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On the last track, we discussed discussed three common types of marriages in which the couple has chosen togetherness over intimacy. These three types of marriages are the parent-child marriage, the stormy marriage, and the "perfect" marriage.
On this track, we will discuss a research study into factors that influence the development of an optimized therapeutic alliance during conjoint therapy for couples dealing with marital conflict.
Although the role of the therapeutic alliance in individual therapy has been given much attention in literature, there has been relatively little examination into the role and effect of the alliance in conjoint therapy. Clearly, one reason for this may be that the development of a therapeutic alliance in multiclient therapy is potentially far more complex. Thus the role, development, and course of the alliance in conjoint therapy is less well understood.
Dianne Symonds of Kwantlen University College... and Adam Horvath recently conducted a study into factors influencing the therapeutic alliance in conjoint therapy. Symmonds and Horvath gathered information from 44 couples undergoing conjoint therapy. The study focused on concerns regarding optimizing the alliance in conjoint therapy so as to increase the chance of positive change in the patterns in the clients’ relationship. The optimized alliance also may increase both partner’s responsiveness to new communication strategies.
As a lead-in to their research findings, Symmonds and Horvath offer the following case study:
Brandon, a middle aged accountant states that he has come to therapy because he is tired of arguing with his wife. Alice, a teacher, states that there is little intimacy in her relationship to Brandon, and wants their intimacy to improve. During the initial session, Brandon admitted that Alice had threatened to leave him if he did not come to therapy.
Brandon stated, "The real problem here is that Alice is too emotional. Everything makes her fly off of the handle." Alice then stated that something must be wrong with her, because she cannot control her emotions when they disagree. After hearing this, Brandon stated, "Well, if that’s the problem, shouldn’t Alice just continue therapy by herself? Why do I need to be here?" clearly, Brandon and Alice had dissimilar ideas about the goals for therapy, which introduced tension into their therapy sessions. Do Brandon and Alice remind you of a couple you may be treating?
1. Allegiance & Alliance
Symmonds therefore states that the way that the therapist responds to and participates in the process of reconciling these two relationship may be crucial for the development of a working therapeutic relationship. Clearly, if the dynamics of conjoint therapy create situations in which the clients loyalty to his or her partner (the allegiance) comes into conflicts with the demands of the therapeutic alliance, this may negatively impact the outcome of the conjoint therapy. A conflict between the couples’ allegiance and the therapeutic alliance may also negatively impact the development of a working therapeutic relationship.
The study also points out that each partner may attempt to enlist the therapist to understand the issue sympathetically from his or her own perspective. Symmonds states that the extent to which each partner feels the therapist accepts his or her version of the problem and preferred outcomes as the goals of treatment influences how strongly the therapeutic alliance is formed. The study found that this process of attempting to gain the sympathy of the therapist may replicate the relationship dynamics that brought the couple in to treatment.
According to Symmonds and Horvath, this attempted co-opting of the counselor may lay the blame for the problem on the other partner, and damage the therapeutic allegiance between the couple. As a result, the couples in the study would perceive the alliance as unbalanced, resulting in a more negative outcome. Symmonds and Horvath observed that a therapist in this situation would then need to balance building a strong alliance with each partner against the strain this would impose on the therapeutic allegiance.
The results of the study indicated that if the therapist was able to resolve this dynamic by moving from an ‘either/or’ position to a ‘both/and’ position, the therapeutic alliance to both partners was strengthened. Switching from an either/or position to a both/and position also resulted in stronger agreement between the partners regarding the nature of the alliance and the goal of the therapy.
3. Implications of a Disagreement
Disagreement between partners regarding the strength of the therapeutic alliance also could indicate that the couple had disparate levels of trust in the therapist’s ability to help them. The findings of the study indicated that these factors had a negative impact on the outcome of conjoint therapy. Symmonds and Horvath did find evidence that resolution of this dilemma could provide a good model for the couple in regards to dealing with other issues in their marriage. This was evidenced by the fact that couples who disagreed about the strength of the alliance at the third session of the study, but were able to come to an agreement before termination, had more positive outcomes than those who did not come to an agreement.
4. Gender Differences
Symmonds hypothesized that these men may have been more reticent as they felt they had less ability to exert their influence within the context of the dynamics of an intimate interpersonal relationship. The study also suggested that if female partners were more motivated to begin therapy, they were more able to work towards positive outcomes regardless of the strength of their alliance with the therapist. A further possible explanation for the finding may have been that a strong therapeutic alliance with the male partner provided compensation for a weak allegiance between the partners.
Symmonds and Horvath concluded that regardless of the reason for the results, the findings of their study suggest that if a therapist has to "risk" straining the relationship with one of the partners, the failure to have a strong alliance with the male partner may have more negative consequences.
On this track, we have discussed a research study into factors that influence the development of a working therapeutic alliance during conjoint therapy for couples dealing with marital conflict.
On the next track we will discuss four specific patterns by which couples commonly undermine communication. These four patterns are escalation, invalidation, negative interpretations, and withdrawal and avoidance.
- Symonds PhD, Dianne and Adam O Horvath EdD. Optimizing the Alliance in Couple Therapy. Family Process; Dec 2004; Vol 43, No. 4; p. 443.
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