My Approach to Couples & Family Therapy

1. My Approach toCouples & Family Therapy Combines Person-Centered and Emotion-Focused

2. More Work • A PhD in clinical psychology once told me he did not study couples and family counseling because it is more work. • That is true.

3. Background • I did not like any of the standard approaches to couples and family counseling taught in graduate school; so I invented my own approach: “Person-Centered Couples and Family Counseling” and tried it out on a few clients in internship. • More recently, I have learned about emotion-focused coupes and family counseling. • I liked it so much that I wanted to combine it with person-centered, which this presentation attempts to do. • I welcome any feedback or suggestions for adding to or modifying this approach.

4. Long presentation • This is a very long presentation (39 slides), because • It introduces an approach that is unique and • It combines two approaches, and • For the benefit of future clients, it includes everything I value about couples and family therapy. For my criticisms of standard approaches to family therapy, see my Power Point on family therapy on D2L.

5. Outline of this slide presentation: my approach to family therapy. • What person-centered theory teaches us: A. Congruence. B. Incongruence. C. Authenticity. D. Authentic and congruent relationships. E. “Yes” & “No” in counseling. F.12 areas of incongruence. G. Person-centered assumptions. H. Person-centered interventions.

6. Outline, continued- Emotion-focused part: II. Emotion & Attachment Theories • Importance of Emotions • 4 types of emotional response • 3 Dysfunctional types • Working with emotional response types • Emotional Incongruence • Attachment Theory • Attachment Incongruence • Attachment Needs • Relationship Distress Occurs • Still face experiment • Emotion-Focused Teaches: Need for Relationship • How it works • Mourning end of relationship and building for the future.

7. Person-Centered Teaches: Needs for Congruence & Authenticity • When we express ourselves congruently we are authentic.

8. Congruence • Our experience of the outer world (feedback) matches our intention and hope. • Our communication honestly and accurately matches our inner world (our feelings and thoughts). • “‘Congruence’ is no more, and no less, than being all of who we are at a given point in time with another human being. Congruent communication is a committed, active pursuit of clarity of meaning with another person” Brothers (1991).

9. Incongruence • We do not experience in feedback from others what we expect and want to experienceand/or • We do not feel we can honestly and accurately communicate our feelings &/or thoughts in a relationship. • If the client(s) do(es) not feel that there is an incongruence in their life and a need for congruence and authenticity, then no amount of counseling will result in inner or inter-personal growth. • One possible exception may be group counseling, which can inspire and resolve incongruence.

10. Authentic & Congruent Relationships • A person is in an authentic and congruent relationship when they can communicate honestly and accurately concerning their needs to be cared for from another, • And they can hear and genuinely care for the needs of another.

11. In a congruent & authentic relationship: • We will feel that our true-self is nourished and encouraged to grow -- even beyond the relationship. • We will nourish the other person’s true-self, even if that encourages them to outgrow or leave our relationship.

12. Yes & No • We require some positive feedback in intimate relationships (some smiles). • A little “yes” goes a long way,

13. Negative Feedback • For dialogue and learning and growth, we must also have a little “no.” • Many person’s self-esteem is so fragile that even a little negative feedback can be devastating – especially coming from a person of power and authority such as the counselor. • They have received negative feedback all their lives: from parents, teachers, et al. • They already carry that negative, critical voice inside them. • Who are we to tell them what is “right” for them?

14. Negative Feedback, continued: • To be effective in counseling, all the “no” must come from within the client. • It must be a “no” that is congruent with the client’s true-self, not imposed from without. • Clients can be trusted to continue to question themselves until they feel Ok about themselves alone and in relationships. • That is the goal of therapy; not for the client to behave in ways that are Ok with the therapist (or anyone else, including other family members), but to behave in ways that are Ok w/ the client’s true-self. • The counselor’s job is limited to correctly and empathically reflecting the client’s meanings and feelings in 12 problematic areas. • The client will take it from there: Each individual is a soul who has infinite capacity for growth – and desire to grow. • Each client knows in what ways they need and want to grow.

15. Exceptions • I have only met three people who did not want to grow, who did not want to be better, all as a criminal defense atty, none as a mental health counselor: • One man who was a hired killer, another who had sexually abused every girl and boy who had come under his power in 20 years, and a girl of 14 who was an exact copy of The Bad Seed.

16. (at least) 12 Areas of Incongruence& Felt Need for Congruence (may overlap) • Physical. • Mental. • Emotional. • Attachment issues. • Social/relational. • Spiritual. • Moral. • Creative (the ways we see and express the world differently). • Revolutionary (the ways in which we wish the world were different). • Maslow’s basic needs: physiological, safety, love and belonging, esteem. • Maslow’s higher needs: self-realization, self-transcendence. • Meaning and meaningful work.

17. Incompatibility & Overlap • In areas of spirituality, creativity, and revolution, the parties may see their attitudes as incompatible. • Where emotions and attachment issues are recognized, understood, accurately re-stated, and perhaps re-framed by the counselor is where person-centered and emotion-focused therapies overlap.

18. Correctly reflecting the client’s meaning and feelings • In order to correctly and empathically reflect the client’s meaning and feelings in these 11 areas, it is necessary for the counselor to have experience: not so that the counselor can give advice based on that experience, but so that the counselor can understand where the client is coming from in each of these 12 areas. • My 67 years helps: not because I know more cognitively, but because I am more understanding of clients’ feelings.

19. Person-centered assumptions • The family comes to counseling because it is experiencing “incongruence” between the family’s idealized picture of itself and its actual experience. • That incongruence may involve any of the 11 areas – but is likely to include relationaland attachment issues. • A communication within the family and within therapy is congruent if it honestly matches the member’s experience and awareness. • Increased congruent communication within a family leads to mutually accurate understanding of communications and improved psychological adjustment and satisfaction among all family members. • Each member of the family is seen as having the potential and yearning to become a fully functioning individual in a fully functioning family. • Fully functioning persons are those who can meet their need for positive regard from others and have positive regard for themselves. • Fully functioning persons can meet their need for intimacy within the family and meet their need for individual development outside the family. • Fully functioning persons allow others to express intimacy within the family and to grow outside the family. • In family counseling each member needs to learn to feel and show positive regard for the other members, and each member needs to be seen to show that regard.

20. Person-centered interventions • To help the family achieve the above, the counselor will: • Listen attentively. • Show empathy. • Show understanding by making kind-hearted restatements of each client’s individual concerns. • The counselor must demonstrate unconditional positive regard, and acceptance for each member and for the family as a whole. • The family therapist must draw out member’s strengths and validate those strengths; and • The therapist must be felt by the family members to be genuine, empathic, and fair. • In order to do his job effectively, the counselor will value each member of the family and each member’s point of view equally.

21. End of Growth • In some relationships growth is impossible – or no longer possible. • It may be necessary to end the relationship. • In that case, turn to the final slides of this presentation re. ending and building.

22. Equality • “In order to do his job effectively, the counselor will value each member of the family and each member’s point of view equally.” • That is the most difficult aspect for both counselor and clients: • Clients expect and want the counselor to side with them: wife vs. husband or parents vs. children. • The counselor must not do this.

23. Emotion-focused part -- Introduction to Clients • Clients are first shown the person-centered assumptions and interventions above. • Clients are then shown the following slides on dysfunctional emotions and attachment needs. • Whether the clients choose to re-frame any of their own problems, in terms of mislabeled emotions or attachment needs, is left up to them.

24. Emotion & Attachment Theories • Emotion-focused couples and family therapy combines individual emotion theory with attachment theory. • Emotion theory teaches us that we may misinterpret our own emotions and why, when, and how that is so, so that we can listen to them and interpret them better. • Attachment theory teaches us that we can be overwhelmed by emotions when our attachments are threatened, and may thus misinterpret what the other person is saying and fail to communicate our own feelings to that person effectively, appropriately, and authentically.

25. Importance of Emotions • Many people are afraid of feelings, especially strong negative feelings: their own and other people’s. • This leads to defense mechanisms. • Dishonesty in relationships. • Stunted emotional growth. • Emotionally stunted relationships. • Emotions are adaptive. • We need to listen to them and learn from them, to remain open to them in the here-and-now; rather than repressing them or fleeing from them because of past trauma. • We need to express our emotions effectively, appropriately, and authentically, ideally in the here-and-now

26. 4 types of emotional response: • (1) “Primary adaptive emotional response:” is a direct reaction consistent with the immediate situation and helps the person take appropriate action, e.g. if someone threatens to harm one’s child, anger is the adaptive emotional response: it helps us take assertive and if necessary aggressive action to remove the threat.

27. 3 Dysfunctional types: • (2) Maladaptive emotions: direct reactions based on past trauma that do not match the present reality; e.g. because of past sexual abuse, a client may respond to appropriate caring with fear and anger. • (3) Secondary reactive emotions: the client reacts negatively to the primary emotion, represses it, and attempts to replace it; e.g. a man who feels threatened by loss of a relationship may feel it is inappropriate to feel fear or sorrow. Instead of expressing his fear or sadness, he may get angry at the person who is threatening to leave him and/or he may get angry at himself. • (4) Instrumental emotions: a person reacts to the situation by enacting an emotion that is intended to influence or control others. Some anger has this underlying motivation.

28. Working with emotional response types: • Primary adaptive emotions need to be accessed, fully felt, and fully allowed. • Thus primary emotional pain, sorrow, grief, fear, and anger, which are appropriate need to be experienced and expressed appropriately, not fled from. Emotional pain does not kill. • Maladaptive emotions are best handled by helping the client access, explore, and express a different adaptive emotion (e.g. replacing maladaptive shame with self-comforting or pride). • Secondary reactive emotions require empathic exploration to discover the underlying primary emotions from which they are derived (e.g. primary fear or sadness under reactive anger). • Instrumental emotions are best explored for their interpersonal function or intended impact on others

29. Emotional Incongruence • Anger. • Emotional incongruence is most often characterized by anger. • Anger tells us something is wrong. • Anger is almost always a secondary emotion: it disguises fear or sadness or shame. • Many people are in denial of their anger and afraid of discussing it. • Clients are encouraged to identify their rage and explore the underlying roots of it.

30. Attachment Theory -- Ideal • Ideal of relationship health is based on attachment theory, characterized by: • A secure attachment bond. • Mutual, reciprocal emotional accessibility and responsiveness. • A safe environment, which • Optimizes each partner’s ability to regulate their emotions, • Process information, • Solve problems, • Resolve differences, and • Communicate clearly. • Sees the other as dependable and trustworthy.

31. Attachment Incongruence • We feel an attachment incongruence if we come up short in the ideal attachment relationship.

32. Attachment Needs • The attachment needs and desires of partners are essentially healthy and adaptive. It is how these needs are enacted in the context of perceived threat and insecurity that creates problems. • If the clients ask, the therapist can help them deescalate negative interactions and help them shape new cycles of positive interaction, in which positive emotions arise for both partners and negative emotions can be regulated. • Change occurs not thru insight but thru new emotional experience in present context of attachment salient interactions.

33. Relationship Distress Occurs: • When emotional or attachment incongruence is felt, • When relationship security is threatened. • People typically respond with fight/flight/freeze, in this order: • Anger, tinged with despair and coercion. • Clinging and seeking, accompanied by depression and despair. • Finally, if the attachment fails, the relationship is mourned and detachment ensues. • For how to mourn and re-build, see final section of this presentation.

34. Still Face Experiment • The still-face experiment on the next slide shows a baby’s desperate need for attachment reinforcement and extreme distress when the security of that attachment is threatened. • Distressed adults in a marriage are acting like this baby. • So the therapist’s first goal is to comfort and reassure both.

35. Still Face Experiment

36. Emotion-Focused Teaches:Need for Relationship. • We all have a need for a warm, close, reliable, self-affirming intimate relationship. • When we feel that relationship threatened, we panic and scream. • We feel depressed, anxious, and angry. • We attempt to re-gain that relationship, • Or to gain control of the other person.

37. How it works: Person-centered part: • The counselor will empathically re-state each family member’s feelings and thoughts, until that family member tells the counselor that the counselor has stated their concerns fully and correctly. • The counselor will then ask other family members to re-state that family member’s feelings and thoughts. Emotion-focused part: • When the counselor re-states problems, the clients may re-frame them in emotion or attachment terms, or • Ask for the counselor’s assistance in re-framing.

38. Mourning & Building • Mourning end of relationship and building for the future.

39. Mourning – 5 stages of grief: • denial and isolation ("This is not happening to me"); • anger ("How dare she/he do this to me!"); • bargaining ("Just let me save the relationship this time and I will be a good partner in the future"); • depression ("I can't bare to go through this"); and • acceptance ("I am ready -- I do not want to struggle anymore") (Elisabeth Kübler-Ross) • To these, the end of marriage adds a 6th stage: Re-building.

40. Re-Building • What have I learned from this relationship and its failure that is positive – that I can bring to future relationships? I will advertise my services for divorcing and divorced couples. What advice can you add?

41. The End