Relationship Counselling

Transcription

1 Relationship Counselling Neil Harris CCAA Seminar Lambert s (2009) research presentation at the PACFA conference confirmed that therapy is considered a legitimate form of intervention for mental health issues. Couple therapy is showing great promise not only for normal relationship distress, but also as a valid form of treatment for what has traditionally been seen as the realm of individual therapies. Specifically with such issues as anxiety, depression, and trauma. Johnson (2002, Trauma in Relationship therapy) Greenburg (2010, EFT conference papers, Sydney) 1

2 Psychotherapy is Effective It is about four timesas effective as no treatment It is about twiceas effective as placebo Lambert (2009) PACFA conference All Have Won, So All Must Have Prizes The most controversial conclusion as we enter the new century is that practice should be limited to empirically supported psychotherapies. The claim of superior outcomes for one treatment over another has created a schism between therapist and researcher as well as within the research community. It is surprising to see so much made of so little!! Lambert (2009) PACFA conference Implications for Practice We can be confident that we have an overall positive effect on client functioning. Our treatments are efficient and lead to lasting changes in a variety of important areas. Outcome is largely due to client capacities. Specific techniques are not the most important avenue to getting good results. Lambert (2009) PACFA conference 2

3 WHAT WORKS IN COUNSELLING COMMON FACTORS Support Learning Action Empathy Advice Catharsis Affective Learning Taking Risks Positive Relationship Change Expectations Mastery Efforts Reassurance Feedback Facing Fears Structure Insight Reality Testing Expertness Corrective Emotional Experience Exposure Acceptance Modeling Behavior Regulation Warmth There are many different models of couple therapy currently operating. In vogue at the moment is the EFCT model, Attachment models, Gottman Sound House model, CBT Models, Systemic Models, Strategic models, etc. What ever model a person wishes to use, what's important is the therapist s ability to operate across three paradigms 1 :Theory (What informs me as to how to conceptualize a problem) 2: Model (What specific framework I am operating from) 3: Technique (What intervention skill I am using in that moment) From this perspective I suggest to you that each one of us will end up with an individually expressed model, this is not eclecticism, instead I suggest that we naturally integrate when using this three tier application. E.g. 5 different couples with 5 different models, or parts of models) 3

4 COUPLE AS ATTACHMENT 4

5 P O S I T I V E M O D E L O F SELF SECURE P0SITIVE MODEL OF OTHER Comfortable with intimacy and autonomy in close relationships DISMISSING Down - plays importance of close relationships Compulsive self reliance NEGATIVE MODEL OF OTHER PREOCCUPIED Preoccupied with close relationships Overly dependent on others for self esteem and support FEARFUL AMBIVALENT Needing yet fearful of intimacy due to fear of rejection Socially avoidant N E G A FOUR CATEGORY MODEL OF ADULT ATTACHMENT C. Culow Ed. (2001) Adult Attachment and Couple Psychotherapy T I V E M O D E L O F SELF COUPLE AS SYSTEM 5

6 Systemic Concepts Recall that systems theory holds that many problems are a product of the relationships that surround them. The family is a systemwith characteristics of its own. The focus of investigation is on the interaction within and among systems and individuals. Copyright Allyn & Bacon 2003 Systemic Concepts cont. Circular causality We mutually influenceeach other via Patterns of Interaction Family members characteristic ways of behaving. Centrality of Communication Patterns of interaction expressed are both verbal and nonverbal. One cannot not communicate. Copyright Allyn & Bacon

7 Other helpful models Communication Models Developmental models Contract models Object relation models Narrative models Structural-Strategic models Cognitive models Behavioral models Couple therapy Whilst theory is important, in couple therapy it runs secondary to couple focus/presence. Theory can in fact hinder couple process, stop the therapist listening and cause the therapist to miss important information/ process. The idea is to create a safe enough holding space where the couple can face themselves and their partner within the context of their relationship. Couple therapy Most psychotherapy approaches press clients into conceptual frameworks created by individuals often generated generations before current clients are treated Fisher In trying to define psychotherapy as a natural science, many approaches inadvertently seek refuge in monocausal etiology of mental distress, thereby ignoring that people, different to laboratory rats, live in complex social and natural environments Sattman-Frese

8 Couple therapy Within this comes the gate keeping skills. This allows me to invite each person to become more aware of themselves in the context of their relationship as they hear and relate to each other. Gate keeping allows me to keep a couple focus, so that from this technique, emerges the unique couple relationship sitting in front of me. From this experience comes the process/interventions that hopefully fits best the couple. Gate Keeping The couple bring the RELATIONSHIP to counselling The RELATIONSHIP is the CLIENT THE REALTIONSHIP the BETWEEN has a reality of its own An effective working relationship requires two people who are able to be comfortable with their own embodiment 8

9 REMEMBER THE RELATIONSHIP IS THE CLIENT THINK SYSTEMIC BEWARE OF FOCUSING ON OR JUDGING ANY INDIVIDAUL THE CORE MODEL The basic core of the model is the work in the between of the therapeutic relationship. Therefore the primary goal is the creation of a relational space where clients can reexperience and re-own their sense of and agency for an embodied self in relationship. Doug Sotheren. 9

10 GATE KEEPING ITS PURPOSE 1. ASSIST EACH PARTNER TO CLARIFY AND HEAR THEIR OWN AND THE PARTNER S POSITION AT ALL LEVELS POSSIBLE. 2. RESPECT AND MAINTAIN THE COUPLE BOUNDARY 3. KEEP A FOCUS ON IMMEDIACY IN THIS RELATIONSHIP. 4. EFFECTIVELY SLOW THE PROCESS IN CONFLICTUAL COMMUNICATION AND ALLOW REFRAME OF DESTRUCTIVE STATEMENTS. 5. MAINTAIN THE COUNSELLOR'S CONTROL OF THE INTERVIEW PROCESS. 6. ALLOW A SUBTLE MOVING INTO DEEPER LAYERS OF EMOTIONAL EXPERIENCE (OR REGRESSION TO CHILDHOOD) 7. PROVIDE, IF APPROPRIATE, A SUBTLE CHANNEL OF INFLUENCE THROUGH RE- FRAMES, EMBEDDED COMMANDS AND IMPLIED REALITIES. 10

11 STAGE 1 Connecting with the couple in terms of one partner and then the other. Watch who speaks first, usually the initiator. Using basic empathy skills simply respond as you would to an individual client, in doing so you let each partner know that you have heard and understood their core material and experience at that point. It is important to make the distinction between when a client is using their story to cover material, avoid emotion or control and when it may be important to hear the story in order to make contact. STAGE 2 After empathically establishing each partner s position the counsellor now changes their language to take on the words of the speaker and expresses what the client would like to say. i.e. The counsellor changes tense to speak as if he were the client, making the statement that is needing to be expressed to the other partner whilst looking at the speaker. STAGE 3 The counsellor continues to be the channel through i.e., The counsellor expresses the desired statement to the other partner. 11

12 STAGE 4 At this stage, the counsellor needs to be sure that he has connected well with both partners so that the holding and supporting in this stage will be received and not resisted. The counsellor will begin to invite the speaker to look at their partner and make their statement. This is often more difficult than it appears. Clients often feel inadequate and fearful to really be able to say what they think, feel and want. Sensitive support will be necessary on the part of the counsellor. Care will need to be taken that both partners feel they are being supported and heard often for the first time. A particularly dominant or aggressive partner will need to be firmly held whilst the other partner is given support to make their statement. STAGE 5 As the counsellor becomes more fully in the shoes of the client they are able to listen to one partner and without checking turn, face and address the other partner. This can be very powerful. Unless good empathic connection has been made, resistance and power struggles between counsellor and one partner may emerge at this point. However, it does allow for both sensitive and tender material or powerful hurt and angry material to be stated with clarity. Follow this stage by an empathic Stage 1 response to hold and support the client. You may or may not be able to proceed to the next stage at this point. STAGE 6 The counsellor invites the couple to turn and look at one another (eye contact is very important) and begin their process of speaking, hearing and responding. The goal of couple counselling is to assist couple to speak openly, honestly and directly to each other about their thoughts, feeling, wants, etc. Here the counsellor keeps a guiding hand on the interaction by taking more a monitoring/checking role that assists understanding, expression of feelings and deals with couples process. 12

13 STAGE 7 This stage runs somewhat parallel to the other stages and addresses, at various point the relationship between the couple as a real and tangible entity. The counsellor makes a statement to the relationship that identifies the relationship issue in terms of content, experience and feelings, and assists both partners to discover and own the way they each contribute to the relationship and its distress. E.g. Anne, your involvement and attachment to the children leaves you little time for Bob, and Bob, because or your work and other interests you really pay little attention to Anne. There is a distance between you and the relationship feels quite empty. Practice in Triads Review Learnings 13