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Couple Therapy (source reference link)
First Session
Step One: Intake
It is useful to collect some basic information at the start of the first session, such as the number of years the couple has been together, the current living situation, special health issues, prior counseling experiences, employment, and special interests. While the therapist is recording this information, he or she should make a mental note of how the partners relate to one another. The intake also offers the couple a chance to become comfortable with the therapist.
Step Two: Goals and Why Therapists Are Not Referees
Couples often arrive at the session believing that each partner will be laying out his or her “position” and the therapist will act as a referee to decide who is right. The therapist should inform them that it is not a matter of one person being right or wrong, since both partners make sense from their perspective. Rather, they will be learning a new method of communication so they can better understand each other in the office and incorporate this process into their relationship at home. We tell them the process will work if they “are willing to try on some new ideas.” By pointing out the importance of the “we” and not the “me” in their relationship, they begin to understand that we expect both to participate by making changes. This means that counseling is a joint venture to better understand the relationship rather than an adversarial one.
Step Three: How Our Brain Impacts the Dishwasher
Talking to the couple about basic brain functions and how the 100 billion neurons in their brains make decisions helps them to think of therapy as a conscious exercise. They should become detectives trying to figure out how to help “this couple,” who happens to be themselves, just as they might be athletes learning how to build their muscles at the gym.
We talk to the couple about the neurons housed in the analytical area of their brain, the neocortex, which helped them find the way to our office, vs. the neurons of their emotional brain, the limbic system, which they use to experience joy, love, and ecstasy, as well as anger, sadness, loneliness, and fear.
We let them know that when Kenneth says to Marilyn: “That’s no way to load the dishwasher,” he may be thinking he is speaking from his analytical brain to hers, but in fact, he is stirring her limbic system. She reacts emotionally and, in turn, stirs his emotions. This small incident can blowup into their War of the Roses.
Step Four: The Sun
Appreciations are to a relationship as the sun and rain are to a flower. They trigger the happy neurons in the limbic system and bring couples closer together. The following is a simple exercise to foster positive changes:
• Ask the couple to face one another. (The path to the heart is through the eyes.)
• The first partner (the sender) is asked to state one thing he or she likes about his or her partner. For example, “I really love your sense of humor and how you enliven parties with your jokes.”
• The second partner (the receiver) mirrors this appreciation. “So you really appreciate how I have a sense of humor and entertain friends at a party?”
• Then we ask the sender to deepen the appreciation by using the sentence stem, “This is so special to me because…” He or she says, “This is so special to me because it makes me feel warm and cozy and I am proud I married you.” The receiver again mirrors the comment.
• The process is repeated with the second partner offering an appreciation.
Most couples who come to therapy have not heard appreciations from their partner for months or years, so this exercise sets the tone for rebuilding warm feelings and trust. Couples are asked to offer at least one appreciation each day at home and prepare one to begin each therapy session. They are told that appreciations should not be wrapped in frustrations, such as, “I appreciate that you finally took out the trash.”
Step Five: A Conscious Relationship
A conscious relationship requires each person to recognize their own role and reactivity levels when conflicts arise, as well as to become aware of their partner’s thoughts and feelings. After living with conflicts for so long and having to defend their own ego against attacks, the therapist needs to help them to truly listen and understand what their partner is thinking and feeling.
The following exercise works amazingly well to help one partner get into the mind of the other:
• Again the couple faces each other. The sender is asked to offer a one-sentence “guess” as to why he thinks his partner decided to come to this appointment. For example, “I think you came to this session so the therapist can teach me how to be nice to you.”
• Regardless of whether it is true, the receiver mirrors it: “So you think I came to therapy so you’ll learn how to be nice to me?”
• The sender keeps adding more reasons, such as, “I think you are also here because you love me and want our marriage to survive.” This, too, is mirrored by the partner.
• After the sender completes all his or her guesses and each are mirrored, the receiver is then asked to add to or correct the sender’s guesses. The partner may say, “It is true I’m here to save our marriage, but it’s not a matter of being nice to me. It is more a matter of learning how to talk to each other.”
This guessing game for both partners becomes a vehicle for looking into each other’s minds in a safe way. It also reveals some of the major issues that will be explored in future sessions. The process helps couples understand how their own behavior has a positive or negative impact on the relationship.
Step Six: Summarizing the Session and Preparing for the Future
To end the session, each partner is asked for their thoughts about the session and what they can personally do before the next appointment to improve the relationship. This information helps the therapist plan for the future.
The therapist should also advise the couple to do the following:
• Offer each other at least one formal daily appreciation.
• Avoid “atomic bomb” issues when they are at home and save these issues for office sessions.
• Avoid talking to friends or family about their conflicts since others are likely to support only one’s point of view and that will further emotionally separate the couple. Instead, they may just inform a few who need to know that they are receiving counseling to improve their relationship.
Future Sessions
In future sessions, couples need to continue learning to understand each other’s desires, feelings, and thoughts. The Imago Relationship method of therapy developed by Harville Hendrix, PhD, is a powerful process for this purpose. It uses the mirroring technique along with couples validating and empathizing each other. For example, a partner may state, “It makes sense you would be upset that I came home at 7 because I had told you I would be home at 6, and this probably made you feel anxious, lonely, and angry.”
Therapists can coach couples to use this stem: “It makes sense that you would be upset because...” and ask the sender to think of the reasons. Again, it helps couples to think outside themselves and improves the relationship. People begin to understand that their partner truly loves and cares about them as a dear friend.
Along with continual dialogue and mirroring, there are a variety of other communication tools that can be used during sessions. One is constructing genograms to enable partners to understand how each developed values through their families. The genogram, which displays on a board a family tree going back to grandparents, reveals the lifetime growth of an individual’s feelings and behavior. Couples often experience revelations that improve their understanding of their current relationship when they explore their genogram.
Next Steps
Couple Therapy
Health Tips
Being deeply loved by someone gives you strength, while loving someone deeply gives you courage.” – Lao-Tzu
“You’re my reflection, all I see is you.” – Justin Timberlake
“The person you’re meant to be with will never have to be chased, begged or given an ultimatum.” – Mandy Hale