Working With
Couples in Conflict
by Susan M. Heider, Ph.D.
Part I. - Essential Premises for
Working With Couples
I. Couples therapy. Why are these skills essential?
A. Couple
treatment as the treatment of choice for individuals$ problems, as well as for patients
asking for marital counseling
B.
Consequences of treating married patients in individual treatment (research
described on pp. 177‑79)
II. Five essential premises
A. Premise
#1: Conflicts, within and between people, lie at the core of emotional distress.
(see charts, pp. 59 and 60)
B. Premise
#2: Therapy involves attention to three tasks. (see
chart, P. 191)
1. Eliminating symptoms
2. Guiding existing disturbing
conflicts to resolution
3. Coaching skills for handling
subsequent conflicts
C. Premise
#3: Whatever or whomever the conflicting entities, conflicts move to resolution
via passage through the same three‑step route. (see
chart, p. 22)
1. David Ricks' study of effective and ineffective therapists and
the need for clarity about what healthy functioning looks like
2. The three steps
a.
Expressing initial positions
b. Exploring
underlying concerns
c. Creating
win‑win solutions
3. Critical
conceptual disconnections
a. Concerns
versus solutions
b. The
impact of "but"
c.
Positional bargaining from excessive attachment to initial solution suggestions
(positions)
d. Importance of
specificity and summarizing
e. The
solution versus multiple solution options and solution sets
f. Breadth
and depth of concerns and how these vary for different kinds of conflicts
D. Premise
#4: Movement through the three steps from conflict to resolution has
physiological and communication‑skill prerequisites. (see
charts, pp. 35 and 292)
1.
Physiological factors: hunger, fatigue, stress, clinically significant
disorders of mood or thought
2. Essential conflict‑processing skills
a. Bilateral
listening versus hearing only own or only others' concerns
b. Expressing desires in
positives versus negatives, e.g., “I’d like . . . .” verses “I don’t want to.”
c. Avoiding
either passive (hinting, waiting for others to guess one's thoughts) and
aggressive (bl i g,
criticizing) ways of saying what one wants or feels
d. Combining
perspectives into one data pool versus forming two parallel lines of thought
e.
"And' versus *but' as indicators of addition or subtraction of data
f. Positive
listening (for what makes sense about what the other says) versus critical
listening (for what's wrong with what the other person says)
g. Symmetry
of voice volume, speech rate, and *air time'
h. Summarizing
statements
i. Short chunks; long monologues lose data
E. Premise
#5: Detours from the healthy route from conflict to resolution yield
predictable psychopathologies. (see chart% pp. 62 and
63)
1. Depression: the submissive route
2. Excessive
anger‑ the fight strategy
3. Anxiety‑ immobilization
4. Addictive and obsessive‑compulsive
disorders: flight routes for avoiding conflicts
Part II -
Symptom Reduction, Guiding and Coaching Techniques
I. Provide a dear structure for
treatment overall and within each session (see charts, pp. 190 and 191)
A. The three parts of treatment and the ski
instructor metaphor
B. When do we focus on symptom alleviation?
C. The
laundry list
D.
Identifying upsets that arose during the week
E. How do you know when therapy is finished?
F. Setting
an explicit agenda for each session
G. Two
overall strategies
1. Guiding first (the laundry list strategy): walk through major conflicts first, one by one; then as the system quiets, coach skills
2. Coaching
first; when skills are better tackle the repeated conflicts
H. The
psychodynamic concept of "working through' as a behavioral project of
"walking through'
II. Guiding and coaching: Which do you do when?
III. A
sparking couple: The shopping mail incident
A. Physical
set‑up of the therapy room
1. Right angles for patients
2. Rolling chair for the therapist
B. Guiding techniques
1. Talking with each other, not
through the therapist
2. Calming first, then talking
3. Prompting questions to set up an
effective dialogue
4. Detoxification
5. The 'depth dive' in response to
intense feelings
a. Moments
of emotional intensity offer keys to underlying concerns.
b. Delving into the
put for similar feelings
c. What's the same in
the past and the present?
d. Freeing up from the
past‑ What's different?
6. Greenberg's concept of
"softening"
7. Symmetry of explorations
8.
Interlocking underlying concerns
a. His‑
feeling there are continual demands on him‑, feeling treated like a servant
b. Hem not being
heard; feeling unimportant
9.
Transference reconsidered. Luborsky's concept of core
concerns'
10.
Expressing conflicts and concerns in patients' own language
11. Finding solutions and obtaining full closure
C. Coaching conflict resolution
skills
1. Early in
treatment: setting rules with "hot" couples
2. As
treatment proceeds, do more skill drills
a. "but"
b. teaching
skill sequences
c. listening
for what's right with (positive listening)
Part III - What Do I Do When
They Start to Fight?
I. Basic principle: Know where you're going
A. To alleviate a symptom (in this
case, anger)
B. To resolve a specific conflict
C. To teach skills by exploring why
they utilize anger
II. Symptom (anger) reduction
techniques: Le., ways to stop the fighting (see chart,
pp. 208‑209)
A. Do something. Take charge by
directing what they are each to do next.
B. Visualization as a soothing
technique
C. Who is responsible for calming
whom?
D. The caucus as a way to implement
Omer's rule: In response to emotionally overwrought behavior, simplify the
situation'
E. Assessing dangerousness and
planning accordingly
F.
Preventing splitting
G. The magic question for
clarification of concerns underlying anger, “What do I want?”
H. If emotions are traffic signals,
anger is a stop light
III. Handling anger when the
goal is guiding resolution of a conflict
A. Channel dialogue through the
therapist.
B. Detoxification: so spouses feel
heard and can hear without contamination from the anger
1. Reiterate minus the angry tone
2. Restate as "I" rather than "you" statements
C. To avoid positional bargaining,
shift focus from positions to underlying concerns.
D. Make summarizing statements.
1. So both sides feel heard
2. Feeling heard calms people; feeling ignored
fuels anger.
E. Relax. Anger tells you that you
are succeeding in honing in on vital issues.
IV. Using anger outbursts to
coach skills
A. Anger is often a well‑intended
but ineffectual solution to underlying concerns. (see
chart, pp. 115‑116)
1. What was the intended outcome? To be heard?
2. Who used the anger this way in the family of
origin?
3. What are
more effective strategies to accomplish the same goal?
B. The tendency to rush to solutions
C. Duration of treatment (more
skills deficits, longer treatment)
D. For therapy in this framework to
work, therapists need
1. Firm
belief that conflicts can be resolved.
2. Clear
understanding of the route from conflict to resolution.
3.
Experience in utilizing these conflict and communication strategies in everyday
life so they emerge routinely in both personal and professional functioning.
Notes
Ricks, D. F. (1974). Supershrink: Methods of a
therapist judged successful on the basis of adult outcomes of adolescent
patients. In D. F. Ricks, M. Roff,
& A. Thomas (Eds.), Life history
research in psychopathology (VOL 3).
Norcross, J. (1986). Levels of change.
In J.0. Prochaska (Ed.),
Integrative dimensions for psychotherapy. International Journal of Electic
Psychology 5(3), 256‑274.
"The term "softening' is from Greenberg's chapter,
Interpersonal conflict resolution. In L. N. Rice & L. S.
Greenberg (Eds.) (1994). Patterns of change (p. 112).
Luborsky, L., Crits‑Cristoph, P., & Melon, J.
(1986). Advent of objective measures of the transference concept. Journal of Consulting and Clinical
Psychology, 54, 39-47.
Omer, H., & Spivak, M.
(1987). Contacting the acutely disorganized person.
Psychotherapy, 24(3),
368‑374.