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Infidelity: Cognitive Therapy for the Hurt Partner and Unfaithful Partner
Infidelity continuing education counselor CEUs

Section 24
A Three-Phase Counseling Model for the Hurt and
Unfaithful Partner

CEU Question 24 | CEU Answer Booklet | Table of Contents | Couples
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

This article presents a 3-phase integrated counseling model that draws from object relations and attachment theory for assessment and uses cognitive behavioral techniques to promote constructive client change. A case vignette is presented to illustrate implementation of the model.

Phase 1 — Assessment
Object relations theory and attachment theory. It is generally accepted that the social interactions of early life predict later emotional and cognitive development (Ainsworth, 1989; Bowlby, 1969). Studies evaluating early attachment patterns with caregivers show that similar patterned attachment responses are evident in adult relationships (Flaherty £ Richman, 1986; Kotler, 1989; Winefield, Goldney, Tiggemann, & Winefield, 1990). Available and responsive caregivers provide an environment that allows an individual to become self-reliant and secure in relating with others (Ainsworth, 1989; Sable, 1992). This environment is referred to in object relations theory as the holding environment (Winnicott, 1965). When caregivers are unavailable, unresponsive, and ineffective at providing an adequate and nurturing environment, dysfunctional mental representations (i.e., mental images of self and the relationship of self to others) can occur and result in future problems in interpersonal functioning and adult development. Children quickly learn how to interact with their caregivers with a minimum of anxiety. These patterns of interacting become the patterns used in subsequent relationships (Summers, 1994). According to the object relations paradigm, children  prefer painful attachments to isolation in order to avoid the anxiety of annihilation. This seminal principle is the object relations explanation for the observation that children and adults form intense, resilient bonds with harmful figures. (Summers, 1994, p. 351) Familiarity, no matter how pathological, is experienced as safe and accounts for the tendency to repeat dysfunctional relationship patterns in adulthood (Ginter & Bonney, 1993). Given the importance of the quality of early attachment and an appropriate nurturing environment, object relations theorists have proposed various coping mechanisms individuals use to defend against the reality of inadequate caregivers and holding environments.

Introjection. Introjection is the process of formulating internal working models derived from experience and interactions with significant others such as caretakers (Diamond & Blatt, 1994). If the child is continuously rejected when seeking comfort from a caretaker, the internal working model is composed of representations of a rejecting caretaker interacting with an unworthy self If the caretaker is nurturing, working models consist of representations of a loving caretaker interacting with a worthy self. Internal working models are based on introjections encompassing aspects of both the self and the other in the dyadic attachment relationship (Diamond & Blatt, 1994).

According to object relations theory, the child introjects the negative aspects of the caregiver to preserve the impression of the goodness of the parents (Delia Selva, 1992). The child separates and internalizes the negative aspects of the caregiver, thus preserving control and hope for the child; that is, if the child changes, is different, or somehow becomes good, the parents will "love" him or her (Delia Selva, 1992).

Splitting. Splitting involves viewing the world in an extreme negative or positive fashion (Hamilton, 1989). This primitive defense occurs when the child removes unpleasant qualities of the caregiver and stores them as negative or distressful categories or representations. This minimizes the child's anxiety because he or she relies on the caregiver for survival. In splitting, the child relates only to the positive qualities of the caregiver. Positive or pleasing images are stored as separate categories or representations. The child then identifies with either the positive or negative images as he or she develops a sense of self As the individual matures, he or she becomes unable to view himself or herself or others in a "whole" fashion (known in object relations theory as whole object relatedness), which requires accepting both negative and positive qualities within one person (Klein, 1975). This pattern of dealing with relationships will repeat itself in adulthood. People are related to as either all good or all bad; likewise, the self is viewed in this extreme manner.

Projection and protective identification. The ego attempts to control an imbalance of internal positive and negative representations through projection (Summers, 1994). Through this process, the person projects onto others aspects of themselves that are either negative or positive, but conflicting (Sussal, 1992). Furthermore, through projective identification, the individual behaves in a manner that elicits from another person the affects and self-images that are projected (Ginter £ Bonney, 1993). Adler and Rhine (1992) suggested that the projector gets rid of unwanted aspects of the self while identifying with and maintaining a relationship with the other person to control the projection. Through identification, it is possible that an individual may see a part of herself or himself in another person and then may feel the need to "join that aspect of herself [or himself] in the other" (Hamilton, 1989, p. 1554).

Adult attachment patterns. Sperling and Berman (1994) maintained that adult attachment is the tendency of an individual to establish relationships with specific people who provide the potential for physical and psychological security. Bowlby (as cited in Sable, 1992) described four adult patterns of insecure attachment: anxious attachment, insistent self-reliance, insistent caregivmg, and emotional detachment. Any of these patterns may result in vulnerability to interpersonal problems. Insistent caregiving is defined as the behavior of people who establish affectional relationships in which they devote themselves to caring for others. The person engages in close relationships but always as a caretaker. The childhood experience may have been one with a caregiver who was unable to nurture the child but instead welcomed or demanded care (Sable, 1992). Studies (Collins & Read, 1990; Feeney & Noller, 1990; Hazan & Shaver, 1987) have demonstrated that an early history of poor attachment with significant others predisposes individuals to difficult adult love relationships (also see Sperling & Berman, 1994). In short, what was necessary for the child's survival in early interactions with parents clearly affects personality development and may result in vulnerability to disappointing adult relationships. The interpersonal paradigm maintains that sexuality is a powerful vehicle for expressing relational patterns because of the social meaning it conveys. It can become a medium for connecting with others. The search for reassurance through sexuality may result in compulsive promiscuity (Summers, 1994).

Assessment goals. It is crucial that the counselor empathetically hear the client's story and establish a phenomenological understanding of the client's experience (Ginter & Bonney, 1993). Throughout the assessment process, the counselor builds rapport with the client. The counselor creates a holding environment to provide a safe and secure place within which the client can process painful memories. With the assistance of the counselor, the client can explore his or her "internal working model" or way of making sense of his or her life and how early experiences helped to shape life patterns and themes. A genogram is a useful assessment tool (see McGoldrick & Gerson, 1985). The counselor and client can graphically display the family configuration, including the various types of relationships between the family members and other significant individuals. Important events and transitional periods can also be depicted. This depiction can assist both the counselor and client in discerning and evaluating life patterns. Although the achievement of insight is a major goal within this model, it is insufficient in achieving constructive client change. Ginter and Bonney (1993) maintained that "insight is regarded as a major source of change but only when accompanied by affect and followed by some form of action within and outside of therapy sessions" (p. 154). Furthermore, Ellis described the powerful influence of cognitive processes on client change (Ellis & Dryden, 1987). Therefore, an additional focus of counseling must include exploration of client feelings regarding past and present circumstances and thought patterns influencing the client's interpretational system.

Phase 2 — Linking Insight With the Present: Experiential and Cognitive Techniques
The purpose of the second phase of this model is to create an understanding of how early relational patterns contribute to present difficulties. Bowlby (1988) described the five main roles of the therapist as follows: providing a secure base, encouraging exploration of relationships with significant others, examining the therapist/client relationship, fostering consideration of how working models may be the byproduct of early experiences with caregivers, and assisting the client in recognizing that these working models may or may not be currently effective. Possibilities for new choices must be evaluated, representing the potential for change in problematic areas of the client's life. This understanding is incomplete, however, without including the affective component of the client's experience. Insight can facilitate a focus on affect within the counseling process.

Insight empowers the client to adaptively manage his or her affects, thoughts, and behaviors. This results in decreased anxiety because the client is learning to control his or her inner world. There is less fear about unknown processes within. The client comes to better self-understanding and uses the counselor as a supportive, growth-producing object (Pine, 1992). The counselor supports the client by establishing a "good object relationship" that is internalized by the client and, in turn, fosters a more positive sense of self (Buckley, 1994). With this support from the counselor, the client is able to face painful memories, feelings, and thoughts. Processing previously repressed and dissociated memories and feelings in counseling can lead to changes in perceptions of self and others (Delia Selva, 1992). Clarification and confrontation are useful techniques in assisting clients with changing perceptions.

Through clarification, the counselor assists the client in sorting through personal history, affirms responses to descriptions of situations, encourages recall of memories and feelings in which there is reluctance, and facilitates reinterpretation of misconstrued events (Sable, 1992). Hamilton (1988) defined confrontation as making an observation to a client about himself or herself As these observations are interpreted by the client and the counselor, the client either assimilates or rejects the interpretation. Interpretation becomes psychoeducational because the client learns to connect early patterns of relating to caregivers with present patterns of relating to others. The client examines inner representations and how they emerged as a result of past object relationships. This new understanding can then be integrated as the client begins to form new representations and to alter his or her worldview in a therapeutic manner. This is more direct and time effective than the usual psychoanalytic emphasis on working through transference as the means to change internal representations (Rothbard & Shaver, 1994).

Kohut (1959) and others (Buckley, 1994) noted the crucial importance of the empathic-introspective qualities of the counselor. Therefore, it is important to establish the therapeutic relationship before beginning interpretation. This development of the relationship through empathic understanding enables the growth of the client's sense of self and promotes stronger ego functions (Buckley, 1994).

Through cognitive restructuring, the client is introduced to new ways of thinking about life and interpreting situations. New perspectives coupled with more adaptive choices and worldviews are examined. "The client's life situation is cognitively restructured in ways that permit her [or him] to move actively [italics added] to improve it" (Blocher, 1980, p. 6), This restructuring promotes personal responsibility and a sense of self-efficacy within the client to foster growth. The client, in this phase, learns and uses such techniques as situational analysis, cognitive refutation, and goal attainment scaling. The client learns to calm himself or herself and think in a more adaptive and self-enhancing manner.

Throughout the process, the counselor must consistently demonstrate that he or she is a secure base from which the client can ventilate, explore, and risk. Notably, object relations counselors do not become surrogate mothers or physically hold their clients to make up for past emotional injuries. Primarily, the counselor uses an understanding of development to provide the therapeutic environment that allows the client to use insight to facilitate growth (Hamilton, 1988). Furthermore, the client learns to self-nurture through the separation and individuation process experienced in counseling. A healthy process of separation and individuation, which may not have been experienced by the client during past crucial junctures of development, can be modeled through the counselor-client relationship. Phase 2 counseling goals for

Phase 3 — Promoting Change: A Behavioral Approach
Resolving, affirming, and acknowledging feelings in conjunction with efforts toward cognitive restructuring are integral components of this model. However, meaningful and adaptive client growth is not fully demonstrated until the client makes behavioral changes. During the final phase of counseling, the client attempts new behaviors based on insight, understanding, and cognitive restructuring achieved in Phases 1 and 2. According to Egan (1994), "one of the goals of counseling is to help clients become more effective agents in life; to help them become doers rather than mere reactors, preventers rather than fixers, initiators rather than followers" (p. 75). Counseling is not complete unless the client takes action. The client must do more than achieve insight. The client must be willing to risk and make changes (Corey, 1991).

Assessment Of Intervention Effectiveness
The effectiveness of this intervention can be assessed at each phase. The assessment phase is completed and successful once rapport and trust are established between counselor and client, history has been clarified, and the counselor has a complete conceptualization of the client. Phase 2 is assessed by the evaluation of client insight and understanding through the object relations and attachment paradigms. The extent to which the client accesses painful feelings from past experiences and losses and then relates them to current feelings determines the success of the experiential component of this treatment phase. Cognitive restructuring involves new, adaptive ways of thinking and coping. This restructuring is evident in the manner in which the client verbalizes perceptions and insights about past and future choices. Phase 3 is evaluated by observation and self-report. Successful completion of this phase requires that the client engage in goal-directed activities and active coping efforts. The counselor relies on client report of experiences and perceptions. The client and counselor should decide to terminate the therapy based on a perceived qualitative change in the client's relationships and lifestyle. It should be noted that working through the three phases of this model is not necessarily accomplished in a linear fashion. Depending on the client's ego strength, cognitive developmental level, ability to engage in introspection, and readiness to move toward constructive change, components of the model such as maintaining the holding environment, fostering the client-therapist relationship, confrontation, interpretation, and providing a secure base from which the client can explore change may need to be revisited frequently throughout the counseling process.
- Morgan, Barbara; Mac Millan, Pamela; Helping Clients Move Toward Constructive Change: A Three-Phase Integrated Counseling Model; Journal of Counseling & Development, Spring99, Vol. 77 Issue 2

Personal Reflection Exercise #10
The preceding section contained information about a three-phase counseling model for the hurt and unfaithful partner.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 24
What are three defense mechanisms in object relations theory? Record the letter of the correct answer the CEU Answer Booklet.

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