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Difficult couples are even more challenging than individual resistant clients. They also drop out of therapy faster if things arent going their way.
become difficult to work with for a number of reasons; being combative is only
one of the most dramatically challenging scenarios we must confront in our line
of work. Luther and Loev have identified other expressions of resistance in marital
therapy, described below:
As daunting as these forms of marital resistance are to confront, they pale in comparison to the weapons of the couple who express themselves primarily in the language of conflict, usually at high decibel levels. These are marriages not made in heaven; in the words of a character from a novel by Tom Robbins, Mine was made in Hong Kong by the same people who make those little rubber pork chops they sell in the pet department at K Mart.
With combative couples, it takes not one difficult person but two individuals who exhibit a high degree of inflexibility and disturbance to create such poisonous interaction. The other qualities that make them so unique among the clientele who seek marital therapy are the intensity of their conflicts, the vested interest they both have in maintaining their argumentative behavior, the perverse enjoyment they seem to derive from the ritualized combat, and the degree of resistance they show to changing their dysfunctional patterns. People tend to resist change in general because of a fear of the unknown; this situation is made worse when a persons emotional security is at stake. Whatever the causes, the need for stability in families is so strong that it is usually not the desire for change that leads families to seek therapy, but rather it is the failure to accommodate to change. Most families come to therapy in response to changes which they do not like or have not adjusted to.
Each member of the couple in conflict is reluctant to give up something that is familiar for some other elusive goal that could turn out much worse. The partners cling together in destructive patterns in an effort to minimize further risks or threats to their self-esteem. The possibility of change becomes even more frightening than the prospect of spending an eternity together locked in combat.
I hate all this bickering, one spouse was heard to say, but it is really not as bad as it seems once you get used to it.
For once, his wife agrees: I dont like this fighting all the time, either, but it is all we know.
Of course, they are not telling the complete truth. On some level, they do enjoy mixing it up with one another. It is the way, maybe the only way, they have learned to express their feelings and communicate their needs. It is also a wonderful distraction that keeps them from ever having the time or the opportunity to explore deeper into the core issues that each partner keeps at a distance.
and Stan had their routines down to split-second timing. They were artists, even
maestros, in their uncanny ability to sense just when we were getting close to
something significant; then one or the other would quickly start a fight to get
us off track. If Fran would forget the rules temporarily and start to express
some tenderness toward her husband, Stan would sneer or ridicule her for being
weak. If he on some rare occasion of clarity (or insanity) would compliment Fran
for something she did that he appreciated, she would use that as a starting point
to berate him for not doing it himself.
we are really off and running. I find a way to get their attention so we can begin
anew. Unknown to me, however, they have already signaled a new play.
Ethics - Interventions
with Combative Couples
Greenberg and Johnson have developed an emotionally focused therapy for couples that seeks to access primary emotional experiences of each partner, and then helps each one communicate these feelings in ways that the other spouse can hear and respond to. This is standard operating procedure in many forms of marital therapy. Each partner is helped to express the feelings that underlie the hostility, whether it is the fear of abandonment, engulfment, or intimacy. In the case described earlier, for example, Fran is encouraged to share with her husband the underlying feelings of mistrust and hurt that she expresses through anger. Simultaneously, Stan is assisted in his efforts to express his fear of losing his wife and how he covers up his vulnerability by keeping her off balance.
More specifically, consider a multistep program for diffusing the marital conflict, beginning with a delineation of the salient issues. The therapist identifies and labels the position each partner is taking in relation to the another. The problem is then redefined in terms of emotional pain: How are your needs not being met by your partner? What pain are you experiencing? In what ways do you feel vulnerable? What are you afraid of? When you become so angry, what else are you feeling inside?
Next, the therapist attempts to sort out the interaction cycle. Considered systemically in terms of communication patterns and interaction sequences, what vicious cycle has been established? How is one partner aggravating the other, and in turn, being reciprocally punished?
I notice the following scenario unfolding between the two of you: First, Carol, you ask your husband to be more open with you. Then, Burt, you try to comply. You start to tell her what things are like for you. While your voice sounds sincere, you seem to have a smirk on your face that says Ill do this, but I dont like it. This attitude develops at just about the same time that you, Carol, start to get frustrated because Burt is so concrete in his descriptions. You then interrupt Burt in the middle, because you dont think he is being responsive. And then Burt withdraws, feeling hurt. He starts to snip at you. You snap back. And the next thing you know, it is World War III. Ive seen this happen several times right here in this office.
It is at this point in the process that therapists tend to diverge in their next step with this couple. Greenberg and Johnson, as well as other experientially based practitioners, would help the couple to admit and express their feelings more sensitively and clearly while fostering greater acceptance of each others positions. Instead of resorting to rage and combat when a partner feels neglected, rejected, or inspected, he or she can express needs and wants in caring, sensitive ways.
Some would disagree that more direct and open communication is possible, or even desirable, with combative couples. Behaviorally oriented marital therapists would home in much more directly on those actions that are counterproductive and attempt to substitute for them more caring responses. Structural therapists might work to realign the power balance within the couple while strategic practitioners would be more concerned with disrupting the dysfunctional communication patterns. Others, such as Nichols, prefer an even more pragmatic approach with polarized couples, concentrating on helping the partners to renew their commitment to one another, bridging misunderstandings between partners, and rebuilding the trust that has been ruptured.
The important point, however, is not that there are a dozen valid treatment strategies that may be helpful but that with violent, abusive couples it is necessary to do everything possible to disrupt their destructive patterns. This includes working with their unexpressed feelings and their irrational cognitive structures, and their unresolved family-of origin issues, and their individual intrapsychic issues, and their power struggles, and any external situational factors that are compounding everything else.
Reducing all these interventions to their essence, Shay reminds us of the most basic therapeutic principle of all when working with discordant couples who fight a lot: EVERYBODY WALKS OUT ALIVE. As I mentioned earlier, like many members of our profession, I came from a conflicted family. My parents fought constantly. I fell asleep many nights to the sounds of slamming doors or screaming voices. While I was unsuccessful at keeping my parents from divorcing, at age ten I decided I did not like being around people who were cruel to one another, and I did everything within my meager power to stop people from hurting one another.
As a marital therapist, if there is one thing I do well (and sometimes it is the only thing that I can do), it is to not permit couples to be abusive to one another in my office. They can fight, but the fight must be fair. They can argue, but only with respect. They can be as passionate, emotional, and expressive in their communications as they would like, as long as they do not jeopardize each others physical or psychological safety.
Most couples are usually more polite and civilized in their behavior when a witness is present, especially one whose approval they are trying to win. There are occasions, however, when one or both partners cannot or will not control themselves, no matter who is present. They would just as easily rip into one another in a crowded restaurant or your office as they would in the privacy of their own living room.
we can get the couple to behave themselves and find a therapeutic window in their
intense conflict, little else we can do will be helpful. The object, then, in
making sure everyone leaves the room alive is to do something to shift the level
of interaction away from the battle. Shay recommends turning to the past as a
way to restore calm although some couples will use this intervention to
renew their fight over some favorite issue that is good for a few licks. I tried
this very technique with an elderly couple:
When history fails, the next option Shay suggests is to try problem solving. This changes the emotional tenor of the interactions as the participants work together toward a mutual goal. With the couple above, we brainstormed ways to lower the decibel level of their screaming matches. They decided to try wearing surgical masks when they fought since it is harder to yell through those things (and besides, they look so silly wearing them). They bought the masks, but refused to wear them.
Whatever ingenious method is eventually stumbled on, explosive couples must be neutralized before they ever have the chance to listen or talk to one another, much less change the pattern of their interactions. Once they have agreed to abide by certain basic rules of human consideration: speaking in a more subdued tone of voice, not interrupting one another, refraining from abuse, accusations, or verbal violence, combative couples can then learn to communicate with one another more healthily. They need to find ways to express accumulated resentment without being abusive, and they must learn to be more responsible for what happens to them instead of blaming their partner.
Bergman finds it especially helpful to assign homework assignments to couples trying to devour one another. Each evening the couple is instructed to spend five minutes each telling one another the ways that they feel hurt. They are to use only the pronoun I throughout the exercise and to refrain from blaming the other, attacking, or becoming angry. While one partner speaks, the other listens quietly and finally responds with an apology to the effect that he or she has been unaware of the hurt, feels badly about it, and then asks for forgiveness. Although these assignments can be potentially problematic or even dangerous without adequate supervision, most of the difficulties can be circumvented by first having the couple practice the exercises in the sessions before trying them out at home. This strategy will probably work for only about half the couples who comply with the task, but half is certainly impressive. And the other half, who will not comply, can always be given the paradoxical assignment of arguing more often.
As frustrating as combative couples and other violent, abusive, and aggressive clients can be to work with, we often feel some appreciation for the passion with which they express themselves. They are people who are intensely committed to their beliefs, and while quite rigid and obstructive, they most definitely engage us thoroughly in their struggles.
-Reamer, Frederic G., Social Work Ethics Casebook: Cases and Commentary. Washington, DC: NASW Press, 2009.
Reflection Exercise #5
Ethics CEU QUESTION
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