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A Direct Approach to Couple Therapy

July 31, 2015

Marital therapy is about uncovering issues that intrude upon and undermine the relationship. Once discovered, the challenge is to alter either how one or both thinks, feels or acts, in order to improve upon that relationship.

Depending on the approach of the therapist, how one goes about achieving those objectives and the length of time involved will vary greatly. However, there are four immutable beliefs when it comes to therapy: Don’t ask direct questions; don’t share your hypothesis; don’t tell anyone what to do; and therapy is scheduled for 50 minute sessions, week after week.

I shake up those immutable beliefs. In my approach to therapy I ask questions, lots of questions and rather than the standard 50 minute session, I schedule a good three hours for the first meeting and meetings rarely occur weekly. Three hours is necessary because after asking lots of questions, I then share my hypothesis – my opinions on the matters at issue and what drives them and then I give advice; I tell people directly what they can do differently to improve upon the relationship. It remains the couples’ discretion what they chose to do with guidance provided.

The questions asked are related to an extensive individual and family history taking procedure, trans-generational in nature and probing for issues related to mental health, physical health, addictions, violence/abuse, quality of relationships, developmental histories, personality styles, etc. I am looking for or assessing issues that may be either contributory or intervening variables, past or present, to the current problem. In this approach it is my experience that couples come to learn things about themselves and each other that were largely unrealized.

When Jane called to set an appointment for couple therapy in their 8th year of marriage, she explained that while their relationship had been by and large peaceful, her husband Jason retained resentment towards her mother and this flared a few days earlier resulting in pushing and shoving between them with police intervention and child protective services called to investigate. They were at their wits end with each other.

In therapy it was revealed that her parents separated when she was about 9 years of age, the result of her father having beaten her mother for the umpteenth time. She witnessed the attacks and remembered having never felt safe in her father’s company. Her mother continued to reinforce the view that men were not to be trusted and in the mother’s next relationship although not physically abusive, her partner, now stepfather, was verbally abusive to the mother reinforcing the view that men were not to be trusted.

Jason hailed from a family where father was alcoholic and unavailable although not otherwise abusive.  Jason lived a life continuing to crave closeness to an intangible ghost of a father. He forever sought to feel connected to Jane in lieu of his father and she was forever suspicions of his motives and hence remained distant. She and her mother formed more of an intimate relationship, her place of emotional and physical safety, than did the relationship with Jason. This in turn triggered Jason’s loss for his father’s availability and the closeness he sought. Notwithstanding this dynamic, decisions favored Jane’s preferences and while Jason did not begrudge that whatsoever, what upset him was that Jane’s preferences were more influenced by the opinion of her mother than him.

Surfacing their past and the impact upon them and the dynamic it created was enough to produce a new and more compassionate view of each other. Direct guidance was provided to help Jane shift her boundaries to be more inclusive of her husband and less dependent upon her mother. Jason was helped to understand the importance of his demonstrating both emotional support for Jane’s shifting boundary as well as appreciation for doing so.

As the session unfolded, the couple spontaneously drew closer together upon the couch. With little prompting to start, Jason put his arm around Jane when she appeared distraught, surfacing painful memories. Thereafter he continued to  provide tangible support when Jane was upset throughout the remainder of the session. Jane was able to apologize for having triggered his feelings about his father’s unavailability and craving for their relationship by having gone to discuss matters first with her mother over him. This in turn touched Jason who welled up with tears for having been both understood and appreciated. He openly mourned the loss of the relationship with his father he had always sought yet was never available. The couple achieved a sense of emotional intimacy that had previously eluded them.

The couple were satisfied with this one meeting and felt they could work with the new information and guidance provided. While another session was not scheduled, they were informed that they could return should the need arise. They expressed their gratitude for the meeting. They got what they needed to alter the trajectory of their relationship.

From my perspective, people need time to unpack their story in therapy. Fifty minutes is just not enough for people to feel satisfied and indeed, the biggest argument against the 50-minute session I hear from people I serve is that in their work with prior therapists, while they may just start getting somewhere, they run out of time and the moment is lost. In follow up meetings the lost moment is not recaptured. To add, they complain to me that with prior therapists, they are not provided guidance and leave feeling aimless.

I wouldn’t want my surgeon asking me off the table for having run out of time, saying the scalpel would be removed next week. I am of the view that we need to provide ample time in every therapeutic meeting so that the meeting can conclude at a point in time where it makes sense as opposed to arbitrarily for having run out of time. As such, I always set aside three hours for all my sessions yet I bill for actual time used. I also wouldn’t want my physician to lay silent on the connection between my smoking and my lung cancer so similarly, I provide education as to the impact of things like domestic violence, drug and/or alcohol abuse, parental conflict, etc. My approach is active, informative, educational and directive. Hence brief.

This is the result of not only 33 years of practice, but in training in multiple treatment moralities, continuing education, ongoing familiarity with social science research, but most of all listening to people about what is most helpful to them.

Admittedly, this approach is not helpful to everyone, but it is an informed approach.

Ask the people you serve if they found your session helpful and if so, why or why not. Ask them what they might prefer for you to do differently and consider their input. Let the people you serve guide the approach and development of your practice and see how it evolves.

I am Gary Direnfeld and I am a social worker.

https://garydirenfeld.files.wordpress.com/2013/07/gary-feb-12.jpg?w=200&h=301

Gary Direnfeld, MSW, RSW

gary@yoursocialworker.com
http://www.yoursocialworker.com

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Gary Direnfeld is a social worker. Courts in Ontario, Canada, consider him an expert in social work, marital and family therapy, child development, parent-child relations and custody and access matters. Gary is the host of the TV reality show, Newlywed, Nearly Dead, parenting columnist for the Hamilton Spectator and author of Marriage Rescue: Overcoming the ten deadly sins in failing relationships. Gary maintains a private practice in Dundas Ontario, providing a range of services for people in distress. He speaks at conferences and workshops throughout North America.

If your relationship is faltering, then set it as your priority.

Read: Marriage Rescue: Overcoming ten deadly sins in failing relationships.

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2 Comments
  1. Jan permalink

    Enjoyed your article. Good assessments are the foundation to good interventions. So often we are pressured to skip the assessment and focus on the symptoms which typically miss the rot cause as they focus on content not context. Sounds like you integrate EFT into your work. It all comes back to attachment.

  2. Jocelyn R Elliott permalink

    Gary,

    I just read the article and could not agree more!! Whether working with individuals or couples or families, irregardless of age I have heard what has come to be a familiar response to my (our) approach: “you aren’t like the other therapist(s) we have tried. You don’t just sit there. We feel like you are an active part of this”. Which allows my clients to be more trusting and open in their communicating.

    Thank you for sharing!!!

    Jocelyn R. Elliott, LSCSW
    Clinical Director, Credentialing Specialist, Outpatient Therapist
    Counseling Solutions, LLC
    2950 SW Woodside Drive
    Topeka, KS 66614-5326
    785-272-5134
    Fax: 785-272-4370
    Cell: 785-250-7753

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