COUPLE THERAPY FRAMEWORKS
Some therapists have a clearly articulated theory that they apply systematically to every couple they see. At the other end of the spectrum are the therapists who tailor their approach to the couple they’re seeing and may not think of themselves as having much of a theory at all.
Every therapist, however, has at least wisps of theories—conceptualizations of the couple problem with a plan how to address it—that snap into place at least for a moment. If a husband in a couple you’re seeing gets angry at his wife, you might find yourself thinking, “Could this anger be leftover resentment toward his father?” or “How can I get him to take responsibility for his own feelings?” or “Would anger management help him?” or “What is the wish or fear hidden in his complaint?”
Such questions, which arise spontaneously in a therapist’s mind, represent distinct theoretical frameworks. I believe all couple therapists are guided by such frameworks. Furthermore, we can tell what framework we’re using by the questions that pop into our minds.
Here is a list of common frameworks together with the associated questions that pop into the therapist’s mind.
FRAMEWORK ORGANIZING QUESTION
|Family of Origin
|“What unresolved issues from past relationships, particularly from childhood, lie at the root of this problem?” Harville Hendrix believes that the purpose of a couple relationship is to complete and heal each partner’s childhood.
|“What personal pathologies or character defects of one or both partners lie at the root of this couple problem?” “Is this person borderline, narcissistic, or bipolar?” “Does s/he have ADHD or Aspergers?” “Should I get a psychiatric consultation?” Terence Real sees grandiosity—partners getting too much out of their dominating, controlling, or abusive behavior to be willing to give it up—as a common character problem.
|“What is the pattern, often taking the form of a vicious circle, at the root of this couple’s problems?” A classic example is Thomas Fogarty’s pursuit & distance. Ellen pursues when Roy withdraws and Roy withdraws when Ellen pursues. Bunny Duhl talks about the negative Velcro loop, Michele Scheinkman & Mona Fishbane about the vulnerability cycle, Carol Jenkins about interlocking vulnerabilities, Daniel Wile about interacting sensitivities, and Susan Johnson about the pattern of vulnerabilities to separation and loss. Often the problematic exchange is connected with what originally attracted the partners to each other. Roy, who is shy, was charmed by Ellen’s energy in reaching out. Ellen, who is volatile, was charmed by Roy’s calm steadiness. Stan Tatkin talks about the positive potential of the couple system: the ability of the partners to manage each other during stress. The question on the therapist’s mind would then be, “How can I make this couple more of a co-regulatory team?”
|“What are these partners getting out of the problem?” “What hidden purpose does it serve?” You reveal this purpose in order to give partners the chance to work out something more adaptive. Couples appear to be distressed by their fighting, but they may be getting hidden benefits from it. Fighting may be their way to re-establish contact after being too distant or, alternatively, to move back to a more comfortable distance after being too close.
|“How might enmeshment, codependency, lack of separation-differentiation, or an inability to self-soothe lie at the root of this couple’s problems?” “How does taking too little responsibility for oneself or too much responsibility for the other lie at the root of the problem?” The therapeutic goal is to enable partners to be intimate while remaining independent. Among contemporary proponents of this theory are David Schnarch and Ellyn Bader & Peter Pearson.
|Hidden Wishes and Fears
|“What longings or apprehensions underlie the couple’s problem?” “What is the hidden wish or fear behind this person’s complaint? As Marshall Rosenberg puts it, all attack, blame, and criticism is the tragic expression of unmet needs. Among contemporary proponents of this theory are Lee Kassan, who traces problematic couple behavior to fears, John Gottman, who traces it to dreams (lifelong wishes), and Susan Johnson, who traces it to attachment wishes and fears.
|“How might feelings of self-reproach, guilt, humiliation, or low self-esteem lie at the root of the couple problem?” In Bernard Apfelbaum’s terms, “How might the heart of the problem be the partners’ sense of unentitlement to their experience: their belief that it’s not okay to have the thoughts and feelings they do?” This factor has been variously labeled the punitive superego (Sigmund Freud), inferiority complex (Alfred Adler), negative self-talk (cognitive therapy), pathology-saturated narratives (narrative therapy), pathogenic beliefs and survival guilt (control mastery), and internalized homophobia, sexism, racism, classism, or ageism.
|“Is there a power differential based on gender, class, age, ethnicity, culture, societal norms, wealth, or personality that negatively affects the couple’s ability to be mutually supportive?” Carmen Knudson-Martin discusses this issue. People resort to power tactics, Mona Fishbane writes, when they don’t know how to self-regulate or to share power in a relationship based on mutual respect. Terrence Real confronts “grandiose” partners with the possible outcome of their bullying—the loss of their partners or children.
|“What skills or information could solve this couple’s problem?” Seeing the problem as poor communication, you give the partners communication-skills and problem-solving training, teach them not to react but, instead, to listen (active listening: Bernard Guerney, Harville Hendrix) or ask questions (initiator-inquirer: Josette and Ba Luvmour, Ellyn Bader & Peter Pearson). Seeing the problem as the partner’s unrealistic expectations about relationships—for example, that the honeymoon feeling should last or that partners should be able to fulfill all of the other’s needs—you disabuse them of these expectations. Seeing the problem as the partner’s lack of information about relationships, you provide this information. You tell them what John Gottman and Robert Levenson found that distinguishes satisfying from unsatisfying relationships. Or, like Mona Fishbane and Stan Tatkin, you engage in neuroeducation and teach partners what is driving their reactivity. Cognitive behavior therapists have a rich set of psychoeducational procedures.
Practically every couple therapy approach includes a psychoeducational element—something the therapist wants to teach the couple. Depending on your framework, you’d want partners to know that their problem is a displacement of unresolved feelings toward people in their pasts (family of origin), results from the special sensitivities of one or both partners (personal problems), is a function of the relationship (couple system), serves a hidden purpose (unconscious purpose), results from failure to take responsibility for their feelings (poor boundaries), or is rooted in unexpressed wishes and fears (hidden wishes or fears) or self-reproach (hidden shame).
That’s my list of common couple therapy frameworks. My guess is that every couple therapist selects from such a list a set of primary frameworks—ways of thinking and understanding that constitute the heart of his or her approach. Among John Gottman’s primary frameworks appear to be hidden wishes (dreams) and psychoeducation. Among Harville Hendrix’s are family of origin and psychoeducation (active listening). Among Ellyn Bader & Peter Pearson’s are poor boundaries and psychoeducation (initiator-inquirer). Among Susan Johnson’s are hidden (attachment) wishes & fears and the couple system (the pattern of vulnerabilities to separation and loss).
Therapists also have secondary frameworks, those which they appeal to in a supplemental way. “Family of origin” is one of my mine. I don’t focus on it, but I go to it readily when it looms up in front of me.
Therapists may also reject some frameworks. A therapist’s approach may be defined in part by the frameworks he or she excludes. Therapists who focus on the here-and-now may exclude the past-oriented “family of origin” framework. My focus on “hidden shame” leads me to reject “unconscious purpose.” I see people as already blaming themselves for their symptoms. I don’t want to join them in this by suggesting that they’re getting too much from their symptoms to be willing to give them up.
Turning now to primary frameworks, some therapists have a large number that they shift in and out of depending on what strikes them at the moment with a particular couple. Other therapists have a few that they combine into an integrated whole. Still others appeal to them sequentially. They have a preferred primary framework (e.g., tracing the problem to childhood), but shift to another (e.g., communication-skills training) when they feel the first isn’t working.
If you sit down to look at your primary frameworks, you may find that some are not on the list. Or you may find—as I’m about to show for me—that they’re sort of on the list—that is, they can be shoe-horned into one or more of the common frameworks. And you may prefer to name them in your own way. Here are the names I give to mine.
MY PRIMARY FRAMEWORKS ORGANIZING QUESTION
|1. Loss of Voice
|“What does this partner need to say and have heard in order to feel relieved in the moment?” What partners need to say and have heard, among other thing, are wishes, fears, and self-doubts. It’s feelings about the frustrating patterns they get into and the power imbalances between them. It’s the relationship between present events and those in childhood. Loss of voice is an umbrella under which most of the common frameworks are included.
|2. Collaborative Cycle
|“How can I turn this fight or withdrawal into an intimate conversation?” My way to do so is to repeat what the partners just said but change their angry or withdrawn statement into a collaborative one. I’m modeling how to talk more skillfully—my version of psychoeducation.
|3. Joint Platform
|“How can I get this couple to step back and look collaboratively and compassionately at the situation they’re in?” The situation in question is typically a vicious circle or some other kind of impacted interaction—the couple system.
As I’ve just shown, I have my own preferred set of frameworks. But any set can be effective. As is generally believed for individual therapy—and probably true also for couple therapy—the skill of the therapist is more important than the theory to which s/he subscribes. What that means, as I see it, is that some therapists are good at maximizing the advantages of their particular theory and minimizing (working around and compensating for) its disadvantages. It may be true, however, that some theories have more deeply engrained disadvantages to work around and compensate for.
In this discussion, I’ve tried to create a platform for therapists—much like the one I create for couples—from which therapists can look at the range of possible couple therapy frameworks and see where they fit in.