
  2. Two subjectives to each fights – they are both right –i.e. speak about perceptions – express first their own perception and asking about whether they understand the other’s perception – [not explaining to the partner anything!]
  3. Accept responsibility for mis-communication [admitting mode]
  4. Find one way to make conversation better – [collaborative mode]
 
 

4 stages:

  1. Identify emotions?
  2. How do you see this issue?
  3. What was your role in the fight?
  4. How can you make this better?

-can only do it after dealing with 4 horsemen 

November 7th, 2011

Assignment: due date: December 20th, 2011

  1. Case example – summary
  2. Assessment: names of inventories – why did you use them?
  3. Conceptualization a la gottman-related to theory
  4. Recommended treatment plan: re: what to do with them, inventory
 

5 pages single space 

Creating Shared meaning

-got to have a culture within a family

 

Creating Shared Meaning

-Marriage can have a spiritual dimension that has to do with creating a culture rich in symbols, rituals, and an understanding of the roles and goals that help one to understand what it means to be part of the family they have created together.

-When a marriage has a shared meaning system that is well known, implemented, and honored there is less likely to be intense gridlock conflict. What is important is that the culture and rituals that they create incorporates both of their dreams (needs) – vs. one-sided incorporation of dreams. 

Assessment

The clinician should familiarize themselves with the questions in the Meanings Interview (handout) and incorporate them in their assessment or treatment plan. Questions include routines and rituals – basically outlining how they live. This dialogue fosters the development of how the people live. You do not start at this point, because you first want to deal with commitment to the relationship – you do not want this to be another source of contention/gridlock. 

Intervention

The goal is to build shared meaning in;

Use the questions from your chapter -(p.251-258)

Refer to Chapter 11 - in The Marriage Clinic

      Gotttman, J.M. (1999): The Marriage Clinic, New York: W.W. Norton & Company. 
 

Resistance to Change – video

-resistance is understood as revisiting the cycle of conflict – must look at the stages of the “sound house theory” that does  not work for the couple. 

-flooding: i.e. a timeout [re: flooding] request seemed to the other to be bad timing [felt shut down]. Other has to learn that when the other is flooded, nothing can be achieved before a calming down. But the more one tries to calm down, the more the other pursues. Therefore, they have to understand that the more they pursue, the more the other withdraws [flooding]. 

Primary goal: to end gridlock

Stages/goals:

  1. learn the 6 skills
    1. label and replace 4 horsemen with their antidote:
      1. criticism with complain/soften start-up
      2. defensiveness w/ accepting responsibility
      3. contempt vs. Climate of appreciation
      4. stonewalling with self soothing, withdrawal-break ritual, stay connected
    2. soften start-up
    3. accepting influence
    4. physiological self-soothing – managing flooding with a break ritual
    5. effective repair
    6. compromise
 
  1. process fights without therapist
    1. feelings
    2. subject reality
    3. can you understand part of other’s subjective reality
    4. what are your unstated needs here
    5. move to admitting mode
    6. what does this pattern remind you of?
    7. What is one thing you can do to improve the next session?
  2. Process failed bids for emotional connections without the therapist – no hierarchy of emotions according to Gottman – i.e. turning towards. Look at above questions too. Bids also include building
    1. State clearly, using soften start-up
    2. Making clear that this is a bid for connection:
      1. Attention
      2. Interest
      3. Enthusiasm and excitement about something you are excited about
      4. Affection
      5. Humor
      6. Support for a tough situation you are facing
      7. Understand and validating your feeling
      8. Help in problem solving
  3. help set up rituals and maintain them as family habits. Some scripting work.
  4. Plan for relapse and schedule sessions – i.e. every 6 months for 2 years.
    1. If therapy is too successful (flight into health?) speak about relapses, or fading of achievement.
    2. Is marriage goes towards dissolution, attempt mediatory processes. If no fondness and admiration, relation is likely dead.
 

Summary- examples of rituals

 

November 14th, 2011

Many of the key concepts of family therapy come from Murray Bowen: i.e. genograms, family assessment, evidence-based therapy, cut-off, triangulation, intergeneration transmission of issues, coaching, management consultant. Structural-strategic family therapy. Bowen also wrote about how his ideas apply to organizations. He was trying to promote differentiation. 

-it may be easier to read about Bowen’s own family work by drawing a genogram 

-unlike Ackerman, Whittaker, he did not use psychoanalysis as a basis, but see the system as having its own wiring. Bowen was the first to see family as a natural system – multigenerational emotional unit. What happened in the generation before you affects how your current family looks like. Bowen concepts include

    1. differentiation of the self – has a scale: enmeshed [caught up in family emotional life].
    2. Pseudo-self – lack of real differentiation
    3. Triangulation/ Family emotional life - to manage anxiety
    4. Interlocking triangulation – triangles within triangles – blocks differentiation
    5. Cut-offs: if the family fighting/hurts lead to one member being isolated. Much of the work is about repairing the cut-offs
    6. Sibling [ordinal] position. Eldest is often the over-responsible.
    7. Multigenerational transmission
 

An Intergenerational Approach

Lecture 1 

Required Readings:

  1. The Family Therapy Networker, Murray Bowen, 1913-1990. Bowen’s Legacy: Family Therapy’s Neglected Prophet, March/April,  25-46
 

________________________________________________________________ 

 1.   Introduction

    1. Professional Background
    2. Practice experience
    3. What do you hope to get from these three lectures?
      1. More discussion
      2. Lectures
      3. Discussion of articles
    4. Cards with email addresses.
    5. Evaluation—the 10% given to contribution to class
 
 
 
 
 
 

   d. Eight concepts central to Bowenian theory. 

 
 
 
  1. Professional Biography
 
 

   1954 Bowen moved to the National Institute of Mental Health. 

 
  1. Murray Bowen as Intellectual Beacon
 

Mary Sykes Wylie citing Braulio Montalvo and Salvador Minuchin in the commemorative issue of the Family Therapy Networker, (March/April, 1991 played tribute to Murray Bowen as: 

"the intellectual beacon for everyone who was first trying to understand Family Therapy in the early 1960's.” "Almost every major concept in family therapy can be traced back to him.  He taught everybody" (page 26) 
 

Wylie characterizes each of the early founders of family therapy Nathan Ackerman, Don Jackson, Jay Haley, Salvador Minuchin, Virginia, Satir, Carl Whitaker as original thinkers who "stood alone--all innovators and pioneers who explored new territory ahead of the pack.  

 
 
 
 
 
 

Discussion of Article 1.  

The Family Therapy Networker, Murray Bowen, 1913-1990. Bowen's Legacy: Family Therapy's Neglected Prophet, March/April, 1991, pp.25-41 

Bowen and his research team at the NIMH observed whole families in the unit provided

 
 

Other reciprocal patterns were noticed. 

 
 

Bowen's family systems theory, unlike psychoanalysis sees human beings young or old, married or single--as elements in a structure of interlocking relationships rather than as autonomous psychological entities.  

The treatment would be more effective if the clinician's evaluation of the problems had been broader, had included more sets of relationships.    

Many therapists have long recognized the importance of assessing variable from many levels of observation but this has been difficult to do in the absence of an integrative theory. 

Psychoanalytic Theory which had been developed through the study of individuals had viewed the family as a relatively autonomous group of people.   

Family systems theory radically departed from previous theories of human emotional functioning by characterizing the family as an emotional unit and the individual as part of that unit rather than as an autonomous psychological entity.  Family systems theory did not ignore the psychology of the individual but placed it in a larger context.  (Kerr, 1988) 

It was out of the study of families of schizophrenics that Bowen devised his notion of the emotional interdependence of the family unit and the transmutation of anxiety.   In these families and one frequently observed pattern emerged that of reciprocal family relationships.  

Thus one could not know the extent of the interdependence without both pieces of the puzzle.  A number of incidents of emotional interdependence among family members led Bowen and his group to conclude that the family could be accurately conceptualize as an emotional unit.  
 

      Broad overview of the genogram as an assessment tool:

 

   History

     Research

 

     Theoretical Underpinnings

      Major Assumptions:

 

         Bowen’s Theory

 

         Contextual Theory

      Objectifiable Facts

         Individual Psychology

      Family Transactions

      Rational ethics

    Postmodern Theories 

Using the Genogram in Assessment

Locating Key information

Genograms with a Specific Focus

The Use of Technology

   

3. Discussion of Supplementary Article

Sample Case:  The Nelsons 

Paul 14 admitted to a residential treatment centre for truancy and behaviour problems to great for his parents to manage at home. 

Lilly 42 yrs.   

 

Structural FT Therapist:   

 

Strategic FT Theory: (MRI Palo Alto) Don Jackson, Paul Watzlawick, Greg Bateson and Jay Haley

 

Therapist

 

Intergenerational Family Therapy Murray Bowen Ivan Boszormenyi-Nagy (Nahzsh) Theory

 

Context is also very important

 

Therapeutic Process

 

Experiential FT 

Integrative Models

 
 
 

Carol Cumming Speirs       
 

Bowen’s Therapy-- Review of the Concepts 

Required Reading: 

Friedman, E. H. (1991). Bowen Theory and Therapy, in A. S. Gurman & D. P. Kniskern, Handbook of Family Therapy, Vol.2., New York: Brunner/Mazel pp 134-170.

 
 

Plan for Today

 

Feedback?

Short exegesis of the Friedman material by me

Three Presentations

      15 minutes each with 5 minutes for discussion. 

 

We have had two sessions and have two to go after today….like to take five minutes to check out how we are doing.

 

Edwin H. Friedman

 
  1. On Bowen Therapy
 
  1. no distinction between theory and therapy—clients are taught the theory.
  1. supervision of therapists aimed at thoughts and differentiation of the therapist in order to promote differentiation in a family
  2. the ultimate goal is to promote differentiation--a parallel process in both therapist and family or organization
  3. there are very few techniques other than teasing out, challenging and encouraging the emergence of self via the pathways of:
  1. promoted by a non reactive therapist--continuing to work on his/her own maturity in the service of differentiation.
  1. Three Principles re Conduct of Therapy
 
 
  1. The objectivity of the therapist;
 
 
  1. The effect of proximity on protoplasm;
 

        c.   Healing as a Self-Regenerative process.

November 21st, 2011

Argyle Institute of Human Relations

 

Bowen Lecture 2                  Carol Cumming Speirs

 
 

November 21, 2011

 

Article:

Bowen, M. (1986) On the Differentiation of Self, Family Therapy in Clinical Practice, Northvale New Jersey: Jason Aronson.  

 

Housekeeping Items:

 

Lecture

This paper is a seminal paper, delivered by Murray Bowen to colleagues at the

1984 AAMFT Conference.

 

Murray Bowen believed his theory was best understood if therapists position themselves outside the emotions of the family and illustrates in this paper what he means by inside and outside an emotional system.

 
 
 
 
  1. Theoretical Background
 
 
Autonomous Self                                                 | Pseudo Self
“I” position stances. Autonomous, less emotional fusion  Fuses with others in an intense emotional field. 
The basic self is not negotiable in the relationship system  
 Self emotionally fuses into a common self within the relationship system; achieves its greatest intensity in marriage

Feeling subjectivity vs reason objectivity

Constitutes a mass of heterogeneous facts beliefs principles acquired thru relationship system in prevailing emotion

Energy available for goal directed activity   Does not distinguish feeling from fact, and major life decisions are based on what “feels right”. 
Basic self may change within self, based on new info or knowledge

Not changed to gain approval.

|

Friends/spouses chosen in same level of autonomy

 Beliefs based on what “one is supposed to know; or borrowed to enhance one’s position in relationship to others.   

                     

    

      0    Differentiation Scale         100

 
 
 
 
 
 
 
 
 
 
 

class – November 21st, 2011

-bowen – wrote letters to his family in order to stir up a fight so that he can differentiate. He tried to manipulate the system to increase differentiation

November 28th, 2011

 

Murray Bowen Lecture 3

 
 

Carol Cumming Speirs     November 28, 2011

 
 

Bowen’s Therapy-- Review of the Concepts

 

Required Reading:

 

Friedman, E. H. (1991). Bowen Theory and Therapy, in A. S. Gurman & D. P. Kniskern, Handbook of Family Therapy, Vol.2., New York: Brunner/Mazel pp 159-170.

 
 

Evaluation:

 
 
 

Edwin H. Friedman NB Notes are from the beginning. 

 
  1. On Bowen Therapy
 
  1. no distinction between theory and therapy—clients are taught the theory.
  1. supervision of therapists aimed at thoughts and differentiation of the therapist in order to promote differentiation in a family
  2. the ultimate goal is to promote differentiation--a parallel process in both therapist and family or organization
  3. there are very few techniques other than teasing out, challenging and encouraging the emergence of self via the pathways of:
  1. promoted by a non reactive therapist--continuing to work on his/her own maturity in the service of differentiation.
  1. Three Principles re Conduct of Therapy
 
 
  1. The objectivity of the therapist;
 
 
  1. The effect of proximity on protoplasm;
 
 
  1. Healing as a Self-Regenerative process p. 159
 
  1. A Natural Systems View of Pathology
  1. A Natural Systems View of Healing
 

Conclusion: Society’s way of understanding itself

 

Bowen’s theory—is also applied to society’s way of understanding itself.  EF believes that the most significant aspect of Bowen’s theory may not lie in its therapeutic potential for a given family, but rather in its power to reformat the knowledge conventions of the social sciences and so influence what therapists see.

 

 
 
 

Luepnitz, D.A. “Murray Bowen: The politics of rational man.” The Family interpreted: feminist Theory in Clinical Practice. (New York: Basic Books, 1988) 36 – 47.

 
  1. Introduces us to Murray Bowen as a brilliant pioneer of FT; Highlights for Luepnitz:
  1. Common Ground with Feminism p.37
 
  1. Bowen on Sexual Politics
 
  1. Differentiation: (p41).
  1. Bowen on Social Theory (p45-47).
 

Luepnitz: Bowen had a tough stance on homosexuals, protesters, ect. and negated the downside of his theory on women

 

Dec. 5, 2011

 

         

 

 

      An individual’s work and education is an essential source of data, not only to socioeconomic status but also to the client’s functioning and self-concept.

      Nature and motive for service request

      Person or persons making request for service

 

      All sources of information, an estimate of their credibility and the context in which that information is gathered

 

 

 

      Description of the problem and/or needs from the perspective of each member of the family, in their own words

NOTE:  This process can take the entire first interview with a family

  

      Includes the history and antecedents to the problem,  predisposing factors and precipitating events.  Any differences in each member’s perspective should be noted

      An estimate of the disruption in the  family’s functioning   and degree of distress of each member

      The geographical location of the problem – any differences in each member’s perspective should be noted.

 

 

      Any current factors that contribute to the perpetuation of problem;  cultural,   environmental, life cycle, discrimination or systemic variables related to the problem.

      This component would include any current factors, excluding client characteristics, which contribute to the problem

 

      The scope of content could be very broad as it might include cultural, environmental, life cycle, or systemic variables including any evidence of discrimination that specifically related to the perpetuation of the problem.

      The priority each member and therapist gives to the solution of the problem

      This may be considered a generic variable as most clients present with several problems and some priorities must be established by both parties about the change potential of the problem.

NOTE:  A kind of MSE for family therapist.  The observations of the therapist 

      Includes the family’s strengths and coping skills according to the family and therapist

   Positive factors in the family’s relationships.

 

      Concrete resources, formal and informal,  needed to resolve family problem(s) and obstacles to their access.

 

 

 “the backbone of any profession’s claim to competence” (Mailick, 1991)

 

      “a time for reflection, enquiry and vigorous analysis.  Assessments encourage practitioners to stop and think about what is going on” 

 

      “…even more important is the likelihood that treatment itself would be more adequate and at times would move more rapidly if the interpretation of the worker benefited more often by the clarity and penetration which precise formulation in writing tends to develop. “(p. iii)

      client’s problems and the basis for intervention

 

  i.e.  The connection between the problem, the process of intervention and the result of family therapy treatment.

 

 

“A family (with one or two parents) consists of several people who live together, normally the two generations represented by the (real, adoptive, foster, or step) parents and the (real, adopted, foster, or step) children.  Life together in the family is characterized by joint tasks, the wish for intimacy and privacy and by the family’s utopia.  When a family is founded, each partner contributes his own personal notion of family utopia, which is realized as a life form and adapted to incorporate the partner’s ideas and social reality.  Thus a framework is created for the developmental and life tasks that are to be fulfilled by the family. “

 

-

ABOUT THE PRESENTER

      Frank M. Dattilio, Ph.D., ABPP, holds a joint faculty position with the Department of Psychiatry at Harvard Medical School and the University of Pennsylvania School of Medicine.  He was formerly the Clinical Director of the Center for Integrative Psychotherapy in Allentown, Pennsylvania, and is currently in private practice.  He is a licensed psychologist, listed in the National Register of Health Service Providers in Psychology.  Dr. Dattilio is board certified in both clinical psychology and behavioral psychology with the American Board of Professional Psychology and formerly served as a full Professor (Adjunct) at Lehigh University in Bethlehem, Pennsylvania.  He has been a visiting faculty member at several major universities and medical schools throughout the world.

      Dr. Dattilio trained in behavior therapy through the Department of Psychiatry at Temple University School of Medicine under the direction of the late Joseph Wolpe, M.D., and received his postdoctoral fellowship through the Center for Cognitive Therapy, University of Pennsylvania School of Medicine under the direction of Aaron T. Beck, M.D.  He has also completed one year of post doctoral forensic training through the Department of Psychiatry at the University of Pennsylvania School of Medicine under the direction of Robert L. Sadoff, M.D.

      Dr. Dattilio has more than 200 professional publications in the areas of anxiety and behavioral disorders, forensic and clinical psychology, and marital and family discord.  He has also presented extensively throughout the United States, Canada, Africa, Europe, South America, Australia, New Zealand, Mexico, the West Indies, and Cuba on cognitive-behavior therapy.  His works have been translated into more than 23 languages.

      Among his many publications, Dr. Dattilio is co-author of the books, Cognitive Therapy with Couples (1990); Panic Disorder: Assessment & Treatment through a Wide Angle Lens (2000); The Family Psychotherapy Treatment Planner (2000); and The Family Therapy Homework Planner (2001); co-editor of Comprehensive Casebook of Cognitive Therapy (1992); Cognitive-Behavioral Strategies in Crisis Intervention (1994) (2nd edition (2000); Cognitive Therapy with Children and Adolescents: A Casebook for Clinical Practice (1995); Comparative Treatments for Couple Dysfunction (2000); and editor of Case Studies in Couple and Family Therapy: Systemic and Cognitive Perspectives (1998).  He has filmed several professional videotapes and audiotapes including the popular series “Five Approaches to Linda” (Lehigh University Media, 1996) and remains on the editorial board of a number of professional journals, nationally as well as internationally.  Dr. Dattilio’s areas of expertise are in couple and family problems, forensic psychological evaluations, as well as the treatment of anxiety and depressive disorders.  Dr. Dattilio is the recipient of several professional awards for outstanding achievement and can be reached at Suite 304-D, 1251 S. Cedar Crest Blvd., Allentown, PA 18103, USA, Fax no: (610) 434-6960, E-mail address: frankdattilio@cs.com - Website: www.dattilio.com.

Introduction

I. Historical Development of Cognitive-Behavior Therapy

      A. Philosophy and theory – an overview

  1. Application of Cognitive-Behavioral Strategies with Couples and Families

      A. Role of the behavioral perspective

      B. Role of the cognitive perspective

      C. Combined perspectives within a systems framework

      D. Role of cognition, emotion, and behavior

      E. Myths of cognitive-behavior therapy

  1. Assessment Techniques and Case Conceptualization

      A. Conjoint, individual, and family interviews

      B. Use of surveys, questionnaires, and assessment measures

      C. Development of case conceptualization including negative automatic thoughts

      D. Assessing personality and other disorders

      E. Orient couple or family to the cognitive-behavioral model

      BREAK 

IV Video Clips of Assessment 

      LUNCH

V. Techniques and Procedures for Couples and Families

      A. Identify automatic thoughts, underlying schemas, maladaptive assumptions, and cognitive   distortions

      B.  Draw link between emotions and negative automatic thoughts and misperceptions.

                  Use of the Daily Dysfunctional Though Record

      C. Identify negative frame and ingrained beliefs associated with cognitive distortions

      D. Weighing evidence and challenging automatic thoughts and schemas

      E. The use of new evidence in correcting distorted thinking and ingrained schema

      F. Practice alternative (balanced) explanations and behavioral follow through

      G. Reframing through restructuring of thoughts and belief systems

      H. Additional techniques: Quid Pro Quo behaviors, communication training, problem-solving   strategies, caring days and pleasing behaviors, positive behavior change, agreements, role play, the   Pad and Pencil Technique, coaching,  time out, homework assignments, and bibliotherapy

      I. Family therapy intervention

      J. Integration with other modalities of treatment

  1. Videotape or Live Demonstration

Questions and Answers/Summary Discussion

 

MYTHS

OF

COGNITIVE THERAPY

  1. COGNITIVE THERAPY DOES NOT USE INFORMATION AND MATERIAL FROM THE CLIENT’S PAST
  2. COGNITIVE THERAPY DOES NOT USE THE THERAPEUTIC RELATIONSHIP IN TREATMENT
  3. COGNITIVE THERAPY IS THE POWER OF POSITIVE THINKING
  4. COGNITIVE THERAPY IS TOO SIMPLE AND WORKS ONLY ON SYMPTOM RELIEF AND NOT THE UNDERLYING ISSUES
  5. THE ONLY GOAL OF COGNITIVE THERAPY IS CLEAR THINKING

                    

COMMON COGNITIVE DISTORTIONS WITH COUPLES

Arbitrary Inference.   Conclusions are made in the absence of supporting substantiating evidence.  For example, a man whose wife arrives home a half-hour late from work concludes, “She must be having an affair.”

Selective Abstractions.  Information is taken out of context and certain details are highlighted while other important information is ignored.  For example, a woman whose husband fails to answer her greeting the first thing in the morning concludes, “He must be angry at me again.”

Overgeneralization.  An isolated incident or two is allowed to serve as a representation of similar situations everywhere, related or unrelated.  For example, after being turned down for an initial date, a young man concludes, “All women are alike, I’ll always be rejected.”

Magnification and Minimization.  A case or circumstance is perceived in greater or lesser light than is appropriate.  For example, an angry husband “blows his top” upon discovering that the checkbook is unreconciled and states to his wife, “We’re financially doomed.”

Personalization.  External events are attributed to oneself when insufficient evidence exists to render a conclusion.  For example, a woman finds her husband re-ironing an already pressed shirt and assumes, “He is dissatisfied with my preparation of his clothing.”

Dichotomous Thinking.  Experiences are codified as either black or white, a complete success or total failure.  This is otherwise known as “polarized thinking.”  For example, upon soliciting his wife’s opinion on a paperhanging job underway in the recreation room, the wife questions the seams, and the husband thinks to himself, “I can’t do anything right.”

 

Labeling and Mislabeling.  One’s identity if portrayed on the basis of imperfections and mistakes made in the past, and these are allowed to define oneself.  For example, subsequent to continual mistakes in meal preparation, a spouse states, “I am worthless,” as opposed to recognizing her error as being human.

Tunnel Vision.  Sometimes spouses only see what they want to see or what fits their current state of mind.  A gentleman who believes that his wife “does whatever she wants anyway” may accuse her of making a choice based purely on selfish reasons.

Biased Explanations.  This is almost a suspicious type of thinking that partners develop during times of distress and automatically assume that their spouse holds a negative alternative motive behind their intent.  For example, a woman states to herself, “He’s acting real ‘lovey-dovey’ because he’ll later probably want me to do something that he knows I hate to do.“

Mind Reader.  This is the magical gift of being able to know what the other is thinking without the aid of verbal communication.  Spouses end up ascribing unworthy intentions onto each other.  For example, a gentleman thinks to himself, “I know what is going through her mind, she thinks that I am naïve to her ‘shenanigans’.”

ASSESSMENT AND CASE CONCEPTUALIZATION

I Initial Conjoint Interview

II Individual Session with Spouse

 

III Second Conjoint Interview

Family Interviews

 
 
 

QUESTIONNAIRES AND INVENTORIES FOR COUPLES

AUTOMATIC THOUGHTS

Thoughts or Images that occur to the spouse(s) simultaneously and are usually associated with negative affect.

e.g.: “It’s too late to save our marriage, its over.”

SOCRATIC QUESTIONING

Therapist: John, I see that on the Beliefs About Change Inventory under “Defeatist Beliefs,” you

      placed a checkmark next to the statement, “My partner is incapable of change.” 

      What immediate thoughts come to your mind when you say that statement?

Spouse: Well, you see, it was a mutual decision for both of us to come here for counseling;

      however, I really do not believe that my wife is capable of changing her ways, even

      though she may act motivated to do so when in your presence of the presence of others.

Therapist: Then your thought is that while she appears motivated, there is little likelihood that she

      will change.

Spouse: Yes, it’s almost a waste of time.

Therapist: Any other thoughts or beliefs about it?

Spouse: Yes, I also think that I will be placed in a position of expending a lot of energy

      toward making the marriage work, and then the joke will be on me when we still end

      up in divorce.  So, I view it to some degree as a trap.

Therapist: So, you believe that going ahead in marital therapy will only result in making a fool of

      you.

Spouse: Yes, I do and, therefore, I am reluctant to believe my wife when she says that she wants

      to try.

Therapist: What is your belief about change in general?

Spouse: Well, basically, if you want to know the truth, I truly feel that people basically remain

      the way they are and are impervious to change, even though they might state that they

      wish to change.  I believe in the old adage, “A leopard never changes its spots.”

Therapist: I see.  Then your underlying belief is that change is futile.  Therefore, nothing can

      improve your relationship.

DOWNWARD ARROW

“I need to scream because Harry doesn’t always listen to me.”

“If I don’t scream, I’ll never be heard.”

“If I am not heard, I am nobody.”

“If I am nobody, I am helpless.”

“If I am helpless, people will run over me.”

“Harry will run over me and this will give him complete control.”

Ref. Dattilio, F. M. (1993).  Cognitive Therapy with Couples and Families.  The Family Journal, 1(1), 51-65.

BEFORE

JEFF’S VIEW OF MARGE

WONDERFUL

CHARMING

CAREFREE

SPONTANEOUS

LIVELY

PLAYFUL

MARGE’S VIEW OF JEFF

STEADY

RELIABLE

SELF-CONFIDENT

DECISIVE

LOGICAL

INTELLECTUAL

AFTER

JEFF’S VIEW OF MARGE

FRIVOLOUS

SUPERFICIAL

IRRESPONSIBLE

IMPULSIVE

EMOTIONAL

AIRHEAD

MARGE’S VIEW OF JEFF

RIGID

UNYIELDING

COMPULSIVE

CONTROLLING

OPPRESSIVE

STUFFY

Automatic Thought

“My wife should know when I am grouchy, I am not always angry with her.”

“It’s too late to do anything about this marriage.”

“It’s dead on arrival.”

“Things are either on or off with us – it’s an emotional roller coaster.”

Cognitive Distortion

Mind Reading

Magnification

Dichotomous Thinking

                                   

QUESTIONING YOUR INTERPRETATIONS

1. What is the evidence in favor of my interpretation?

2. What evidence is there contrary to my interpretation?

3. Does it logically follow from my spouse’s actions that he or she has the motive that I assign to him or her)?

4. Is there an alternative explanation for his or her behavior?

      Take an example in which you spouse spoke gruffly or in some other way that upset you.  Ask yourself these questions:

            A)     My spouse doesn’t love me?

            B)     My spouse is always unfriendly?

            C)     My spouse will make life miserable for me?

            D)     I did something wrong?

BEHAVIOR INTERVENTIONS

      - Communication training

      - Problem solving strategies

      - Behavioral change agreements

      - Assertiveness training

      - Paradoxical intention

      - Behavioral rehearsal

      - Bibliotherapy

      - Homework

RULES FOR THE SPEAKER

When speaking to your spouse, try to emphatically identify the needs of the listener so that he or she can understand your message.  The following guidelines are helpful when expressing yourself.

  1. Speak attentively: Just as one listens attentively, one should also speak in the same manner, maintaining appropriate and direct eye contact and looking for body signals (facial or posture) which indicate that your partner is listening.
  2. Phrase meaningful questions: One way to keep a conversation short (and unproductive) is to ask a question that can be answered by either a “yes” or a “no.”  Instead, try to ask questions that lead to more of a response from you partner that will help you understand him or her better.
  3. Don’t over talk: Speak to the point and avoid drawn-out statements that “over tell” a story or reaction.  This will give your spouse a chance to clarify and reflect on what he or she hears from you.
  4. Accept silence: Sometimes one of the best ways to make a point is to pause or use a period of silence after speaking.  This allows you and your listener to digest what is being said.
  5. Don’t cross-examine: Avoid firing questions at your spouse when attempting to learn something during a conversation.  The use of tact and diplomacy express respect and may serve as a far better means of learning what you need to know.

Adapted from Dattilio, F. M. (1989).  A guide to cognitive marital therapy.  Innovations in clinical practice: A source book.  Professional Resource Exchange, Sarasota, FL. and

Beck, A. T. (1988).  Love is never enough.  Harper & Row, New York.

RULES FOR THE LISTENER

Many couples listen to each other, but only in the strict behavioral sense.  They do not actually hear what each other is saying.  Good listening skills involve a clear understanding of what is being said.  Here the therapist may want to instruct the partners how to listen and hear what is being said by following several guidelines.

  1. Listen attentively: Keep good eye contact with your spouse and acknowledge that you are hearing him or her.
  2. Don’t interrupt: It’s difficult to hear when you are talking yourself.
  3. Clarify what you hear: Sum up or make clear with your spouse your understanding of what is being said at the end of a statement or phrase.  This will aid you in getting the correct message.  It is also important to admit you don’t understand something.
  4. Reflect on what you hear: This is different than clarification.  Reflection involves showing your spouse that you are aware or understand what her or she feels.  In essence, you hold up a mirror so your spouse can see what he or she is saying.
  5. Summarizing: Both spouses should always attempt to summarize their conversation so that no loose ends are remaining and both have a clear understanding of what has been discussed.  A summary also allows a couple to set a direction for constructive follow-up.

Adapted from Dattilio, F. M. (1989).  A guide to cognitive marital therapy.  Innovations in clinical practice: A source book.  Professional Resource Exchange, Sarasota, FL. and

Beck, A. T. (1988).  Love is never enough.  Harper & Row, New York.

STEPS FOR COUPLES’

PROBLEM SOLVING EXPERIENCES

Adapted from Epstein, N. & Schlesinger, S. E. (1994).  In A. Freeman & F. M. Dattilio (Eds.) Cognitive-behavioral therapy in crisis intervention.  New York: Guilford.

QUESTIONNAIRES AND

INVENTORIES FOR FAMILIES

      Lavee, 1985.

FAMILY CONSTITUTION1

  1. Standards for interrelationships among family members

      -     the manner in which behavior and emotion is expressed

      -     the maintenance of power and control in the family

2. Standards for the division of labor

      -     how chores are assigned

      -     who does what

3. Standards for dealing with conflict

      -     what is tolerated and what is not

      -     how resolution is sought

      -     how balance is restored

4. Standards for boundaries and privacy

      -     how and where the lines are drawn

      -     who can do what

5. Standards for individuals outside of the family unit

      -     procedures to be used with extended family members

      -     procedures with friends

 

1Adapted from Schwebel, A. I. (1992).  The family constitution.  Topics in Family Psychology and Counseling, 1(1), 27-38.

CONTEXTUAL APPROACH

SOLUTION-FOCUSED APPROACH

Similarities

Dattilio, F. M. (1990).  Cognitive marital therapy:  A case report.  Journal of Family  Psychotherapy, 1(1), 15-31.

Dattilio, F. M & Bevilacqua, L. J. (2000).  Comparative treatments for relationship dysfunction.  New York: Springer.

Dattilio, F. M. & Jongsma, A. E. (2000).  The family therapy treatment planner.  New York: John Wiley & Sons, Inc.

Dattilio, F. M. & Padesky, C. A. (1990).  Cognitive therapy with couples: A practitioner’s guide.  Sarasota, Florida: Professional Resource press.

Dattilio, F. M. (1990).  Una guida alla teràpia di coppia àd orientàsmente cognitivistà.  Terapia Familiare, 33, 17-34.

Dattilio, F. M. (1992).  Les therapies cognitives de couple.  Journal de Therapie  Comportmentale et Cognitive, Marche 1(2), 15-31.

Dattilio, F. M. (1993a).  Cognitive techniques with couples and families.  The Family Journal,  1(1), 51-65.

Dattilio, F. M. (2000).  Families in crisis. In F. M. Dattilio and A. Freeman (Eds.) Cognitive-behavioral strategies in crisis intervention (2nd ed.) p. 316-338.  New York: Guilford.

Dattilio, F.M. (1994).  Videotape.  Cognitive therapy with couples:  The initial phase of treatment, (56 minutes).  Sarasota, FL:  Professional Resource Press.

Dattilio, F. M. (1995) Cognitive therapy with families.  In G. Corey (Ed.) Case approach to counseling and psychotherapy.  Pacific-Grove, CA: Brooks/Cole.

Dattilio, F. M. (1997).  Family therapy.  In R. Leahy (Ed.) Practicing cognitive therapy.  Northvale, NJ: Jason Aronson.

Epstein, N. (1992).  Marital therapy.  In A. Freeman and F.M. Dattilio (Eds.) Comprehensive casebook of cognitive therapy, p. 267-275.  New York: Plenum.

Epstein, N., Baucom, D.H. & Rankin, L.A. (1993).  Treatment of marital conflict:  A  cognitive-behavioral approach.  Clinical Psychology Review, 13, 45-57.

Epstein, N., Schlesinger, S. E., & Dryden, W. (Eds.) (1988).  Cognitive-behavioral therapy with families, New York:  Brunner/Mazel.

Faloon, I. R. H. (1991).  Behavioral family therapy.  In A.S. Gurman and D.P. Kniskern (Eds.)  Handbook of family therapy p. 65-95.  New York: Brunner/Mazel.

Fischer, J. & Corcoran, K. (1994).  Measures for clinical practice: A sourcebook Vol. 1 couples, families & children (2nd ed.)  New York: Free Press.

Freeman, A. & Dattilio, F. M. (Eds.) (1992).  Comprehensive casebook of cognitive therapy.  New York: Plenum.

Jacobson, N.S. & Addis, M.E. (1993).  Research on couples and couples therapy:  What do  we know?  Where are we going?  Journal of Consulting and Clinical Psychology, 61(1), 85-93.

Jacobson, N. S. & Christensen, A. (1996).  Integrated couple therapy: Promoting acceptance and change. New York: W. W. Norton & Company.

Jacobson, N.S. & Margolin, G. (1979).  Marital therapy:  Strategies based on social learning  and behavior exchange principles.  New York: Brunner/Mazel.

Schwebel, A.I. & Fine, M.A. (1994).  Understanding and helping families:  A cognitive- behavioral approach.  Hillsdaye, NJ: Lawrence Erlbaum Associates, Inc.

SUGGESTED PATIENT READINGS

Abrams-Spring, J. (1997).  After the affair: healing the pain and rebuilding trust when a partner has been unfaithful.  New York: Harper/Collins.

Alberti, R. E. & Emmons, M. (1986).  Your perfect right (5th ed.).  San Luis Obispo, CA: Impact Publishers.

Beck, A. T. (1988).  Love is never enough, New York: Harper & Row.

Gottman, J. (1995).  Why marriages succeed or fail.  New York: Fireside Books.

Guerney, B.G. Jr. (1977).  Relationship enhancement.  San Francisco: Jossey-Bass.

Markman, H., Stanley, S., & Blumberg, S. L. (19940.  Fighting for your marriage.  San Francisco, CA: Jossey-Bass.

McKay, M., Fanning, P., & Paleg, K. (1994).  Couple skills: Making your relationship work.  Oakland, CA: New Harbinger Publications, Inc.

 
 

      Barkley, 1995, Brown 1996, Conners, 1998,  Mehringer et all, 2002, West et al, 2003)

 

      “Sometimes” to “Very Often” 

          “Sometimes” to “Very Often” 

      “Sometimes” to “Very Often”

      4)  When you have a task that requires a lot of thought,  how often do you avoid or delay getting started?

      “Sometimes” to “Very Often” 

      “Often” or “Very Often” 

      “Often” or “Very Often” 

REFERENCES

       Gina Pera 2008

      Melissa Orlov   2010

Painful Misinterpretations of ADHD Symptoms ad Motives

Destructive Symptom-Response Cycle

Tendency to blame ADD for all difficulties.

Destruction of relationship comes from combination of ADD symptoms (e.g. distractibility) ---- non-ADD spouse misinterpretation --- negative response to response. 

e.g. ADD husband considers wife’s anger (as a response to ADD symptom) as real cause of their problems

       

Parent-child dynamic

        “Why can’t you do anything right” 

     

 Make sure the professional has experience    with ADD

The Blame Game

She blames him for her misery.  He blames her for ruining their relationship with her anger or coldness. 

It is not a game at all and if they continue playing this game, nothing will improve

Poisons the atmosphere

 

Pursuit and Escape

Non ADD spouse pursues the ADD spouse by nagging, escalating the emotional content of conversations and sometimes follows a spouse around in effort to get him to pay attention.

Sometimes done with the best of intentions.

Husband will often use computer time as an escape.   

Losing Faith in Your Spouse and Yourself

Start to question why you got married in the first place and whether you can survive as a couple.

Your negative view of today colors what you can remember from yesterday. 

Your Sexual Relationship Breaks Down

 

Believing that ADD Doesn’t Matter

  1. Cultivating Empathy for Your Spouse
  1. Addressing Obstacle Emotions
  2. Getting Treatment for Both Partners
  3. Improving Communication
  4. Setting Boundaries and Finding your own Voices
  5. Reigniting Romance and Having Some Fun

Group of ADD partners studied by Pera:  The wrong therapy is worse than no therapy

 

      A Non-ADD spouse

      “It take two to tango” 

 

Couples often want more than just emotions – but also a cognitive component.


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