This article was written by Lawrence Kaufman (L.M.F.T),  561-302-0568  contact@kaufmancounseling.com  

Introduction:

So much happens, so quickly, with such intensity in couple therapy! Words, feelings, sensations, reactions, and counter-reactions (reactions to others’ reactions) fly back and forth — faster than our minds can process. Emotional ups and downs (crescendos and decrescendos) rapidly follow one another. Sometimes a relative calm is suddenly shattered by a volcanic-like eruption. This may be the result of a “straw that broke the camel’s back,” we can speculate. Sometimes tears subtly emerge or pour forth unexpectedly. Sometimes a disturbing memory or image surprisingly floods into consciousness. Shifts of attention and focus can sometimes be rapid. One thought or idea expressed may be responded to, or the new speaker may change the subject to something seemingly unrelated.

Where did that come from? Why are we now feeling so intensely negative towards one another? Why does he/she now seem like such a stranger, adversary, or enemy? What happened?  How can we understand this sudden deterioration in our communication skills? “But we were doing so much better!” How can we account for what is getting played out in the office? How are we to make sense of all these confusing, disturbing, and unexpected feelings, thoughts, associations, and interactions?

Couple therapy can be a messy and unpredictable affair — very distressing, but also very gratifying and hope building. Since so much happens in such a short period of time, and since the consequences of what happens are so important, I decided, as a therapist, to slow the process down when meeting with couples. My aim was to help my couple clients get more meaning and benefit from their usually emotionally intense interchanges.

Below is an example of how this approach could be applied in practice — working with a fictional couple. What follows is a brief part of an imagined couple session. After each person speaks, I may provide my comments (– what I may be thinking at the time, but not necessarily sharing this with my clients.) My aim is to give you “an inside look” into how I think, reason, and understand what is going on during a session.

Be aware that in a typical, actual session, I do not interrupt or say as much as I do in this kind of interaction. Neither do I go into as many details as to what I think might be going on between the partners in a couple, and between the partners and me. I’m presenting what I am now as an (psycho)educational tool. I am providing ideas here for the reader to consider. Further, I am not presenting what I am saying as facts, the truth, or the only way to understand what is being presented. Everyone on his or her own can determine what is, and what is not, helpful and beneficial to him or her.

At times, I ask the partners to talk to one another while I observe their interactions. Prior to therapeutic “exercises” (also called “enactments”), I get both participants’ permission/ consent to interrupt them frequently. I explain to them that I think it could be beneficial to them to hear my observations about their interactions together.

A Portion of a Couple Therapy Session

Rob to Sharon: So, what would you like to talk about today?

Therapist: Let me stop you here. (Said first looking at Rob and then at Sharon.) Do you know why am stopping you already?

Comments: I want this couple to begin to think about and reflect upon what might be typical patterns between them. For example, does Rob typically not assert his own agenda in approaching Sharon? Is he beginning to show a pattern of shifting the focus of conversation from himself to her? Is he possibly not saying a feeling he is having at the moment?  Does he feel more comfortable taking a more intellectual approach? These are some of my first thoughts when hearing what he says, and how he is saying it.)

Rob: I have no idea.

Sharon: I don’t know.

Therapist (To Rob): How typical or not is it for you to not assert your own agenda with Sharon?

Rob: I don’t know. I never gave it much thought.

Sharon: He usually waits for me to take the lead in a conversation about our relationship.

Comment: Now Sharon is beginning to look more closely at how they usually interact with one another.

Sharon: I have something I’d like to bring up for discussion. (She then turns to Rob.) You never spend time with me when you come home from work.

Therapist: Let’s pause here to reflect on a couple of things. First, I think it is a plus that you have asserted what you would like to talk about. However, I suggest that before you start talking about a subject, you first get Rob’s agreement to talk about it.

Sharon (to Rob): Is it okay if we talk about this issue?

Rob: Sure.

Therapist: Before we move forward, I want to suggest to you that you be aware of using exaggerations in what you say to Rob. I have found that most people start having defensive reactions when their partner uses words like “never,” “always,” and “all the time.” These are exaggerations. Also, I think you would be more direct and be on safer ground if you used the word “I” instead of “you.” To me, for example, there is a big difference between saying “You never…” and “I feel.”

Comments: Particularly in the beginning of a course of therapy, the therapist can usefully provide psychoeducation (psychological education) to clients. The therapist is being pro-active in heading off (nipping in the bud) the use of dysfunctional (ineffective) communication styles, and providing more functional (effective, workable) alternatives to the less effective wording typically used.

Sharon: I get upset with you when you ignore me when you come home from work.

Commentary: Since this statement is somewhat an improvement over the previous version of what she said, the therapist decides it is best at this point not to interrupt any further the flow between them.

Rob: I’m exhausted when I get home. Why can’t you cut me some slack?

Therapist: Rob, what were you feeling when you just said that to Sharon?

Comments: The therapist intervenes (interrupts) here because he senses that the couple is soon headed for a negative interactional cycle — a repetitive (repeating), dysfunctional dialog that will only drag them down further. The therapist is also shifting the focus here to see how well Rob can identify and express his feelings, and can distinguish between feelings and thoughts. I find that most people tend to tell me what they are thinking when I ask them what they are feeling.

Rob: I felt put off, annoyed.

Therapist: (After Sharon does not respond for about ten seconds, the therapist says:) “I’d like you to respond to what Rob just said.” (As an alternative to this intervention, the therapist could have asked Sharon how come she didn’t respond to what Rob last said. I might at times even ask the listener what it is she just heard her partner say. Sometimes, it turns out, the “listener” can’t remember what the speaker just said. I then think that the person in the listening role never registered (took in) the communication in the first place. [One cannot “remember” something said if it wasn’t even heard in the first place. Sometimes the “listener” is so preoccupied with his or her own thoughts, concerns, and perspectives that (s)he has no internal space present to focus on what the other is saying.] This suggests to me that we need to work on listening skills as much as, or more than speaking skills.)

Sharon: You’re always thinking about yourself!

Therapist: Let’s step back now to understand about what you just said and the impact it may have had on Rob.

Rob: See how impossible she is? (Said in an exasperated manner, as you probably realize.)

Therapist: Please let me talk to Sharon about this matter for the next couple of minutes. This is going to be in the best interest of both of you. (Slight pause.) They both remain quiet. The therapist then continues, looking at Sharon.) I’m planning on saying some things to you that you may have a negative reaction to. Do I have your O.K. to say these things to you?

Comments: The therapist is modeling here, in part, practicing “meta-communication.” This is a form of communicating about the communication process itself. It has the effect of de-escalating the emotional tensions that are starting to build up between Rob and Sharon.

Sharon: That’s fine with me. I’m open to hearing what you have to say. That’s why we’re here.

Therapist: I appreciate your non-defensiveness about this. (The therapist gives reinforcement for valued, therapeutically helpful responses.) (A slight pause.) A couple of minutes ago you said to Rob “You’re always thinking about yourself!” How were you feeling when you said that to him?

Sharon: He’s so self-centered. Why can’t he think about what I’m going through, for a change?

Comment: The therapist decides to bypass (not focus on at this time) what sounds like Sharon’s blaming, attacking, and sarcasm. He wanted to control the “dosage” of his constructive criticism at this point. Challenging her further at this point would probably be counterproductive.

Therapist: What you just said is not your feelings. I have found that a large majority of people have difficulty distinguishing between feelings and thoughts. What was your emotional reaction to Rob?

Sharon: I felt fed up with him.

Therapist: That sounds like you are starting to see the distinction between feelings and thoughts. (Slight pause.) I also want to point out to you that you started your sentence off with the word “you,” and you used the exaggerated word “always.”

Therapist continues: Listeners to this form of communication often become defensive when they hear these words. Let’s try to avoid this kind of negative interaction between the two of you. Before we continue, I want to ask you, Sharon, if you are aware of having any negative feeling towards me about what I have just said.

Comments: The therapist wants to check in with Sharon to see how she is reacting emotionally to his confrontation of her. (I believe that the relationship of the clients to the therapist is very important. However, in couple therapy — as opposed to individual therapy — the therapist tries to remain focused more on the relationship between the partners than on the relationship of each individual to the therapist.) Timing, tact, and sensitivity are always important in a situation like this. The therapist wants to move the therapeutic process forward but not to the point of antagonizing the client. This would be counterproductive (that is — work against therapeutic progress). This type of confrontation is usually not appropriate during the initial sessions of couple therapy. Engaged in prematurely, it can lead to negative (adverse) reactions, such as clients prematurely leaving therapy.

Sharon: I’m all right with this. I’ve been in therapy before.

Therapist: Good. Now let’s play the scene again with Rob where you start off your sentence with “I,” and don’t use words of exaggeration like “always” and “never.”

Sharon (To Rob): I realize I wasn’t being as constructive with you as I could have been. It’s just that I get so upset and frustrated when I see you not taking my needs into consideration.

Therapist: I think that’s much more constructive. I’m impressed! (After a slight pause…) Rob — Sharon and I have been talking for a while together. How left out have you been feeling about this?

Rob: I’m O.K. with this. I know it’s for my benefit as well.

Comments: We certainly could continue with this dialog much further, and in greater depth. But we’ve covered a lot of ground here already. There’s plenty to think about. I want to emphasize that this session segment is somewhat artificial and condensed. In an actual session, the therapist probably would have made major modifications in what was said, how it was said, and the pace at which it was handled. The clients too probably would have handled the dialog differently as well.

What I think could be helpful to the reader is to imagine yourself from the vantage points of the three people engaged in this interchange. (Put another way, it is important to identify with each of the three people present in the room.) What can you learn from identifying with several different perspectives simultaneously? How could doing this help you get the most from your therapy sessions with your couple therapist?