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Notes on Helping People with Relationship Problems
I have seen thousands of couples over my 35+ year career as a psychologist/couple/family therapist and much of the time one of the two people in the couple has told me he/she had been in individual therapy due to the problems in the relationship before the couple came to see me. Unfortunately, the individual therapy had not led to any improvement and in many cases had actually been going on while there was increased alienation and conflict in the couple’s relationship. I have always wondered how many relationships have ended as a result of one partner seeking relationship help only to end up thinking/feeling that the relationship could not be improved and should end. Is this an unintended consequence when an individual is seen in individual therapy for relationship problems?
One of my early mentors was Chuck Kramer, a child psychiatrist who was trained as a child psychoanalyst in Chicago and was a pioneer in the development of family therapy. He had determined that seeing a child in analysis without also seeing the child with his/her parents was counter-productive and in most cases missed the essential aspect of why the child was having emotional difficulties. What he found to be missing was being able to observe the interaction patterns between the parents and the child and the link between these patterns and the child’s difficulties. Other family therapy pioneers around the same time had begun to understand the vital link between direct observation of the problem and being able to modify it. This included another of my early mentors, Carl Whitaker, also a child psychiatrist and a founder of the family therapy movement, who would regularly refuse to see an individual with a relationship problem in a clinical interview unless all of the relevant parties were present and accounted for. This led to many abbreviated sessions in which he would sympathetically explain that no good could come from seeing the patient alone without also having his/her problematic spouse, child, parent, sibling, or significant other present in the session. What is the basis for this clinical stance? Many relationship problems are likely based on how the two partners interact with each other and having these problems behaviorally demonstrated to the helper, and more importantly, to the couple themselves, is invaluable and may represent the only realistic hope of “saving” the relationship by showing and teaching the couple how to behave differently with each other. Of course, when one or both partners refuse to make the necessary changes to improve the relationship a “moment of truth” can then be faced and decisions can be made about the future of the relationship based on clear behavioral evidence.
The practice of treating relationship based problems relying only on the lens of the individual client still persists today despite over at least 60 years of research, theory, and clinical insight about systemic relationship dynamics. Why is this so and what are the likely pitfalls when a client is seen individually for a relationship-based problem?
The most obvious shortcoming in working clinically with only one person in a relationship is that you are hearing only one side of the story. We all know, or should know, that while “perception may be reality” to the person we are talking to, that doesn’t mean that we should adopt that person’s perception without question. In fact, the person we are talking to may have difficulty accepting that what is perceived by him/her can be legitimately viewed differently by his/her partner; or the obverse may be true, in which case the person we are talking to may be complaining about this very problem in his/her partner. Disparate perceptions and views of reality in a relationship is only one example among many other countless possibilities in which what the helper “sees” is determined by whom he/she is interacting with.
One reason some therapists do see individuals alone for relationship problems is that conducting couple therapy is much harder on and for the therapist to tackle. What makes this clinical modality so much more demanding than seeing an individual client? The helper must be able to quickly process information and from more than one source at the same time that he/she directs the communication “traffic” in the session so that the most is made of the time spent with the couple. There is nothing more frustrating to a couple seeking help than finding that they are simply replicating their problems in a session without the helper facilitating a therapeutic experience in which they can be different with each other as a result of being with the helper. In order for all of this to take place, the therapist needs to have developed a conceptual understanding of two person psychological systems so he/she can analyze all this additional information and then intervene effectively. This is not an easy task. The truth is couple therapy is a specialization that requires advanced training and supervision over many years and not just a clinical activity that one takes on casually by applying an individually-based clinical theory to a two-person psychological system.
Notes on How to Help People with Relationship Problems
We all come into this world as individuals and leave the same way. Ultimately, any clinical approach that purports to deal with relational systems (couples, families, organizations) also must be able to illuminate a path that permits individuals to address problems, adapt to their circumstances, and to grow. Such an approach, therefore, must be able to account for the complexities and ambiguities associated with being an individual while at the same time living within a web of social relationships. Arthur Koestler, in his book The Ghost in the Machine (1967, p. 48) coined the word “holon” in an attempt to reflect the fact that while we are all always relating to others we still can and must act in a autonomous and self-determined manner as individuals. So, any clinical approach must be integrative in that it has to be able to permit a simultaneous appreciation of the individual’s relationship with and to himself/herself as well as offer a concurrent “view” of his/her relationships with others.
One of my past teachers at the Family Institute of Chicago was Bill Pinsof and he developed such a clinical approach which he called integrative Problem-Centered Therapy and is now referred to as Integrative Problem-Centered Metaframeworks Therapy. This approach allows the clinician to see the client from the many perspectives that impact his/her life; the individual in relation to himself as well as the individual in his relationship to the significant others in his/her life now and from his/her past. This multilayered lens provides a powerful vantage point for the helper in understanding the external presses and internal pressures that each of us have to contend with in navigating our life circumstances. Pinsof’s approach also provides the helper with a roadmap of sorts to assist in making judgments about how to choose the best interventions in helping the client, e.g., the present problem or past history (individual or relational or some mix of the two), present day individual concerns or relational- based issues, and cognitive or emotional (past or present or both) regulation. As can be seen from these decision points, the clinician must come to appreciate the specific problems of each client, why their problems developed when they did, and the specific ways in which these problems have been maintained over time. I have found that a problem-centered approach permits such an appreciation while a clinical approach based just on diagnosis, theoretical orientation, or a prescribed treatment philosophy is much more likely to produce a “one size fits all” understanding of each individual case.