David and Mary enter the therapist’s office, but by the look of Mary’s face, she looks sulky and sullen. David has a formidable figure but has an expressionless face. The therapist, Ms. Green had worked at St. Peter’s Health Center for twenty years and she was about to hit her fifty-fifth birthday. She was popular in the neighborhood for her contribution in restoring people’s marriages and enhancing wellness. Obviously, she had a wealth of knowledge in family, and in particular, couple therapy. Although her hair was a bit grey, she could afford a smile and display a charming face to her clients. Ms. Green had arranged her workstation in a manner that couples would sit facing each other while she sat at the rear end of the table. In such a position, she would observe her clients best, especially the way they interacted with each other. However, this day Mary decided to carry her seat and sat on the same side as her husband to avoid facing him.
Ms. Green as with her routine introduced herself and asked them general questions such as their names and where they lived. Since David appeared calm and collected, Ms. Green asked him to explain what was amiss. David retorted that his wife, whom they had been in marriage with for now eight years had begun to yell at him whenever he asked something. Most of the time, according to David, Mary would use children whenever she wanted something from David. Their relationship had become so cold that they would go to bed at different times and never talk to each other.
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When Mary was asked to respond, she angrily remarked, “Ask him if he wants to stay with me or his mother.” This response seemed to annoy David. “This woman does not have any respect for my mother at all,” David said angrily. It was time for Ms. Green to investigate the problem and try to provide a solution.
Treatment Plan
Although Mary’s statement seemed a bit harsh, Ms. Green could sense where the problem emanated from. David was not giving Mary the attention she needed. It turned out that David would spend a lot of time communicating with his mother on the phone and sometimes he would hold a private conversation outside the house or even in the bathroom. Mary later learnt that David had private investments, which he had involved his mother and not Mary. David’s frequent and prolonged conversations as well as the private investments made Mary to ask herself whether she had done anything wrong to David. Each time she thought about these questions, she became angrier. On the other hand, David did not see anything wrong with holding frequent and long conversations with his mother. Additionally, he thought it was perfectly normal to help his mother by involving her in his investments without consulting his wife.
In this case, both David and Mary are attached to each other. David obviously loves his wife and it is the major reason he goes to the therapist to find out why she had started behaving strangely. Mary is also attached to her husband and feels angry that her attention is being diverted elsewhere. She even feels as if she is the cause of the problem. For both David and Mary, the best treatment plan is the use of emotionally focused couple therapy. According to Brubacher (2018), most couples, as a consequence of being in love experience emotional problems, which may evoke negative perceptions. They need someone to explain to them that it is normal and thereafter turn the negative feelings into positive feelings.
The first step in the treatment process of David and Mary’s problem is to listen to them. It is not just about listening but also trying to understand them. This listening and trying to understand is what is referred to as empathy (Stith et al. 2012). The therapist immerses himself or herself in each of the couple’s position. Brubacher (2018) even describes the process better by referring to it as some kind of tuning to the client’s internal emotional experiences. For instance, at the onset, David and Mary appear to be talking only about external experiences, which could be typical of any relationship. For a person who does not understand couple therapy, he or she may conclude that the couple’s experiences are normal and that with time, the two would get along well.
Listening and trying to understand the couple means using other cues such as nodding or gestures. In this case, David and Mary will develop the perception that the therapist understands their condition. Mary seems to be angrier but David does not understand her. If the therapist tunes herself to Mary’s internal emotional experiences, at least David will feel that the therapist understands his wife’s condition and that within a short time, he will also know it. Empathy leads to another aspect known as empathic reflection. The reflection is derived from some of the comments expressed by the client. For example, Mary’s statement, Ask him if he wants to stay with me or his mother, could be interpreted by the therapist as, Ask him if he is ready to give me the attention I deserve as his wife. In regard to David, his complaints could suggest that he was unhappy because his wife was not communicating and giving him the right attention. The more his wife turned away from him, the more he found solace in his mother.
Ms. Green could use repetition or emphasis to spur on the couple’s to open up their inner emotions. For instance, she could remark as follows in regard to Mary’s angry face, “David, you dread Mary’s look because she looks as if she will bite you the next minute”. A response of “Exactly!” from David would mean that Ms. Green deeply understands David’s emotions. On the other hand, Ms. Green could remark as follows in regard to David’s behavior, “Mary, you feel far apart from you partner.” Mary may not necessarily respond verbally but even the slightest non-verbal cues may indicate that she agrees with the therapist.
Owen et al. (2014) note that while showing empathy and engaging in empathic reflection, therapists ought to avoid non-reflective or non-empathic responses. An example of a non-reflective response would be to tell Mary, “Is it difficult to concentrate on something else when David speaks to his mother?” Or, “Can’t you also carry out your own private investments?” According to Luebeke et al. (2014), such kinds of responses could distract the couples from their present moment experiences and distort the message they were trying to pass across. It is, therefore, desirable to interject with emphatic responses such as, “I understand how difficult it is for you David when your wife does not want to talk to you” or “I know how painful it feels for you Mary when your husband does not give you the attention you deserve or involve you in his plans.” Such empathically reflective responses seem to be very simple yet very communicative. They show the couple that the therapist cares, and as such sets stage for anticipation of a solution.
When Ms. Green uses such empathic responses, Mary’s internal emotions are triggered and she registers something to the effect of “I am missing him, yes! I feel lonely and unwanted when he does not include me in his conversations and investment plans. I feel all the attention is being directed to his mother. I would like him to start directing his attention towards me.” On the other hand, David is triggered to think of, “My wife is trying to avoid me these days. I would like to know her problem so that we solve and carry on like in the start.” The therapist also thinks of “You blame yourselves for getting angry or lonely while underneath you harbor pain caused by being attached to each other.”
The next stage in conducting emotionally focused therapy for couples such as David and Mary is what Brubacher (2018) refers to as validation. Validation is akin to justification of a client’s comments as understandable or legitimate in the context of the attachment relationship. In regard to David and Mary, Ms. Green can say of Mary, “It makes sense that you are hesitant to share your concerns with David because you fear that he will accuse you of being too insecure.” Ms. Green would seem to present Mary’s case, an action that helps bring down the anxiety in the room. The uneasiness that at first prevailed in the room when Mary refused to sit facing her husband is eliminated slowly because she would expect her husband to refute or accept the claims. Having calmed the couple to some extent, the therapist can then resort to the use of empathic questions. For example, Ms. Green can ask, “Mary, how do you feel when David does not involve you in his investments?” Or, “David, how do you feel when Mary sends children to you instead of talking to you directly?” Such questions are evocative and even if the client does not respond verbally, body response can give vital hints. In case the couple decides to talk, the therapist can even realize how long their problem had persisted and how deep it had affected them. If Mary says something like, “I have been sad for years but I have never said anything, and now my husband does not appeal to me sexually” Ms. Green would realize that the implications of the problem were too deep.
David would also want to respond by saying, “I have been unhappy that she has not been talking to me but I would like to repair our marriage.” Such responses present Ms. Green with a further opportunity to see whether the couple is ready to reconcile. For example, Ms. Green could ask questions such as, “David, how does repairing your marriage look like to you?” Or, “How long do you think it will take for you to reconcile?” Gottman & Gottman (2015) posit that during the process, the therapist needs to vary her tone to attune to the client’s experiences. The tone ought to be low, soft and in a language that uses the clients’ words. Again, Ms. Green can say to Mary, “So, when David’s phone rings and he opens the door to go outside to talk to his mum, you picture him talking, laughing and discussing ideas with his mum while you are seated there lonely as if you do not matter .”
It is crucial to point out that the emotionally focused therapy combines aspects of Freud Sigmund’s psychoanalysis theory and humanistic approach to psychology. Although Freud proposed that people’s repressed childhood experiences emerge in their adulthood, there is a similarity in David and Mary’s case because the repressed feelings are threatening their marriage. By Ms. Green listening and seeking to understand the couple, she is probably using what is known as talk therapy. When David and Mary talk, the experiences that are repressed in their subconscious mind are released and they feel more relieved. Even much better, Ms. Green helps them identify with their situation by immersing herself in their positions.
The humanistic approach on the contrary, is drawn from the belief that people have unique life experiences that require tailor-made solutions. The emotionally focused therapy in itself is a process that heavily relies on the responses from the clients to devise a solution. Different couples experience different problems in their marriage, hence, custom-made solutions are desirable. However, one could argue that the two approaches are more effective in investigating the genesis of a problem. A therapist can also use approaches such as behavioral and cognitive therapy to provide a solution to David and Mary.
Behavioral therapy in this regard would be aimed at changing the behavioral patterns of David and Mary by emphasizing on the adoption of positive habits (Marin, Christensen, & Atkins, 2014). Since the couple had not been talking to each other for a long time, Ms. Green could come up with activities that would require the participation of both David and Mary. For example, Ms. Green could propose that the two exercise together or read a book together every day. When the couple adheres to such habits, they get acquainted and their relationship improves.
Cognitive therapy is beneficial in changing the negative thinking patterns to positive patterns. The proponents of cognitive therapy believe that people’s wellbeing is greatly influenced by their emotional patterns. When people harbor negative thoughts about themselves, they are likely to experience psychological problems (Lebow et al. 2012). Mary thought that her husband did not want to take to her because she had done something wrong. However, as Mary would advise, she had genuine concerns, which would need reassurance from her husband for her state to improve. She was so emotionally attached to her husband that she did not want to lose him. In the first place, Mary would need to be told that it was not wrong to get attached to her husband that much. Nevertheless, she would need to open up to her husband so that the problem is solved. While cognitive therapy is direct, emotionally focused therapy uses reflections and empathic responses to make the process even easier. Cognitive therapy is different in that while the therapist may understand the problem experienced by the clients, he or she does not immerse himself or herself in their positions. Rather, counsel is provided to the couples encouraging them to reconcile.
Conclusively, treating couples who are involved in conflict needs a lot of care. Because conflicts are not disorders, one cannot claim to have a specific solution for conflicts in marriage. From the case study of David and Mary, the couple is too attached and everyone is afraid of losing another. The most effective treatment method for the couple is the emotionally focused therapy. It is a process that combines different aspects such as psychoanalysis, cognitive, behavioral and humanistic approach. The most prominent aspect of this treatment model is that it uses empathy and reflection to understand the clients’ problems and consequently present a solution. The belief is that when the therapist immerses in a client’s situation, the emotional burden is transferred and the client begins to experience relief. It is also one of the best ways of avoiding taking sides since the intention is to reconcile the couple. By asking questions such as “How long do you think it will take you to reconcile?” seeks to understand the readiness of the couple to cast aside their differences. Through a step by step process, the couple starts talking to each other and the therapist can use other approaches to reinforce their relationship.
References
Brubacher, L.L. (2018). Stepping into emotionally focused couple therapy: Key ingredients of change. New York, NY: Routledge Press
Gottman, J. S., & Gottman, J.M. (2015). 10 principles for doing effective couples therapy. New York NY: W. W. Norton & Company ISBN: 978-0-393-70835-6
Lebow, J.L., Chambers, A.L., Christensen, A., & Johnson, S. M. (2012) Research on the treatment of couple distress. Journal of Marital & Family Therapy, 38(1), 145-168
Luebeke, B., Owen, J., Keller, B., Shuck, B., Knopp, K., & Rhoades, G.K. (2014). Therapy interventions for couples: A commitment uncertainty comparison. Journal of Couple & Family Psychology: Research & Practice , 3(4), 239-254
Marin, R.A., Christensen, A., & Atkins, D.C. (2014). Infidelity and behavioral couple therapy: relationship outcomes over 5 years following therapy. Journal of Couple & Family Psychology: Research & Practice , 3(1), 1-12
Owen, J., Shuck, B., Stanley, S., Rhoades, G., Fincham, F.D., Markman, H., & Knopp, K. (2014). Commitment uncertainty: A theoretical overview. Journal of Couple & Family Psychology: Research & Practice , 3(4), 207-219
Stith, S.M., McCollum, E.E., Amanor-Boadu, Y., & Smith, D. (2012). Systemic perspectives on intimate partner violence treatment. Journal of Marital & Family Therapy, 36(1), 220-240
