Couples Counseling: Tools and Interventions

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs register@allceus.com counselortoolbox hi everybody. I'm Dr. Donnelly Snipes and I'd like to welcome you. Today's presentation on couples therapy, common issues and interventions. We're really going to be talking about not the issues that couples present with so much, but the issues that clinicians and supervisees face, especially those of us who weren't trained as marriage and family therapists when we're seeing couples, because counseling couples is not the same as individual therapy. It's a 113 sort thing. So we're going to talk about that. We're going to identify, spend about the first half of class identifying the goals of couples therapy. We'll identify some common mistakes that I see, especially my supervisees making in couples therapy. And we'll explore things counselors need to consider when working with couples. One of the first goals of therapy with anybody is to provide a confidential dialogue which normalizes feelings. And when you're working with a couple, you may have two people that feel very differently about a particular situation, maybe their finances or how the relationship's going or sex, or who knows? We want to be able to allow them to express themselves and normalize their feelings so they're not feeling like one person's wrong and one person's right from their phenomenological reality. They're both right from their own perspectives. We want to enable each person to be heard, which is generally a challenge initially because a lot of couples, by the time they come to therapy, they've already sort of tuned each other out and they're trying to get their point across so much that they're not hearing the other person. We want to enable each person to be heard by. By the other one. And we want to enable each person to hear themselves. We want to hear people, or we want people to hear themselves saying it's your fault, this, and projecting blame, or hearing their part in what's going on. What's important, though, in the session is to make sure that we as clinicians set boundaries so each person feels safe and empowered to express his or her point of view in a way the other person can hear and understand, even though the other person may not agree. That's a lot of stuff crammed into one thing. So how do we do that? One of the things is laying ground rules. And another thing that I do from the very beginning is I teach active Listening. I teach people to use I statements and objective terms. When you're working with your kid, for example, and maybe they're not doing their chores the way they should, and you're like, oh, my gosh, you are such a slob. Well, that's so many things wrong with that statement. That is not helpful because the child doesn't know. What's your definition of clean? Instead of saying that, saying, I feel very frustrated when I walk into your room and I see that there are clothes and underwear all over the floor and dirty dishes on every countertop, on every flat surface. Okay. That is objective. The youth at that point can say, okay, I hear you. I don't agree that it's a mess, but I hear you, or, I hear you, and I can try to do better because now the person knows what's bothering you. Saying this room is a mess or you're a slob doesn't help the person figure out behaviorally what they need to change. That's one of the first important things. And when couples are in counseling, encouraging them to talk to each other instead of talking to the therapist and then the therapist relaying what was said, or talking to the therapist and then saying, you know, Bob, did you hear what Sally just said? I want them to talk to one another. That way they can start practicing these skills in session. And if they start going to you statements and blaming statements and not using active listening, I can call a timeout, and I can help them rephrase and restate what they're trying to state. They're still communicating the same message, but saying it in a way that is less likely to provoke resistance from the other person. We want to help people reflect the relationship's difficulties and the potential for change. Okay, you know, you're here. You're in counseling. There are problems right now. However, the fact that you're here indicates to me that you believe there's capacity for improvement, that this relationship can change. Do you agree? Start talking to them about that. Start talking to them about times when the relationship was good and maybe what they hope to get back. To make sure to inform couples that it's not a matter of one person being right or wrong, since both partners make sense from their perspective. For example, if you have a couple come in and one partner is like, my spouse comes home and never gets any of the stuff on the honey do list done, and the partner responds with, so you're saying I'm a lazy sack of crap? No, that's not what I said. Encouraging them to take each Other's perspectives. The partner who comes in after a hard day's work and sits down and they're just plumb exhausted. You know, they need to be able to articulate that and how they're, you know, thinking about getting those things on that honey do list done. And the other partner needs to be able to empathize some. So we need to help people start understanding their own perspectives. We want to identify times in the past, like I said, that have been good and what was different. Maybe it was before you had kids, or maybe it was before your job got so crazy, or what was different back then when the relationship was good or you were happy. And that's very subjective. We want to look at not only just environmental differences, what was different in the family or in the relationship, but also what was different with each person because people grow, people evolve, people change. We want to look at what happened that precipitated this potential fracture in the current relationship. Help each partner begin to understand how he or she is contributing to the conflicts and can contribute to the solutions. I don't want to just stop with, see how you're contributing to the problem. I want to talk about. When you respond this way, it causes your partner to become defensive, which exacerbates the problem. However, you have something to say and you feel you need to be heard. So when you respond in a different way, and let's talk about how you might be able to respond in order to precipitate a different reaction from your partner so you don't get hit with this resistance and irritability and defensiveness. We want to help people move from the blame game to. To looking at what happens to them as a process. What happens, you know, ask couples to look at what happens when you start blaming your partner for things that are going wrong. When you start blaming your partner for the problems in your relationship, what happens to the relationship? It becomes you against me. It becomes an adversarial sort of thing. And there's no more sort of us. There's no collaboration, working together. The blame game also implies that it's all one person's fault, generally, which we know that it's almost never just one person's fault there. I don't want to say never because never say never. But in large part, we want people to recognize that if we start blaming, we're not taking responsibility. And one of the things that we talk about, sometimes it's appropriate with adult clients, sometimes not. You just kind of have to feel it out is the finger pointing when you blame Somebody, you're pointing your finger at them. When you point your finger, you've got two fingers, your thumb and your index finger pointing at them and three fingers pointing back at you. That encourages people to identify, you know, what was your part in the situation. When there are conflicts and when there are problems, we want people to start looking for exceptions. If they come in and they go, we fight all the time. Okay, well, we can talk about what's contributing to those conflicts in a little bit. But let's also look at the times when you're not fighting. What are those exceptions? What's different during those times and how can we build on those? Maybe they're not fighting when they're having a family meal. Okay, well, that's a good thing that we want to focus on what's different during the family meal. Maybe it's because the kids are there. We don't want to use kids as pawns for, you know, in counseling. But we do want people to start recognizing that, you know what, I can sit through an entire meal without being adversarial. So how can I generalize that, those feelings and behaviors and thoughts to, you know, after dinner, to in the morning. We want to help both partners see the relationship in a more objective manner instead of all good or all bad or oppressive or using any of these extreme words. Recognizing that relationships are almost never perfect. And what parts of this relationship, even though there are some parts of it right now that are really unfortunate, some, maybe even unbearable, what are some parts of it or aspects of it that are okay if not good? And let's start balancing those scales and embracing the dialectics, using radical acceptance of the fact that it's not going to be perfect and every day is not going to be wine and roses. We want to help them identify repetitive negative interaction cycles as a pattern. One of the common conflicts that comes up is sex and intimacy. And a lot of times, and this is not always this way with, with genders, but I'm just going to use gender biased explanations. You may have a couple that comes in and the husband says, we never have sex. And the wife says, yeah, you're right, we never have sex. And the husband says, well, she's like, well, I don't want to have sex with you unless we have some level of intimacy. I need intimacy in order to feel close enough to you to have sex. And the husband may say, well, I need to have sex with you in order to feel close enough to you to share intimate feelings. So we need to help them figure out how to Bridge this gap instead of being at a stalemate where both of them are saying, unless you meet my demands, I'm not going to be able to meet you halfway. Resentments and explosions are another thing, another negative cycle. We often see where one or both partners will just take stuff and they get these little resentments and they push them down and they get these little resentments and they push them down and eventually their resentment take is full up and they just become Mount Vesuvius of resentments. And there's a litany of done me wrongs that goes back three years that haven't been discussed. We want to talk about how that impacts the individual, but also how it impacts the relationship and the level of trust and intimacy and communication. And that kind of goes along with what Gwen's pointing out about. We want to be proactive rather than reactive. We want to help them. See, like in this example, what can you do in order to be proactive so you're not developing this litany of resentments that you're just filled with. We want to help people change the view of the relationship through functional perspective taking, which basically means looking at what is the function of your partner's behavior. If you've got two people in a relationship and one partner comes home and knows that it's going to be adversarial, that there's going to be tension in a fight, so it goes directly to his or her room and just spends time there, what function is that behavior? Serving. Does that mean that that partner doesn't want to be intimate or close or have a relationship? Does that mean that that partner, you know, what does it mean? And how is that protective? And you know, in that particular example, a lot of times it's protective because that partner just doesn't want to fight. They don't want to get into it, but they don't know how to be around their significant other without fighting for whatever reason at that point in time. We want to see how that behavior is helpful. Have people make lists of things that their partner does or do does that are frustrating or aggravating. And let's look at the function of those behaviors. Some. Some of them will be if you don't put away your glasses or don't put away your dishes at the end of dinner, that may just be habit. We can look at those things. Other things may be, maybe they don't put away the groceries when you bring the groceries in because they tried to put away the groceries once before and they got scolded for not putting stuff in the right place. So they don't want to do it now because they want to respect your organization system. We need to step back and look at the meaning of the behavior for the person. We want to understand the source of reactive emotions that drive this pattern. If there are reactive emotions, you walk into a room and automatically you have feelings of tension and anxiety. Where does this come from? Where is this tension and anxiety come from? If looking at how this situation triggers past hurts, whether it's in that relationship or in prior learning experiences, in what way does this trigger pain for a person? Going back to the sex example, you know, maybe one partner is not feeling close to their spouse and they say, you know what? I just, I don't feel close enough to you, I don't want to have sex. And the other partner feels like that is very rejecting and they feel like they're being abandoned. So we may want to go back to other abandonment experiences. We also want to look at how they got to that point where the intimacy had dissolved that much. We also want to look at how the situation triggers feelings of failure, rejection, loss of control, or isolation in both parties. But generally in the party who's feeling upset by it, you know, in what way does this make you feel like you're a failure as a partner, as a person, or you're being rejected? And we want to start talking about those things and actually getting it out there, not just assuming that the other person understands. We want to empower partners to take control and make vital decisions in the relationship. As a therapist, I'm not going to be there in three months, six months, a year from now to say, okay, y' all, sit down. Now, this is the plan. It's important for us to empower partners to think, think about what are the workable solutions to this problem. Help them learn how to research workable solutions to the problem. I may give some suggestions, I may give some worksheets, but I generally also encourage people to go online and, or go to the library and get some books or read, read some blogs online that might help them and then bring it back to therapy and let's talk about, you know, what they learned, what they read, how they think it might help, and talk about how they might apply that to their situation. My goal here is to empower them to be able to learn how to find the tools they need should they encounter hurdles after therapy is over. We also want to facilitate a shift in partners interactions. Instead of getting to this point where they're at a stalemate or they end up screaming at each other. Identify alternate interactions. When you start to feel frustrated with your partner, or abandoned or deserted, whatever words are coming up, when you start to feel that way, instead of screaming, yelling, stomping out of the room, avoiding going home, whatever your current reaction is, what other solutions are available to you? And let's start making a list of what those things are so people can start thinking, okay, a different solution might be one couple I worked with, they were very volatile and they had a hard time when discussing problems without becoming extremely emotional, Even if they started out in a calm frame of mind, Part of that was they had difficulty with active listening. But while they were developing those active listening skills so they didn't get frustrated, I had them. When they had a problem, I had them write down, write a narrative about what that problem was and exchange it, or hand it to the other person and let the other person read it. When you write things down, you can edit, you can take out those blaming words, you can emphasize the I statements, do all those sorts of things. It also encourages people and reinforces those verbal behaviors. If you're writing them down, the other partner would get the narrative of what was going on and be able to read it without feeling like they were being attacked or put on the defensive. And they would have time to read and process and digest and formulate their response, which, when we're talking, a lot of times, especially when couples are talking and it's a charged situation, and one partner, you know, feels defensive and the other partner's angry, and both people are trying to prove their own point, they're not listening to one another. They are so busy formulating their own response that they're not hearing what the other person is saying. And we need to figure out how to put a time out there. Another way to facilitate the shift in interactions is to identify, okay, in these solutions here, what is each partner's responsibility? So even in the narrative writing thing, the person who's upset, that person's responsibility is to write down, using I statements and objective language, what the problem is and maybe even what the hoped for solutions are. The other person, it's their responsibility to read that, to process what's being said. And without remaining defensive, they may get defensive for a minute. That's okay, it's a normal feeling, but without remaining defensive and then paraphrasing what the other person said so they can calmly discuss what's going on. And if the other person is also not able to actively discuss what's going on without getting overly emotionally dysregulated, they can write a narrative back. It gets tedious if you start having to write back and forth all the time. However, sometimes that's a way to start, especially a very touchy topic. Create new and positively bonding emotional events and establish intimacy. One of the key mistakes I see is clinicians jumping way too far ahead of where the clients are. You need to meet the couple where they are at, what can they currently do? If they cannot currently be in the same room without wanting to pull each other's hair out, then expecting them to go on dates and snuggle on the couch or whatever, that's probably too much. We need to back off and go, okay, what do you think you can handle doing right now? This is where you're at. What's one thing you could envision yourself doing? And they may not have an answer for that right away. So another question you can ask is, what do you hope you'll eventually be able to do as far as intimacy is concerned? What do you want that to look like? Do you want to be able to snuggle on the couch while your partner rubs your feet? Or whatever the case may be? Just get an idea of what it looks like and go, okay, that's a 10. Now we're at zero. So what's the first step to getting there? Maybe being able to share a meal together and then maybe working up to being able to watch TV together in the evening, or, you know, do something in the evening where you're not really having to interact, you're just in the same room, and then getting to the point where you're sitting on the couch together, maybe holding hands, maybe not even just sitting on the couch together next to each other so there's contact can be effective. Not everybody likes to hold hands. Figuring out what those steps look like and helping people start nudging in that direction, recognizing that, you know they're going to only be able to do what they can do. Teach the five love languages. In order to establish intimacy, we need people to feel like they're heard and feel like they're loved and respected and appreciated. Help people learn, and you don't have to have them read the whole book. You know, the five Love, Touch, Gifts, words, acts, quality, time. Have them list, in order of preference, their five love languages and then give examples of what those love languages look like for them. For example, touch could be a hug, or it could be a back rubber, or it could be something more intimate than that, or it could be kissing, or it might not be. We don't know until Somebody articulates what that looks like. Having them define what those love languages look like, it clues their partner in, and they exchange sheets. So each one knows, okay, when I am not, if I am, when I am showing love and appreciation for my partner, these are things that I can do that he or she will recognize as an attempt toward appreciation and intimacy. We want to foster a sense of attachment between partners, secure attachment with kids. With adults, it's characterized by responsiveness. Being responsive to your partner's needs when they're having a bad day, being willing to say, tell me about your day. Being consistent, having compassion and empathy, actually caring for the other person, and mindfully paraphrasing what's going on. And we're going to talk about that activity in a minute. But responsiveness, consistency, compassion, and caring are so important, and we want to teach people how to do this. Sometimes they'll look at you again like you're crazy. I want you to think, if your child walked into the room and was, you know, walking like that and acting like that or grumbling or seemed upset, what would you do? Okay, I want you to do that same thing for your partner. You know, if you would ask your child, you know, what's going on? You seem like you're having a bad day. Hey, let's do that to your partner. Sometimes the walls of resentment have built up so high that people can't generalize. You know, they might do something very nice and be very responsive and consistent with everyone else, but they have this wall between them and their partner. So I want them to continually ask themselves, if this were my best friend or my child who was acting like this or saying this, how would I react? Okay, now let's see if I can mirror that with my partner. Decrease emotional avoidance. When people are feeling upset, what will they do? And we want people to practice mindfulness. And mindfulness paraphrasing can be really helpful if you have two people, and now this is maybe shooting for the moon. And it may not be an immediate thing to do with couples because they may not be ready. But when they get to the point where they can have breakfast together or dinner or whatever, have each person go through a mindfulness inventory and just say, you know, I'm feeling really tired today. I had a hard day at work. I'm frustrated about whatever. And then the other partner paraphrases that. So I hear that you're just, you know, really worn out from all of the stuff that happened at work. Oh, my gosh. Imagine that. So the person is practicing Mindfulness and checking in and hearing themselves and their partner's paraphrasing it and validating how they feel. How awesome is that? And then you switch roles. So we want people to know that or identify ways to decrease emotional avoidance. Instead of just not feeling anything, or when you get upset, automatically going to the computer, or when you get upset automatically, you know, burying yourself away in a room and watching TV in your little cave, what can you do? Practice mindfulness. Know what you're upset about? Practice radical acceptance. The fact that. Or accepting the fact that things may not be great right now or there may be a problem, but there are also other good things that are going on. Practice distress tolerance. And you can look up the acronym improve or accept from dialectical behavior Therapy to help people identify tools that they can use to help them get from their emotional mind into their wise mind and problem solving. Obviously, eventually we want people to get down to problem solving. One activity you can do in session is ask them, when you're upset with your partner, what will you do? So the problem is right here, and we want to identify right now when you get upset with your partner, when you have a problem, what behaviors do you do? Do you yell? Do you slam doors? Do you withdraw? Do you drink? What is it that you do? What thoughts do you have about yourself, about that other person and about the relationship and just kind of life in general? And sometimes people may think, life's not worth living or I'm going to be miserable the rest of my life. Whatever the thoughts they are, get them out there. And what feelings do you have? And each partner is doing this on their own, own worksheet, getting all that stuff out so they can see that these. Those are behaviors, thoughts, and feelings that probably move them away from their goal of mending this relationship. Their goal of mending the relationship is still there. It's over here on the right hand side. So I want them to identify, what things could you do? What behaviors could you do instead? Instead that would help you handle this problem in a way that will help you continue to start repairing your relationship? What thoughts could you have that can help you deal with the problem in a way that nurtures or, you know, helps you work on your relationship? And what feelings can you work on enhancing that will help you work towards nurturing this relationship? And feelings can be like feelings of forgiveness or acceptance or compassion, empathy, all of those things. All of those feelings are generally toward feelings. They're feelings that, if the person has them, it's going to help them move toward a Healthier relationship. Promote strengths in the couple. Ask them what are your strengths as a couple? You know, not as an individual, but as a couple, you know, what strengths do you have? And a lot of times, you know, they can say, well, we agree on these types of things and we both enjoy doing these sorts. Okay, great then what are your strengths as individuals? You know, for example, my husband and I, we are very, very different. I am very structured. I am very, you know, that time and deadline oriented. I, you know, don't like clutter, I don't like flat surface. Itis, those are sorts of things and I consider those strengths. You know, I tend to be tidy, I tend to be good with money. I tend to be structured, compassionate, yada yada yada. He is extraordinarily gifted at house, household repairs and computer repairs and those sorts of things. There are a lot of things that he's good at. He's much better at teaching our son to drive than I am. So looking at our strengths that we have and both things that we can do and qualities about us, I tend to be overly compassionate. He tends to be, you know, a little bit on the overly logical side. But between the two of us, when we synergize, we balance each other out. Looking at that, respecting the fact that, you know, you may be very different, but you may, that may be a good thing because you might balance each other in some way and identify positive things you did for your partner or positive things that your partner did for you in the past week. That's a way to promote strengths. It's a way to highlight attempts at improving the relationship. One article I read talked about nine minutes of connection. Most people in the morning, right after work and right before bed, those are main transition points during the day. And that's when connection can be most meaningful because people are sort of wrapping up one thing that they're doing and getting ready to launch into the next phase of their day. So if you can spend three minutes in the morning talking to your partner three minutes after work and then three minutes before bed just talking about, you know, doing mindfulness check ins or whatever it is, it can really help promote strengths and communication in the relationship. When we do an assessment for couples, we want, we do want to assess their communication abilities. And a lot of that will be very clear during the assessment. If one partner tends to be dominant in the conversation, we want to make sure that we balance that out and look for blaming, look for lots of you statements, anything that we may want to address as far as less than Helpful communication styles. We want to identify conflict resolution methods. How do you guys solve arguments? And if the answer is we don't, well, there you go. We want to explore how each person appreciates the differences between themselves and their partner. Explore financial management, leisure activities, sexuality and affection, family and friends, relationship roles, children and parenting, and spiritual and cultural beliefs and values. Looking at all those things, how each partner feels each area is going, what each partner wants in each area for themselves as well as for the relationships. And then try to figure out where the us is, where the melding comes together. We also want to identify what each person's goal for treatment is and ask each individual, what changes are you hoping will come out of therapy? And what is the reality of the situation for you right now? When you, you had to describe your relationship to me, what would you tell me it was like? Doesn't mean the other partner has to agree. I want to understand your perception of the relationship from your point of view. And I always look at temperament because I believe it's very, very important to understand people's natural tendencies. And extroverts talk things out while they're thinking and really enjoy being around. A lot of people. If they have a problem, they're going to want to talk it out. And if they can't talk it out with their partner, they're probably going to call their mom or their girlfriend or their best friend or whomever it is to talk it out. Introverts tend to like to have time, quiet time when there's a problem, to think something over, mull it around in their brains. Extroverts often take it personally when introverts take their time away to get their thoughts together. And it's important to help people understand just the different temperament styles. It's not that John is rejecting you when he's had a bad day and he goes out onto the porch as soon as he gets home. He needs to get his thoughts together before he can come in for the other person. You know, for Sally, you know, maybe Sally likes to decompress by talking about her day. If they both get home at the same time, John may be ready to explode already and he may need his downtime. Sally may feel rejected if John goes out onto the porch. We want to negotiate, number one, help each person understand why they're doing what they're doing and how they can effectively help each other, you know, decompress. At the end of the day, if Sally knows that John is going to spend 30 minutes out in his area and then come back in A lot of times that's all that matters. You know, it's. There's an awareness of what's going on is I'll get my turn in 30 minutes. After he's had a chance to decompress in his, in his cave. Sensing versus intuitive. Sensors tend to be very caught up in details. Well, intuiters are the dreamers. You know, they come to counseling and the intuitor will have this Disney idea maybe of what the relationship is going to look like. Not really firm on the details, but, you know, you get the picture there. The sensor is going to have all these particular details and issues that need to be addressed, but maybe missing the big picture of, you know, we just want to be happy. And some of these little things may not really be all that consequential. Thinkers and feelers helping people understand what motivates decisions so they can communicate more effectively. When I was pregnant with my son, this dog, and we ended up naming her Casey, hint about how it ends. Walked up to me on the street, I'm like six months pregnant, and we couldn't afford another dog at that point in time. And I thought she belonged to somebody. So I called the pound and had them come get her because I didn't want her to run out in the street and get run over. She was really well mannered, knew how to heal, all that kind of stuff. Long story short, nobody ever came and claimed her. And we were laying in bed one night and it was about three days after she had gone to the pound, and I called, found out that nobody claimed her and she was going to be euthanized. First thing the next morning, my husband got up and he's like, okay, we're gonna go down to the pound today because we need to get that dog. And I'm like, what? Because logically, you know, I was trying to empathize from his point of view. My compassion was, you know, this poor dog didn't do anything, shouldn't be destroyed. The logical side of him said, we can't afford another dog. But we came in the middle and he's like, I'm never going to hear the end of it, how we ended up killing a dog, so we're going to go get another one. That was his logic for it. I'm motivated by, you know, compassion and mercy and all that kind of stuff. He tends to be much more logical and understanding how we make each other's our own decisions can help us understand how to communicate with the other one. If I want to convince him of something, you know, improve a point or whatever. I need to present it logically if he wants to motivate me to do something. He talks about how it will help the other person be happier or whatever. And judging and perceiving judgers. We're the structured people, and perceivers tend to get really bored if they're overly structured. Helping couples learn how to compromise. In our relationship, we've agreed to schedule in a spontaneous day. One day every weekend, which happens to be Sundays, right now is our family day. And I don't know what's going to happen that day, but I cannot make plans for that day because we're going to do something as a family and do something to be that's relatively spontaneous and that works for us because it's not the same thing. Seven out of seven days, there's one day that we can just kind of get up in the morning and go, hey, let's go kayaking or something. But we need to help. Have couples brainstorm ways that they can both make their temperaments work together and figure out how to respect each person's individual preferences. Conflict resolution. This is a set of steps that I have people go through. Set a time and place for discussion. Define the problem. Being specific and objective. If it means you got to write it out, write it out. List the ways you each contribute to the problem. So how does each person contribute to the financial problems? Or how does each person contribute to problems with intimacy or whatever it is? Identify past unsuccessful attempts at resolution. This will give you an idea about what doesn't work, or at least what hasn't worked until now. Brainstorm 10 possible solutions. Discuss and evaluate each solution. Agree on a solution to try. Describe how each person is going to work toward that solution. What is each person's responsibility? Set another time to discuss the progress and reward each other's efforts. If intimacy is a problem that you're working on, for example, then you know, brainstorm 10 ways to improve your intimacy. Agree on a solution that you're going to try. And for example, if you notice that your partner is doing something that he said he was going to do in order to try to work on the intimacy issue, thank him, you know, or acknowledge that, you know, that was really sweet. I appreciate you going the extra mile. Reward each other's efforts. And then in, you know, two weeks or whatever, when you sit down and review whether you've made progress, you'll be able to talk about those things. Fair fighting. And there should be a different word for it besides fighting. Fair Discussing just didn't Quite have the same ring to it. Know when you need a timeout. I tell people, do not engage when enraged. If you are angry, you've got that adrenaline flowing, that cortisol flowing. You've got tunnel vision probably going on. That means you're also probably not hearing what's being said to you. Do not engage when enraged. Use distress tolerance techniques to get into your wise mind. Identify what you are thinking and feeling and why it became so difficult to discuss it. You are thinking these things and which triggered this emotional dysregulation? What were those thoughts that made you go from having a thought to being enraged? Explore how those feelings are related to assumptions based on the past. John was late getting home from work and Sally all of a sudden got enraged because he was late getting home from work. What was she thinking? She was thinking, he's cheating on me again, or reflecting on something from the past. Let's check and make sure the reactions are not based on assumptions from the past and look at how those feelings are related to fears of rejection, failure, loss of control, isolation, and the unknown. This is something that people should do independently and then, you know, after they've looked at it, you know, looked at it objectively, got an idea of what's going on, where it's coming from. Resume the conversation. When you resume it, stay seated or go for a walk together. And I say that because sometimes it's easier to have a discussion when you're not having to sit there looking right at each other. So if you're both walking, if you're both in a standing position, then there's not a power differential. You don't want to stand in the middle of the living room and talk to each other, though, because then if you're standing and facing one another, it can get more adversarial. When you're walking, it tends to take some of that energy that you know wants to launch out of your throat and put it into your feet. The talker presents his or her points of view about one issue using objective words and I statements. For example, I get anxious whenever you're late because I remember that what happened before and you're having an affair, and I get scared that it's happening again and I'm afraid of losing you. Okay, great. We have this, lots of I statements here. There's no name calling, there's no blaming in this particular situation. This person is just saying, this is how I feel and this is why I feel this way. Not saying it's right or wrong. I'm just saying this is how it is. The listener listens to understand and paraphrases. So the listener would say, when I'm late, you feel vulnerable and get afraid that I might be planning to leave. Okay, that's a decent paraphrase. If the talker agrees, the talker says, yeah, exactly, or no, you're not hearing me, and then clarifies what they were intending to say. The listener continues to listen to understand and paraphrase until the talker feels completely understood. When the talker feels fully heard and understood, then the role switch, and then the person who was listening gets to say, it's really frustrating that, you know, I feel like I have to call in if I'm going to be five minutes late. Yada, yada, yada. Encourage them to start having this discussion where they're paraphrasing so they can take each other's points of view a little bit better. After both parties feel fully heard about what the situation is, then solutions are discussed. One activity that's kind of cool is learning to listen. Couples face each other. You identify one as a sender, and one is the receiver. The sender is asked to figure out or offer a sent one sentence, guess why he or she thinks that the partner decided to come to the therapy appointment. So they may say something like, I think you came to this session so I can learn how to be nice to you. Regardless of whether it's true, the receiver mirrors it. And this is, you know, intro to paraphrasing. So you think I came to this appointment today so you'll learn how to be nice to me? Yes. Okay, so that was a good paraphrase. They may not agree, but that was a good paraphrase. The sender keeps adding more reasons. I also think you're here because you want to save our marriage. And then the receiver can paraphrase that and go, so you think you. That I want you to learn how to be nice to me so we can save our marriage. Okay, that might be accurate. After the sender completes all guesses and each guess is mirrored, the receiver is asked to add or correct what was said. And it may look something like, it's true, I am here to save our marriage. But it's not a matter of you being nice to me, more a matter of helping us learn how to talk to each other so we can work through disagreements instead of arriving at stalemates. Something like that. But this is, you know, one of those intro activities. Obviously, you're doing it the first day in session, which is one way to start helping People learn how to listen and keep their mouth shut. If they're not worried about formulating a response because they know now's not the time they get to talk, then they're going to be more able to listen to what's being said. Seeking forgiveness. You know, sometimes we need to seek forgiveness in relationships. Try to understand or empathize with the pain that you've caused. Even if you didn't intend to cause pain, or if you don't, if you think the other person brought it on themselves or whatever the reason, you know, if something that you did caused the other person to experience pain, or the other person reacted with pain, then understand and empathize where that pain may be coming from. Take responsibility for your actions and make restitution if necessary. I don't like the word restitution, but I couldn't come up with another one. If you did wrong, admit it. Then try to make it right if you need to. It could be saying, I won't do that again. It could be changing your behaviors, you know, it could be, you know, calling your mother in law and apologizing or whatever it is. Take responsibility. Assure your partner that you will not do it again or will work toward a resolution. If you have two partners that are a stalemate over something and you know, one partner, let's stay with the sex thing because that one is one that comes up a lot. One partner does not feel any sort of attachment and just is not wanting to have sex with their, with their spouse. We don't want them to go into it and feel like they have to say, okay, I'm sorry it hurt you that I wouldn't have sex with you. I'll never deny you sex again. Now that's not respectful or empowering in any sort of way. So we want them to agree that they'll work toward a resolution to this so maybe they can resume some level of intimacy that both of them find acceptable. Apologize and ask for forgiveness for what parts you had in it. You know, everything, every situation, both parties played some part in it. Apologize and ask for forgiveness for what part you had and forgive yourself if necessary. Granting forgiveness, it's not as easy as going, I accept your apology. We need to encourage people to acknowledge their pain and anger, be specific about their needs for the future, to give up their right to get even, but they can insist on working toward a resolution. Again, it's not saying that, alright, if I grant you forgiveness, then I'm going to get my way. It's saying, all right, I'm going To forgive you. And we will use that energy. Instead of being angry at each other and resentful, we'll use that energy to work towards a solution. Let go of blame, resentment, and negativity. Communicate your forgiveness to your partner. And when it's safe, work towards reconciliation. And I don't necessarily mean just physically safe. I mean emotionally safe. I don't want people to rush into or feel like they're being pressured into something in order to commit, in order to fulfill some sort of a contract. I want people to feel like they're doing what they're doing willingly and happily. Improving intimacy. Intimacy triggers oxytocin and dopamine. We want to ask the couple to face one another. This can be hard for some couples, that might be as far as they can get. The sender is asked to state one thing he or she likes about the receiver. And so one example could be, I really love what a hard worker you are. You know, that's pretty benign. In the, in the compliment category, the receiver paraphrases this appreciation. You appreciate how hard I work. Okay, we're again practicing paraphrasing, but we're eliciting compliments, if you will, from one another. And it can feel make people feel vulnerable to give compliments sometimes. And it can make people feel vulnerable to get compliments sometimes. So this helps improve intimacy because there's a little bit of risk taking here and there's a little bit of revealing what your innermost thoughts might be. The sender then deepens the appreciation by using the phrase, and this is so special to me because. So they start by saying, I really love what a hard worker you are. And this is so special to me because I know that you work really hard in order to make sure that our family is safe and have all of our needs met and all that, whatever it is. The receiver again mirrors that compliment. So the receiver not only is hearing what's being said, but. But we know that they're hearing what's being said because they have to paraphrase it. And when we say something, as opposed to just hearing it, when we repeat it back, it strengthens that memory connection. So we're strengthening that intimacy pathway. And the process is repeated with the receiver offering appreciation. I like it. If couples will commit to doing this once a day, they face one another. And this can be in one of those little three minute blocks in the morning, right after work or before bed, look at each other and give a compliment paraphrase. Give a compliment paraphrase. You know, it just helps them get used to talking about something other than what's going wrong or what all the problems are. Common mistakes that I see. Letting one partner dominate the sessions. Remind partners that you're not a referee and that they need to be speaking to each other using I statements and practicing paraphrasing. It's so important that neither partner feels like you are taking sides. Interrupt is necessary to redirect the conversation to get it back to talking about one thing at a time. Paraphrasing using objective language and I statements. Another mistake is failing to elicit information from both partners. If one partner tends to be way more dominant, the other partner may not speak up. You also may have somebody that has sort of what I call white coat syndrome. And when they come into our office, one partner may feel timid and not want to offer up anything unless they're specifically asked. So have each person write down and share in session with the other person their perception of progress and paraphrase it. Anything important that transpired. Again, paraphrase it. Experience with the homework. Did it go well? Was it too hard? Was it overwhelming? What was your experience? What did you get out of it? And any concerns they have about the direction for treatment or any interventions that have been suggested so far. Have them do this at each and every session in order to make sure you're on the same page. Practice the communication skills and encourage both couples to have a relatively equal voice. Another mistake is failing to have couples arrive at a workable definition of important concepts such as intimacy. Intimacy means different things to different people. I like whiteboards because I got plenty of room to write, and I'll put a term up there like intimacy, and I'll say, okay, tell me what intimacy looks like to you, and I'll ask one. One partner, and I'll write that on one side of the board. And then I'll look at the other partner and I'll say, okay, tell me what intimacy looks like to you, not add to it, but tell me what it looks like to you. And I'll write on their side, and then we'll look at the similarities, both sides of the whiteboard, for what intimacy looks like to them, and we'll talk about how to develop that. And then we'll look at the differences between each person's concept of intimacy, and we'll talk about compromises or whatever in order to arrive at a universal definition of intimacy. Quality time is another thing, and that can be spending quality time with each other or the kids, financial management. There are a lot of concepts that we talk about, and it's important to look at how each person defines it. Moving too fast. Sometimes the pain is too ingrained. To start with. Intimacy exercises with couples start with what the couple thinks they can both handle. And the final mistake is imposing your vision of a happy relationship. Some relationships are consensually non monogamous or polyamorous. Maybe that's not your cup of tea. Maybe religiously you don't even believe it. But if it's their preference, then we need to understand it and in order support them, in order to help them, you know, work on their relationship as they define it. Pornography. Some couples actually watch porn together. Some couples, you know, watch porn separately, but they know that the other person's watching porn and it's okay, and they are fine with that in their relationship. That is up to them. And pornography doesn't just have to be videos or pictures. It can be, you know, trashy dime store novels or whatever. But it's important to understand if that's something in their relationship that they want to keep, then, you know, we don't need to talk about all the ills of pornography. Not every couple sleeps together because, you know, a lot of times I hear couples don't sleep together because they have very different schedules and, or one partner may have sleep apnea. And even with a CPAP machine, those things are noisy. They can't get quality sleep if they sleep in the same room. Okay, well, if you're not going to sleep in the same room, and that works better for you guys, then how can you maintain that intimacy? What can you do during non sleeping hours? And then sex? There's a whole litany of information out there about asexuality that we need to be aware of. Not everybody has the same sex drive. And it's important to help couples be able to talk about what works for them. And you know, sometimes couples even agree to have an asexual sort of relationship. And there are a lot of articles and things out there that would say, no, you have to be having regular sex. That may not be what works for that couple. We need to be culturally and individually responsive. Working with couples is very different than individual therapy. You got one plus one equals three. You've got one partner, the other partner, and then the relationship. Key challenges are to help each person understand the other person's perception of the problem and resolution. Understanding what the problem means to each person and how it might be triggering stuff from the past or serving to protect them in the present. Helping them increase motivation and efficacy. Ensuring both partners hear each other and themselves and rebuilding the intimacy bridge with a foundation of trust. This episode of Counselor Toolbox has been sponsored in part by Foundations Events. As the behavioral health industry evolves, the need for collaboration is greater than ever. Join Foundations Events at the Innovations in behavioral healthcare conference June 20th and 21st in Nashville. Focused on listening to both the patient and provider, this conference offers two days of sessions that follow the journey from meeting the patient where they are to helping them find recovery. Special pricing for licensed clinicians is available with the opportunity to earn over 20 CEUs. Visit foundationsevents.com counselortoolbox for more information and to register today. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand CEUs for this podcast is@allce.com podcastceus that's allce.com podcastceus to sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to allce.com sponsor. Thank you.