Questions
Couples Theory and Interventions
Clay Gruber Christopher J. Hall
This chapter discusses some of the most common theories and interventions used with couples, as well as introduces contemporary or developing methods. Running themes of communication, differentiation, and relational growth are noted throughout.
LEARNING OBJECTIVES
By the end of this chapter, you should be able to:
•describe theoretical frameworks involving couples social work practice;
•understand the implementation of those frameworks via case studies;
•identify the similar themes and principles of different family and couples theories;
•inform social work practitioners of modern developments, interventions, and influential names in the field of couples therapy; and
•understand the context for couples therapy models outside of the typical nuclear, heterosexual, White, and middle-class couple.
HISTORY OF COUPLES COUNSELING IN SOCIAL WORK
Though literature related to couples counseling has exploded in recent years, it is not a modern invention. For decades, couples therapy existed in a realm outside of the clinical mental health field that it is associated with today. The practice of working with couples was previously reserved for priests or obstetricians-gynecologists (Gurman & Fraenkel, 2002). As the field has developed, much has changed. Couples counseling is now a major component of mental health practice, and literature surrounding the topic is ever-expanding.
Considering the ethics and value base of social work, it should not come as a surprise that social workers began to place importance on the quality of loving relationships and recognizing their impact on clients. In fact, formal couples counseling has its origins firmly rooted in the field of social work. Far before the development of the field of marriage and family therapy in the 1950s, Mary Richmond in her classic book Social Diagnosis (1917) emphasized interventions for the entire family, including recognition of the quality of the relationship between mother and father. Jane Addams discussed the quality of relationships in Democracy and Social Ethics (1902), specifically when discussing her concept of sympathetic knowledge. Addams believed that we come to know one another in relationships and while part of knowledge rests in the collection of facts, relational knowledge comes through the experience of truly knowing and being connected to others, and that one’s well-being and quality of life are determined in part by the quality of those relationships in which one participates. In addition to creating the historical basis for couples counseling, some of the most well-known and influential couples and family counselors have been social workers including Virginia Satir, Insoo Berg, Steve de Shazer, Jay Haley, Lynn Hoffman, Froma Walsh, and Michael White.
ATTACHMENT THEORY AS RELATED TO COUPLES
Attachment theory is a developmental theory that was originally used to describe infant behavior and emotional development as a consequence of interactions with their parents or primary caregivers (Bowlby, 1969). While the theory was originally designed to describe infants, the attachment styles described by the theory affect human behavior well into adulthood. As Bowlby (1979; an early pioneer in attachment theory) stated, individuals’ attachment styles follow them “from the cradle to the grave” (p. 127). In the late 1980s and early 1990s, attachment theory began to be applied in the context of adult friendships and relationships (Hazan & Shaver, 1987, 1990; Shaver et al., 1988). It became evident that the principles defining the relationship between mother and infant were also applicable to adult interpersonal relationships. As Shaver et al. (1988) state in The Psychology of Love, “To the extent that adolescent and adult romantic love are also attachment processes, many of the concepts and principles of attachment theory should apply to them” (p. 69).
The literature that began to extend attachment theory to adults showed that our primary attachment figure changes as we age. While our parents fill that role as infants, adolescents in high school are equally as likely to endorse peers as their primary attachment figures as their parents (Freeman & Brown, 2001). As adolescents transition into adulthood, relationship dynamics change once again as young adults begin to identify romantic partners as their primary attachment figures (Rosenthal & Kobak, 2010; Shaver & Mikulincer, 2008).
The most recent advancements in attachment theory encompass all close relationships maintained by an individual and how needs and expectations are met within those relationships. For example, one tenet of attachment theory is that humans innately seek social, physical, and emotional contact with others. People require a reliable “secure base” from which they can depart, develop, and return (Bowlby, 1988). Without that base, uncertainty manifesting as anxiety can overwhelm the individual. Conversely, the presence of a predictable base is calming and assists in emotional regulation and autonomy.
The attachment structure can best be visualized as a bungee jumper leaping from a great height. To summon the courage to jump, a jumper must have immense trust in the cord and tether. In attachment theory, the “secure base” attachment figure serves as an anchor to which a person can attach their “emotional bungee cord.” They can then plunge into the depths of self-exploration, confident that they will always have a place to return to and once again find solid ground. The strength of that base is determined by a few key factors: accessibility, responsiveness, physical proximity, and emotional engagement, though these factors change over time and require less physical proximity in adulthood (Johnson, 2019). Thus, stronger and more secure bonds lead to deeper, more confident self-exploration.
Those who have strong, secure attachments have several defining traits. Secure individuals are comfortable with their need for closeness with others (Johnson, 2019). Additionally, they have positive expectations of others and are more capable of postformal thought (Sinnott et al. 2017). These traits are considered beneficial for the individual but also appear to serve as a protective factor against stress (Johnson, 2019; Mikulincer & Shaver, 2019). When attachments are not secure, individuals exhibit different behaviors to help cope with the loss or unreliability of their home base. Those behaviors act as an emotional “fight or flight” instinct. Fight or flight responses vary from person to person but fall into three main categories (Johnson, 2019). The first, called “preoccupied,” prevents anxiety by persons depending heavily on others. They avoid the stress of not having a reliable base by never leaving in the first place. The second response, called “dismissive,” approaches the conflict with an opposite solution. Dismissive individuals strive for self-sufficiency and view their attachment to others as a vulnerability. By distancing themselves, they navigate the conflict of unreliable bonds by avoiding attachment altogether. The third and final response is called the “disorganized” attachment style. Individuals in this style exhibit negative health outcomes such as greater emotional disturbances (Beeney et al., 2017), increased rates of borderline personality disorder (Khoury et al., 2019), developmental symptoms such as low recognition of other’s emotions (Forslund et al., 2017), and even enlarged amygdalas (a part of the brain that assists in emotional regulation; Lyons-Ruth et al., 2016). This attachment style usually stems from a history of trauma and is categorized by the paradoxical view that attachment is both the source of and the solution to anxiety (Johnson, 2019).
Even if a strong bond is developed, the strength of that security is not permanent. Security can dissolve or improve, based on further interactions with the attachment figure. Security dissolution can occur when an attachment bond is damaged or is lost altogether, resulting in immense stress and occasionally traumatization (Mikulincer et al., 2003). Conversely, bonds can also strengthen. This malleability presents social workers with an opportunity to provide an intervention to help strengthen bonds, client relationships, and client well-being.
Emotionally Focused Therapy
Emotionally focused therapy (EFT) utilizes the tenets of attachment theory to create a theory-informed intervention. EFT carries with it two primary missions: processing and regulating emotion (Johnson, 2019). EFT is humanistic and experiential in nature, valuing and accepting the individual and their unique life experiences and emotions. In EFT, emotional processing is viewed as a joint effort, requiring input from each member of the couple. When conflict is viewed as an emotional clash between two individuals, co-regulation of emotions as a couple becomes an obvious source of resolution. To partake in this joint emotional exploration, each partner must feel secure in their attachment to each other.
EFT begins with emotional de-escalation and emotional observation. Most couples will present to therapy with a negative pattern of emotions and dialog, often laden with critique and withdrawal. The social work practitioner works together with the couple to identify the damage to their perception of their partner as a secure base as well patterns of negative communication that stem from those perceptions. Specific emphasis is placed on reframing the problem in the vocabulary of attachment theory. One or both members of the couple do not feel wholly secure in their base; therefore, conflict triggers attachment anxieties. Those anxieties feel like threats and fight or flight instincts kick in, often resulting in partners attacking each other with criticism or fleeing through withdrawal. This language also helps remove the problem emphasis from an individual partner and instead places the focus on the subconscious interactions between the couple.
The social work practitioner then works with the couple to promote the recognition and communication of their attachment needs. For example, when a spouse complains that their partner forgets to take out the trash, they often report the secondary emotion—that they are angry. The social work practitioner would seek to deepen that thought and find the primary emotion: often that the individual feels unheard in the relationship. Communication of their needs is then transferred away from the secondary feeling, and emphasis is instead placed on communicating their primary emotions and attachment needs.
Couples often find that this way of communicating is not necessarily difficult, but different from their typical style. The social work practitioner then encourages the couple to process the experience of exploring emotions together. The couple often finds a more emotionally vulnerable conversation is more constructive. This step not only validates the couple for allowing themselves to be vulnerable but also emphasizes a situation in which their partner was a secure base for them. Couples terminate from EFT feeling more secure in their attachment, more skilled in emotional awareness and regulation, and more accepting of each other’s emotions (Zuccarini et al., 2013).
Overall, EFT has been shown to be a highly effective application of attachment theory in both couples and families (Beasley & Ager, 2019; Wiebe & Johnson, 2016). Additionally, recent research has shown that EFT is highly effective with gay and lesbian relationships (Hardtke et al., 2010) and is even being modified to focus on the specific challenges those relationships experience (Allan & Johnson, 2016).
SOUND RELATIONSHIP HOUSE THEORY
Sound relationship house theory and the Gottman model that stems from it are empirically backed, highly effective methods of approaching couple’s counselling (Bradley & Gottman, 2012; Buehlman et al., 1992; Garanzini et al., 2017; Gottman & Gottman, 2008). There is a particular focus on communication (especially in the context of conflict) and building friendship within the relationship in this approach. Conflict is inevitable and sometimes perpetual in relationships (Anderson et al., 2010). It is with that principle in mind that sound house theory addresses how couples resolve conflict instead of taking on the impossible task of avoiding conflict altogether. The Gottmans, the creators of sound relationship house theory and the Gottman method (a therapeutic intervention built from their findings), describe sound relationships as a house with seven levels built upon pillars of trust and commitment. The foundation of this house is built on understanding and the creation of a positive bond between the couple so that, when conflict arises, a positive tone has already been established. The main floors of the house address conflict and the positive-to-negative sentiment balance of the relationship. The core helps couples stay mindful and constructive with their communication during times of conflict. Finally, the top layers address the long-term structure of the relationship and focus on creating a shared meaning and goals for the couple. This conceptualization of couples therapy has been found to be effective in many settings including heterosexual, gay, and lesbian marriages (Garanzini et al., 2017; Gottman et al., 2019), and couples in poverty (Bradley & Gottman, 2012).
The first level of the sound relationship house involves building love maps. The love map exercise involves partners asking their spouse a series of basic questions with the intention of building a stronger connection in the couple. Questions such as “What is your favorite tree” and “What is your partner’s favorite restaurant” tend to reveal deeper emotions as the responder recalls the narrative that led to their answer. Strong friendships act as a protective factor during problem-solving that can help the couple avoid escalations and conflict.
The second level of the sound relationship house involves the sharing of fondness and admiration. This level, like the love map level, seeks to build a relationship that is founded on positive views of one another. Building such a view is easy in the start of a relationship, but couples often find that, later, it begins to take effort. Limerence, colloquially called “puppy dog love,” tends to blind couples to any potential issues that may arise in a relationship. A steady supply of oxytocin warps the lens through which a partner is received, often resulting in unabashed admiration. However, on average, the limerent phase fades around 2 years into a relationship (Tennov, 1979). Therefore, a conscious effort toward maintenance of positive feelings toward the partner is required. Fondness is shown by expressing a positive regard for one’s partner. Phrases such as “I’m proud of the way you dealt with that issue at work” or and “I’m impressed that you know so much about your hobbies” are typical ways one can express fondness. In addition to building a positive view of a partner in the person delivering the message, these expressions also validate the recipient, confirming their partner’s continued positive regard toward them. Building the core of a relationship upon positive views of each other helps limit contempt in future times of conflict. If the foundational view of one’s partner is positive, it becomes much easier to handle conflict from a positive, problem-solving perspective (Navara et al., 2016).
The third level involves turning toward instead of away from a partner’s bids for connection. Bids for connection are often short, small verbal phrases from partners that carry a heavier subtext. That subtext, is often a request for an emotional connection. Take for example an individual who asks their partner to help them water the flowers. Watering the flowers is a task that, for most people, is easily accomplishable by one’s self. The intent of the request was not to ask for help with a difficult task—the request was for the couple to spend time together. It is important to note that these bids are not passive-aggressive in nature. Instead, they’re positive calls for the couple to strengthen their emotional connection and therefore should be embraced or, in the language of sound relationship house theory, turned toward.
Creating a positive sentiment override is the fourth level. Positive sentiment override is comparable to what is colloquially known as “benefit of the doubt.” Those in positive sentiment override tend to take neutral remarks positively. Couples in negative sentiment override take comments that are rated neutral by external judges as negative (Weiss, 1980). Additionally, those who are in positive sentiment override have increased relationship stability and marital satisfaction (Buehlman et al., 1992; Fincham et al., 1995). To build a positive sentiment override, the Gottmans utilize what they call the “emotional bank account.” There must be five positive interaction deposits for every negative interaction withdrawal to maintain a neutral account balance (Navarra et al., 2016). Positive interactions can be turning toward a bid for connection or expressing admiration. This concept helps explain the previous three layers of the sound house—building a strong positive balance early will help when the inevitable withdrawals occur.
The fifth layer, managing conflict, is slightly denser, consisting of two sublevels. The first sublevel is to manage how conflict is approached; specifically, the way complaints are introduced. Gentle introductions reduce negative affect escalation, a particularly harmful conflict pattern in which negativity is matched with an even higher level of negativity. The second sublevel involves creating an active and continuing dialog surrounding problems that will persist over the entire life course of the relationship. From a conflict resolution approach, voicing the concern is vital as it helps prevent pent up aggression and resentment. The removal of that resentment is particularly important when perpetual problems are involved. Creating a perpetual line of communication to address perpetual problems removes the opportunity for pent up anger to fester and negatively impact the romantic relationship (Navarra et al., 2016).
The sixth layer turns back toward addressing not only the future conflict before it occurs but also the future of the relationship and the individuals within it. The goal of this level is to honor one another’s life dreams. The Gottmans postulate that many perpetual conflicts stem from individuals feeling that they are sacrificing part of their dreams (Gottman & Gottman, 2008). Exploring each other’s aspirations by adopting an approach of curiosity and support helps avoid these conflicts. Couples then gain perspective into their partner’s dreams that may feel violated or sacrificed in the relationship. This gained perspective provides context during arguments and reduces the likelihood of resentment toward the partner (Gottman & Gottman, 2008).
The seventh and final layer is to build a shared meaning system. The Gottmans state, “master couples intentionally build a shared story of their relationships and a sense of purpose and shared meaning in which their own individual existential struggles become merged, in part, into a system of shared meaning” (Gottman & Gottman, 2008, p. 159). Couples achieve this shared system by utilizing three key strategies: (a) creating rituals of connection that help form a reliable emotional bond (e.g., having dinner together, traditions involving birthdays or holidays); (b) supporting their partner’s roles in life such as their career, family, and friends; and (c) sharing life goals with their partners. While those goals may have been formed before the genesis of the relationship, others may be formed later in the relationship (e.g., becoming a parent or traveling the world together). The shared dreams help give a relationship meaning and shared goals to work collaboratively toward.
CASE STUDY 5.1
Jack, 27, and Diane, 26, have been married for 3 years and have recently agreed to participate in therapy as their marriage is, in their words, “not what it once was.” Jack and Diane are relatively affluent, both working in the tech industry where they first met 5 years ago. Diane has aspirations of getting a master’s degree in computer programming. Jack supports Diane in this endeavor, and she plans on applying to a local university in the fall. Meanwhile Jack is rising through the ranks at his job and is currently in consideration for a promotion. Diane is very supportive of Jack’s aspirations, citing a promotion and increased salary will help them financially when she begins her master’s program. Despite these positive sentiments, the couple reports that “it’s somehow the small things that cause all of our issues and it’s tearing our marriage apart.”
Jack and Diane came in for a series of three assessment studies—the first as a couple and the following two they attended individually. In their joint session, they were asked to give a brief story of why they were attending therapy and the history of their relationship. Jack and Diane reported that they both attended a nearby university and graduated the same year with the same degree, but never knew each other. It was only when they started working together at Tech Inc. that they began to talk. The couple said it was “love at first sight.” They would go on fun, interesting dates, and explore new parts of the city together. After a year of dating, Jack proposed, and a year after that, they were married. Exploration has been a continued theme in their marriage. Without the responsibility of children, they are able to travel often. In spite of this, the couple reports that, “since getting married, the relationship has gotten more difficult.” While they are more than willing to express their love for each other, the words sometimes feel hollow to the recipient. Jack and Diane “feel like roommates” and say they often engage in self-described petty arguments. Toward the end of their joint session, the couple was asked to discuss a recent conflict. They discussed an incident that has occurred frequently in their marriage—a debate as to who would take care of the dog that day. “Taking care of the dog” is defined in their relationship as refilling the food and water dish as well as taking the dog for a walk. Jack stated that the day before the session, Diane and Jack returned home from work and needed to care for their dog. John began describing the situation, saying that Diane asked him to take care of those duties, but Diane quickly interrupted saying, “I only asked because I had taken care of the dog that morning.” John acknowledged her interjection as true and continued, saying he asked if they could split duties that day—he would let the dog out while Diane refilled the food and water. Diane then stated that she believed Jack was trying to get out of his share of the daily chores to which Jack sighed and responded, “she says I’m lazy.” From there, things escalated, quickly devolving into an attack–defend–counter attack pattern of interaction.
During the first individual session, Diane described her family background. Her father was described as a “country boy” and a widower who was very focused on his career throughout Diane’s childhood in the rural American South. More than anything, her father emphasized that his children learn financial independence and “toughness.” Diane stated that the toughness and independence ingrained in her were both a benefit and a detriment to her relationship with Jack. She stated that Jack was raised to be sensitive and that they balanced each other out. However, she also stated the difference in personalities often led to conflict. Diane preferred utilitarian displays of affection like doing chores or cleaning the home, whereas Jack liked emotionally driven displays such as cuddling and physical affection. Diane stated that, while she loved Jack, she felt that his softness made him lazy.
Jack’s individual session also began with a brief description of family history. He stated that his parents had a bad marriage and that he wanted to break from that pattern. His father was an aggressive alcoholic and generally apathetic of his relationship with his mother. Like Diane, Jack was also very invested in the relationship and loved his spouse but couldn’t figure out why they always fought. When talking about the relationship, Jack was despondent, saying he was running out of hope for the relationship. Jack said he has become increasingly angry when they get in arguments, feeling frustrated when Diane “starts taking everything personally.” He said that he had recently taken to shutting down arguments by saying “let’s talk about this later” but the couple never would, fearing rehashing the argument would lead to more anger instead of resolution.
Theoretical Insight
Like many couples, Jack and Diane’s relationship has strengths and weaknesses. Their “sound relationship house” has a sound foundation but is missing a few key pieces on the higher levels. Their bids for emotional connection (e.g., working together to accomplish the task of taking care of the dog) are denied, there is a negative sentiment override (neutral comments are taken personally), and their communication is marred by the four horsemen. Despite these negative aspects, they also are willing to express their love and admiration for each other, support and understand each other’s lifelong goals, and have a shared meaning of their relationship (traveling the world together).
The case of Jack and Diane articulates the need for a theoretical base to practice, as the highlighted gaps in their sound relationship house inform how intervention will be performed. While Jack and Diane understand each other’s world and share fondness for each other, they have a key weakness in connecting on an emotional level. The build up of denied bids for affection have left their “emotional bank account” overdrawn. Work with the couple would begin by exploring those bids, defining them in a positive light. Almost all couples make bids for connection daily without realizing it—the simple awareness of these calls for attention can be enough for clients to start turning toward their partner instead of away. Another exercise that is helpful in this section is completing Chapman’s love language exercise (1992). By having a better understanding of the partner’s love languages, one can more easily translate and embrace their bids for connection.
Often, simple awareness of the four horsemen can be healing for the relationship. For Jack and Diane, the social worker asked them to once again act out a recent disagreement, but this time asked them to stay mindful of their communication. Incidence of the four horsemen dropped, and whenever one would slip in, the social worker would gently intervene and help keep them on track. Because the four horsemen are typical of “me versus you” conflict, the removal of these practices allowed the conflict to transition to “us against the problem.”
Jack and Diane were able to learn the tools needed to properly communicate within their relationship using the sound relationship house theory and Gottman model of intervention. Again, their goal is not to reduce or avoid conflict but to instead change the perspective of the couple toward a more positive view of each other and a problem-solving method of communication.
THE IMAGO RELATIONSHIP THERAPY MODEL
Imago relationship therapy (IRT), aligning with a strengths-based perspective, views conflict as natural and an opportunity for relational growth (Hendrix & Hannah, 2011). IRT shares many aspects of attachment theory and sound house theory in that familial interactions and positive relationship affects are emphasized. As stated by Dr. Harville Hendrix (regarded as the co-creator of imago therapy with Dr. Helen Hunt) and Dr. Mo Therese Hannah (2011), “Since interconnectedness is the defining feature of human nature (and all nature), the perceived loss of connection is the source of all human problems” (emphasis in original; p. 2).
IRT postulates that all children are born whole, empathic people. As the child grows through key developmental phases, this wholeness is wounded by parenting and their environment. These wounds often result in compensatory behaviors; however, like giving analgesics to a patient with a broken arm, these behaviors often provide temporary relief without resulting in any healing. Healing must instead come through relational bonds. Where parents and society failed the child, their partner must step in as a healing agent. The partner can provide the love and attachment that was missing from the wounded child’s upbringing and help repair the age-old wounds (Hendrix & Hannah, 2011; Muro et al., 2015). This healing process is viewed as a collaborative one, especially between adults in relationships and also with the Imago therapist. IRT proposes four primary principles vital for repairing those wounds and fostering healthy relationships: being present, learning to talk, replacing judgment, and infusing positive regard into the relationship.
The process of being present involves separating the consciousness of the couple, promoting a mutual understanding that the couple is composed of two unique individuals with unique experiences that have shaped them over the course of their lives. The end goal, differentiation, helps build a foundation upon which an understanding of each other’s wounds can be built (Hendrix & Hannah, 2011).
The second process, in contrast to the first, emphasizes togetherness as opposed to separation. However, that togetherness is not related to the joining of people but instead to communication goals. Instead of using the differentiated self to build unique monologues that contrast against each other, individuals “learn how to talk” together. This process seeks to construct an empathetic dialog between the couple, fostering connection (Hendrix & Hannah, 2011). The dialog utilizes skills used by therapists in social work practice but translates them into lay terms that are easily understood by the average couple. The Imago dialog starts by asking the listener to mirror or reflect their partner’s concern. The listener summarizes and reflects back their partner’s message, ensuring clarity and conveying understanding. The listener then validates their partner, accepting the concern without judgment and ensuring that their partner feels seen. Finally, the listener provides an empathic response, reflecting upon how the concern may be affecting their partner. The empathic response validates the emotions that the topic may be invoking in the partner. With the door to emotional expression opened by the listener, the speaking partner will feel safer discussing the concern’s emotional impact.
The final two stages of Imago healing closely mirror the process of building positive regard in sound relationship house theory. However, Imago splits the process into two parts. The first aspect, replacing judgment, takes the dialogical connection and removes negativity. Imago therapy does so by striving to remove judgment and negativity and replacing them with curiosity and positive regard for the partner (Hendrix & Hannah, 2011). If the relationship dialog was rated on a scale of −10 to +10, this process focuses on taking a negative score and returning it to zero.
The final process, infusing positive regard into the relationship, seeks to build upon the zero and push it toward a 10. This step focuses on building a dialog that is not simply not negative, but is instead positive. This is achieved by expressing positive feelings toward one another such as admiration, praise, and acceptance (Hendrix & Hannah, 2011).
Through these stages, acceptance and healing is fostered. Hendrix and Hannah (2011) summarized the healing process of IRT with the following:
This rupture, in order to close, needs the combined work and determination of both partners; if they are going to grow up as individuals, they need to do so as a couple. They were wounded in relationship; their relationship, therefore, is what they need to heal. (p. 4)
CASE STUDY 5.2
David and Amy had been engaged for just under a year when they presented for couples therapy services. They were self-described high school sweethearts and had been dating for 8 years before David proposed. David worked at a local bank as a teller and Amy was a dental hygienist. While engaged, they had not begun planning a wedding. The couple stated that they “weren’t in any rush” and were planning to have a long engagement of around 4 years to give them the opportunity to save for their ideal wedding. In their first session, they stated that their primary presenting issue had to do with disagreements over living arrangements.
David and Amy were living independently, each renting one-bedroom apartments in Beachtown, United States. Rent was rapidly increasing in Beachtown and living separately was becoming more and more of a financial burden on the couple and thus a larger topic of conversation. Amy wanted to move in with David once they got engaged, but David disagreed. David stated that he was raised in a strict Christian household and, even though he did not participate in the religion as an adult, it was still morally wrong for a couple to live together out of wedlock.
Amy, citing David’s lack of religiosity, believed that there were ulterior motives behind David’s position. Amy believed that David did not want to fully commit to marrying her, saying that living together would make it feel too “official.” Engagement, she said, was not legally binding like a shared lease, so there was little physical proof of them being a couple. She expressed her belief that David was using his family’s religion to keep her at arm’s length. When brought up between them, these accusations typically anger David and discussions escalate into screaming matches quickly.
The social worker took note of this point and used it as a segue to explore the couple’s family history. David, an only child, reported that he was raised by two U.S. Army veterans who taught him values and respect. He reported that his parents were strict and had a propensity to ground him for relatively benign wrongdoings. David recalled one night in high school when he went out with friends to see a movie. He was on his way home, barely on track to meet his curfew when he realized that he needed to stop for gas. He called his mom to tell her, but she was not receptive of David’s excuse, simply stating “rules are rules.” David arrived home a few minutes late to his mother waiting in the living room. She lectured him and restricted his driving privileges for 2 weeks. David looks back on this memory in a positive light stating, “I’ve never been late to anything again.”
David was also responsible for a set list of chores such as making his bed, folding laundry, and washing the dishes after dinner. He stated that his parents used the chores to teach him discipline, pointing out flaws in his folding and cleaning until he could perform the tasks perfectly every time. The chores were performed daily apart from Sunday when the family dedicated their day to church and spending family time together. David stated again that he looked back upon his childhood positively, saying that his parent’s toughness made him a better man.
The social worker thanked David for sharing and moved to Amy’s history. Amy described a much less organized childhood. She was the fifth of eight children, one of only two girls. Her father was a night janitor at a local office park and her mother was a third grade teacher at her elementary school. With differing shifts, limited income, and a large family to care for, the distribution of chores became a vital part of maintaining the household. Amy was responsible for cleaning the dishes and folding the laundry but, unlike David, no one went behind her to check for imperfections. She stated that she was performing chores out of household necessity, not to learn values.
She also stated that she could not relate to David’s curfew story. She had very little supervision as a child and would regularly leave home without her parents even knowing where she was going. She said her parents trusted her, but Amy said the trust wasn’t always earned. During high school, Amy’s older siblings started to leave the home to get jobs, leaving Amy with a growing mountain of household chores. She began to grow resentful of these chores and would occasionally act out in class, sometimes even getting in physical altercations with other students. Through it all, Amy was able to graduate high school and move to Beachtown to get a dental hygiene certificate. Now, years removed from her situation, she values the lessons her parents taught her. Like David, Amy also viewed her childhood in a positive light stating that she learned how to maintain a house and learned independence through tough life experience.
Therapeutic Perspective
The social worker, having reviewed the family histories and conflict patterns within the couple, would determine that David and Amy are a Rigid–Diffuse Couple that experienced wounding in the identity phase of their childhood.
In a time in which David was supposed to be exploring and defining his identity, he was restrained to fitting within the mold that his parents deemed ideal. Despite his parents’ best intentions, it was counterproductive for David’s development to impose hard and fast rules in the household. It is, after all, a stage of self-exploration and restrictions limit the child’s ability to safely define their identity. In reaction to these wounds, David has become what the Imago model would refer to as a minimizer (Luquet & Hannah, 2014). He has strong feelings about how things should be and can be quite rigid in these beliefs. He also comes across as controlling, as the idea of controlling what is right or wrong was exemplified during his childhood. While he understands Amy’s desire to move in, he believes it is wrong and has taken an adamant stance against living together before marriage. While he is no longer religious, David says that the values instilled by religion still define him and are vital to being a good person. David wants to be a good person and is quick to defend his beliefs as he views anything contrary as Amy persuading him to do something immoral.
Amy, on the other hand is what the Imago model would call a maximizer (Luquet & Hannah, 2014). Similar to David, she was not given the chance to define her own identity, it was defined for her. But instead of having her role set by overbearing parents, it was set by absent parents. While her parents were working, she was helping maintain the house. As a middle child thrusted into an adult role, she felt invisible in her own family. Those wounds translated to a fear of not mattering or being heard in her relationships. She, like many maximizers, is complacent at first to maintain peace; however, once she feels unheard, she can tend to blame and criticize. While she was complacent with the living arrangements at first, the feeling of invisibility has slowly crept into her relationship. Now, in an effort to be acknowledged, she is lashing out, accusing David of not being invested in the relationship.
Just as each individual was exploring their identity as a young person, they are now exploring their identity as a couple. As they seek to define their couple as an identity, the past wounds they have experienced in this phase are affecting their effectiveness to communicate. David, echoing the themes of his identity phase, is trying to impose hard and fast rules, whereas Amy is trying to feel valued in a situation where she feels invisible.
The social worker will guide the couple through the collective healing of their past wounds. The social worker started healing work with this couple by first building a sense of individuality within the couple by helping them understand their own Imago or image. The individuals reflected upon their childhood experiences, especially emphasizing how those wounds have resurfaced during their relationship. This practice improved their understanding of themselves and their wounds. This process also opened the door for better shared understanding within the relationship as understanding oneself is a necessary prerequisite to having someone understand and empathize with you.
The social worker used this as a base to then create an Imago dialog between the couple. David emphasized slowing down his reactivity and receiving messages as input, not as criticism while Amy emphasized defining her views and conveying messages that appropriately express her opinions. Once the vitriol was removed from the conversation and replaced with empathy, David began to see Amy’s point and Amy began to feel empowered by her more equitable standing in the relationship.
With the newfound dialectal skills and understanding of their partner’s Imago, the couple discussed the matter at home several times over the following weeks, eventually deciding to move in together once their leases expired in 6 months. After discovering the space to safely discuss the topic, they found that they spent the night together most nights and, in a way, were already living together. Moving in would help consolidate their finances and give them the opportunity to begin writing their new chapter as a married couple. While initially the problem was defined as a clash of unwavering family values, the couple was able to find a solution and growth after gaining a better understanding of their partner’s childhood wounds as well as their own.
Their wounds were not instantly healed, however. While Imago theory-based intervention helped give perspective to the topic of living situations, old patterns of childhood wounds can and will quickly emerge in other situations. Continued focus on healing wounds jointly as a couple is a vital part of the success and positive growth of any couple’s relationship.
OTHER INFLUENTIAL COUPLES INTERVENTIONS AND PEOPLE
Bowenian Therapy
Bowenian family systems theory is a developmental theory that applies transgenerational theory to understand the relationships and interactions that occur within families. The theory applies to intergenerational nuclear families as well as intergenerational extended families, allowing for the theory to be applied to couples as well as families (Bartle-Haring et al., 2007; Jeffries et al., 2016). Bowenian therapy is unique in that, while being applied in family’s and couple’s therapy settings, it is practiced with individuals as well (Bowen, 1978).
The primary focus of Bowen’s theory is the multigenerational transmission of patterns of interaction. For example, Bowen held that the ways in which one generation argued, coped with stress, understood roles of husband and wife, could be passed down to the next generation and, without awareness of this transmission, the next generation could replicate those patterns. These multigenerational transmissions could be healthy but in cases where the family is in conflict, maladaptive patterns could also be transferred.
Bowen viewed anxiety as the primary cause of mental health systems (Bowen, 1978). Anxiety is not easy to contain and therefore moves through the family system, usually in triads. Those triads are a by-product of what Bowen calls triangulation. Bowen believed that when anxiety erupted between two members of the family, they would bring in a third aspect to diffuse the direct tension. This concept is seen in the light-hearted example of first dates. The beginning of many first dates is characterized by awkward small talk. Both parties are feeling anxiety, especially toward each other—and so they pull in external third parties. Conversation may begin to revolve around a mutual friend, pets, or the weather. Bringing in these external factors allows for tension to diffuse and anxiety to reduce. However, the same premise can be applied to much higher-stake contexts within families and couples. For example, a couple in conflict may excessively focus on their child’s life in order to diffuse the relational tension between them. The child becomes a tool of avoidance, but this ultimately perpetuates the problem.
Like many of the theories described in this chapter, balancing togetherness and autonomy (i.e., differentiation) is a primary goal of this method. Bowen stated, “The ability to be in emotional contact with others yet still autonomous in one’s own emotional functioning is the essence of the concept of differentiation” (Kerr & Bowen, 1988, p. 145). To differentiate, individuals are required to approach problems with a balance of emotions and logic. In Family Evaluation (1988), Kerr and Bowen describe thought processes as depending on two guidance systems: the emotional guidance system and the intellectual guidance system. Balancing those guidance systems and methodically choosing which to utilize is a key aspect of differentiation.
The other key aspect is separating oneself from others. This is not an endorsement for isolation, but more so for insulation. The previously mentioned child who is drawn into their parent’s conflict will likely take on some of the anxiety the parents are trying to diffuse. By insulating oneself within the system, the child will be able to maintain their role in the family while not taking on the familial anxiety as their own.
Overall, Bowenian theory describes families as being healthily developed when each family member is autonomous and differentiated, emotional consecutiveness between members is high, and interactions are considered rewarding and healthy (Bowen, 1978).
CASE STUDY 5.3
Mark and Debbie have been married for 12 years and have two children ages 5 and 9. There is currently an open social services case on the couple for parental neglect. As a part of their services, they have been required to attend parenting/couples counseling. The social worker uses a Bowenian approach and begins to look transgenerationally at the ways in which their parenting styles may have developed.
SW:
Hi, Mark and Debbie. Thanks so much for sitting down with me. As I understand it you have been asked to come to see me by social services because of some parenting challenges that you’d like to overcome and put behind you. To begin, I think it could be helpful to get some idea of how you both were raised and how you came to understand parenting; would that be okay?
Mark:
Yes, that’s fine. We’re not too excited to be here really, we just want to be left alone. (Debbie nods her head in agreement.)
SW:
Thanks for sharing that with me and I completely understand. Let’s see if we can all work together and get you both where you’d like to be as fast as we can, okay? Mark, could we start with you? Could you tell me a little about how you were raised? Who raised you and what was that like?
Mark:
Well, it was my mom and me really. My dad was around but he was a jackass! So my mom was the one who raised me. She was always real nice to me and protected me from my dad a lot. My dad wasn’t really around that much. He worked night shift and slept during the day. So it was really just mom and me.
SW:
Thanks for sharing that, and what was your mom like? Sounds like you all spent a lot of time together.
Mark:
Yeah. She was real nice to me and we were basically friends. She would tell me things about dad and I would listen and get her calm. And she would help me out, too. If I got in trouble with dad and he told me to do something, like a punishment you know, then mom would get me out of it or tell me I didn’t have to. You know, things like that.
SW:
Ok, so your mom was kind of like your friend, would protect you from your dad, and you would help her out, too. Your dad was removed and not around too much and when he was around he was strict, is that about right? (Mark’s head nods in agreement.) Okay, how about you, Debbie; what was it like growing up for you?
Debbie:
My mom and dad were both hands off. Way hands off. They really didn’t care about me and let me do whatever I wanted. I had no curfew, I could keep beer in the fridge at 16 (Debbie laughs), I don’t know what they were thinking except that they weren’t thinking. They told me basically that they had no time for me and I was supposed to raise myself.
SW:
Thanks Debbie. That sounds like it was a little confusing for you growing up?
Debbie:
I think so. I mean on the one side I could do what I wanted but on the others side I didn’t feel very loved.
SW:
Debbie, how do you think the way you grew up affected your parenting of your children now?
Debbie:
Well, I am the opposite of my parents! I love my kids and I want to do right by them. So if they do something right I love on them, but if they get out of line then I give them work or I take something away. I have rules. I’m nothing like my parents at all.
SW:
Okay, so it sounds like, Debbie, that the way you grew up did affect you in the sense that you are operating in the opposite style of your mom and dad. Mark, what is your parenting like now?
Mark:
Well, Debbie and me are on two different pages with the kids. I don’t want them to get into trouble or have things taken away, so she and I knock-heads with each other on some things. Like our oldest had his phone taken away and she was going to keep it for a week. He came to me crying and I gave it back after 3 days. Then Debbie gets angry at me.
SW:
Okay, Mark. I’m wondering if you see a pattern between the way you were raised by your mom and how she protected you, and how you are as a parent now and the way you may be protecting and aligning with your kids against Debbie?
Mark:
I can see that, yeah, that makes sense. I feel like I am right, though.
SW:
Alright, Debbie and Mark. Let’s set aside right and wrong for now and look at what we have. We could have parenting patterns that have been handed down generationally. Mark, you are operating like your mom, you are being a friend and protecting, while, Debbie, you are operating in the opposite way of your parents, by giving rules and punishments where your parents did not.
In this scenario, the social worker has explored parental transgenerational patterns with both partners and has made these patterns clear to the couple. The child is able to join with Mark, who treats him as a friend, in order to triangulate Debbie. With this knowledge, the social worker then assists the clients to decide whether they would like to continue these patterns in their parenting or if they would like to change them, and if so, how they would like them to change. The couple decided to balance with each other, and Mark agreed to not save the children from consequences and Debbie decided to change her way of loving the children to be less severe and worried when they made mistakes. The resulting changes assisted the children to be less confused in the family; they felt things were fairer and clearer, and their problematic behavior diminished.
Salvador Minuchin and Structural Therapy
Salvador Minuchin was a family therapist from Argentina who developed structural family therapy in conjunction with Braulio Montalvo, a social worker at the Philadelphia Child Guidance Clinic (Minuchin, 1967). Structural therapy posits that there are subsystems within a family and that these subsystems work to maintain a shifting balance within the family called homeostasis. The subsystems are the spousal subsystem (romantic partner and partner), the parental subsystem (parent and parent), and the sibling subsystem (child or children). The theory maintains that these subsystems ideally operate independently of each other and that each member of the subsystem plays a role in that system that is separate from the roles played in other systems. There are also boundaries between these subsystems that can be one of three types, clear (ideal), rigid (unbending or harsh), or diffuse (undefined and easy to cross). In an ideal relationship, there is a boundary between roles and subsystems, and these rolls and subsystems change over time as the members of the system change, as well as to adapt to the environment outside the system. This change and flexibility is known as changing homeostasis.
Problems are understood to arise when the subsystem boundaries are crossed and roles are confused. A social worker operating from a structural approach would assess the structure of the family to determine the balance of each subsystem paying attention to how the subsystem developed. The social worker would look specifically for how each member accommodated the other’s needs as well as negotiated their needs in the relationship. A subsystem in which one member accommodated while another did not can lead to a relationship build on animosity. The social worker also looks for the type of boundaries between subsystems.
Second, the social worker would explore how their families of origin may be impacting their current relationship. For example, have the mother and father of one partner given space for that partner to be a husband and father in addition to being a son? Have the parents let go enough so that the client can individuate from the family of origin? Meaning, are they both connected to and separate from the family of origin?
Third, the social worker helps the couple renegotiate and rebalance their relationships and roles across subsystems. The worker helps re-establish boundaries among these systems so that the homeostasis of the system can readjust to one that is more preferable to both partners.
CASE STUDY 5.4
A couple comes in to see a social worker complaining of arguing to the point of possible separation. The social worker seeks some basic background about their relationship and current existing stressors. The couple has been together for 20 years, have three kids who are all in college, ages 18, 22, and 23. The couple owns and operates a restaurant together and often fight over business decisions. After this discussion the social worker takes out a piece of paper and draws three circles on the paper and writes both of their names in each circle.
The social worker explains to them that the three circles represent the three relationships they have with each other. The first circle is the spousal relationship, where the two are husband and wife. The second is the parental relationship and represents mother and father, while the third is the business relationship and represents them as business partners. The social worker guides a discussion about the quality of the boundaries between these three relationships and encourages the couple to keep these relationships separate. They can do this by being consciously aware and selective about the topics of conversation they choose to have and when they choose to have them. For example, they agree that when they take time away from the house together to relax (spousal subsystem), they will not talk about the kids (parental subsystem) or work (business relationship). They agree that if one brings up a topic that is unrelated to the spousal subsystem, then they have to do something kind for the other.
The social worker guides the couple through the ways in which each of these three relationships developed and if each accommodated and negotiated the relationship in a manner that was fair to both. In those places where one feels things are unfair, the issues are discussed and renegotiated. In the parental subsystem, significant discussion was had around the kids leaving the home for college and how both of their parenting styles had to adjust to this life cycle shift. Through the social worker’s use of a structural approach, the couple was able to reduce conflict through the development of better boundaries between the three relationship subsystems and by renegotiating and adjusting the roles each hold.
Esther Perel
Esther Perel, a Belgian therapist trained by Salvador Minuchin, has pushed to the forefront in the world of modern couple therapy. Perel breaks down the emotional responses that couples experience, using those emotional patterns to help build a stronger bond. Perel especially focuses on the concept of mystery as a place of growth in a relationship. Mystery, as Perel describes it, is not simply being unaware of some aspects of your partner or their past. Instead, mystery stems from the individual differentiation of each member of the couple (Perel, 2007). By being differentiated—their own person—there becomes a bridge to be crossed between them. This journey, Perel believes, is a motivator that promotes success in the long-term relationship. She postulates that humans have two natural cravings in relationships: love and desire (Perel, 2007): love being a closeness and desire being a sense of adventure to explore something new. Those aspects, on the surface, seem paradoxical. To balance this need for simultaneous closeness and separation, Perel borrows from attachment theory stating that adult intimate relationships are similar to the children who have a safe home base attachment figure (Perel, 2007). Partners satisfy their craving for desire by exploring themselves and their world while also satisfying their craving for love, knowing that they have a person to return to and be close with.
Perel also expands her ideas of love and desire into other aspects of life. In Mating in Captivity: When Three Threatens Two (2007), she discusses the often talked about phenomenon of a newborn stifling romance in a couple. She approaches the problem through the lens of love and desire, stating that the primary caretaker of the infant (often the mother) spends much of her day communicating, attaching, and growing with her infant. The mother then ends the day with her need for closeness—love—met without ever interacting with her partner (Perel, 2007).
Perel is also a leading voice in working with relationships that have experienced infidelity. Through the lens of desire and eroticism, Perel views the prominence of infidelity as a testament that contemporary views of monogamous marriage are not practical in practice. Perel posits that infidelity in relationships is deep betrayal, often ending in existential questions, because they defy the very definition of modern marriage—that for each person, “The One” is out there (Perel, 2019). Perel goes against the grain of much of modern relationship culture, providing a unique but valuable perspective into the topic of love and desire that helps give social work practitioners a more eclectic view of the world.
Terry Real
Terry Real, a family therapist and founder of the Relational Life Institute, is another prominent figure in contemporary couples therapy. Real views couples through a lens that features gender and power as prominent factors in both problems and solutions (Real, 2008). Real highlights that the traits associated with traditional gender roles (e.g., strong, handy, provider for men; nurturing, caring, emotional for women) clash and do not lend themselves to emotional connection (Real, 2008). Real also highlights that those traits lead towardpower dynamics in the relationship. Real believes that power imbalance in a relationship is another problematic pattern (Real, 2008). By embracing and addressing the unique experiences of each gender, Real helps clients create balance in their relationship.
COMPATABILITY WITH GENERALIST-ECLECTIC FRAMEWORK
Assessing the quality of relationships and intervening with clients to assist with the enhancement of relationship satisfaction have been mainstays of social work practice since the inception of social work (Addams, 1902; Richmond, 1917). All models of practice outlined in this chapter fit within the generalist-eclectic framework of social work practice in the sense that they explore the systemic and relational aspects of the identified client. It could be argued that depending on the approach of the social worker, some models of practice outlined here could work better than others in terms of the style of the social worker. For example, a worker more attuned to post-modern ways of working may find models of couples intervention that naturally explore client strengths and resiliencies more appealing, while those social workers who are comfortable teaching skills may find modern approaches more to their liking. In both cases, exploring client desires and outcomes in an initial assessment and then matching the model of practice to the goals of the client could increase outcomes (Prescott et al., 2017) as well as enhancing the ethics of practice by meeting clients where they are (National Association of Social Workers [NASW] Code of Ethics, 2018).
CRITIQUE OF COUPLES COUNSELING THEORIES
Strengths and Limitations
While working toward the betterment of romantic relationships seems a logical goal to increase general life satisfaction and to decrease problematic issues of clients, ongoing debate continues around the effectiveness of treatments. Generally, this debate occurs between authors who conduct or write meta-studies of individual research. Alan Carr has provided an excellent summary of couples therapy research and concludes, “the overall effectiveness of systemic therapy is now well established” (Carr, 2019, p. 492). In contrast, while agreeing that couples counseling does show effectiveness, Snyder et al. (2006) explore research findings and conclude that a “sizable percentage of couples fail to achieve significant gains from couples therapy or show significant deterioration afterward” (p. 317). No doubt this debate will continue as notions of empirical truth reign supreme in the current neoliberal academic climate in which standardization of practice has been branded as paramount.
Apart from debate about effectiveness, there is considerable current and historical discussion among couples counseling theorists, particularly those who have been described as post-modern (e.g., Insoo Berg, Michael White, Bill O’Hanlon) and those who have been described as modern (e.g., Salvador Minuchin, Murray Bowen, Jay Hayley). These practitioners generally debate the manner by which counseling should occur, whether a theory of normality should be implemented, or skills taught to clients rather than exploring client organic skills, or the stance taken by the social worker. These debates can be generally distilled down to a debate between first, second, or post-order cybernetic approaches (Hall, 2017).
CONCLUSION
Couples and families are two of the most important ways individuals find unity. However, problems and conflicts are inherent to any relationship. The theories discussed in this chapter are intended to be used to inform the interventions social work practitioners use; for without hands-on intervention, theory alone is not particularly helpful. Instead, theory is a basis and language that social workers use to understand interventions.
While it is helpful, theory should not be used rigidly. Inflexible use of these theories and practices runs the risk of pathologizing and subverting therapeutic interventions. Instead, the theories outlined in this chapter serve to provide a lens through which social workers view clients and their experiences, aligning with the generalist-eclectic framework and the NASW Code of Ethics (2018). It is also important to recognize that theories of individual and family development have been based largely on a White, male, middle-class model. While this chapter makes mention of these theories in “nontraditional” relationships, further research into the topic is still developing. All of these factors lead to one basic guideline: Social workers must respect the unique nature of every person’s experience and practice accordingly.
SUMMARY POINTS
In summary, this chapter has:
•explored couples theories and practices,
•described the different methods utilized by individuals to create unity within these systems while balancing autonomy,
•described the different approaches taken by clinicians to describe healthy communication,
•described influential names and practices in contemporary family and couples work, and
•provided context for how these theories are applied outside the scope of cis- heterosexual individuals (where possible).