Handbook of Couples Therapy pdf

He is the func-2001 recipient of the Distinguished Award for Lifetime Contributions toFamily Therapy Research of the American Association for Marriage andFamily Therapy.. In addition,he

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Handbook of Couples Therapy

Handbook of Couples Therapy

Edited by

Michele Harway

John Wiley & Sons, Inc.

This book is printed on acid-free paper

Copyright © 2005 by John Wiley & Sons, Inc All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.

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Library of Congress Cataloging-in-Publication Data:

Handbook of couples therapy / edited by Michele Harway.

p cm.

Includes bibliographical references.

ISBN 0-471-44408-1 (cloth: alk paper)

1 Marital psychotherapy—Handbooks, manuals, etc I Harway, Michele.

RC488.5.H3263 2005

616.89′1562—dc22

2004042252 Printed in the United States of America.

10 9 8 7 6 5 4 3 2 1

Acknowledgments

COMPLETING A VOLUME like this is accompanied by a variety of

feel-ings The main one is relief at being able to take the manuscript off

my desk, although knowing how busy I get, my desk will probablystay clean for a grand total of about 50 seconds Closely following the re-lief is the sense of gratitude that I feel toward a myriad of people whowere involved in helping me complete this project I first want to thank

Dr Florence Kaslow who encouraged me to develop this edited volume andwho was instrumental in convincing Wiley to publish it Dr Kaslow has al-ways been a wonderful role model and professional cheerleader for me.The staff of John Wiley & Sons, particularly Isabel Pratt and PeggyAlexander (who stepped in when the original editor changed positions), aremuch appreciated

During the time I was developing the concept behind the book and ing chapter authors, I was going through a difficult professional transitionand I want to thank all of my friends at the Phillips Graduate Institute whowere my sounding boards and dear, “family members.” I won’t mentionyou all by name, but I think you know who you are, and I hope you knowthat I care about you deeply

invit-Since joining the faculty at Antioch University, Santa Barbara, I havefound a wonderfully supportive group of colleagues and new friends Iwant to particularly thank Dr Catherine Radecki-Bush who tolerated mybrief moments of insanity as I completed this task Cathy also was helpful

to me in my work by asking me to teach a class on couples therapy, knowingperhaps that preparing for the class would crystallize some important rele-vant ideas

Finally, I would like to thank the many couples I have been honored towork with clinically over the years I have learned so much from you!And to my husband Bruce Antman who has always maintained that anyrelationship is salvageable as long as both members of the couple are will-ing to do whatever it takes to make it work, I say, “I agree.”

MICHELEHARWAY, PHD

Contents

Michele Harway

SECTIONI LIFECYCLESTAGES

Lori H Gordon, Robin Rose Temple, and Donald W Adams

William C Nichols

Linda Morano Lower

C Haydee Mas and James F Alexander

6 Therapy with Older Couples: Love Stories—The Good,

Thomas H Peake and Angela E Steep

SECTIONII THEORETICALPERSPECTIVES ONWORKING WITHCOUPLES

Louise Bordeaux Silverstein

Terence Patterson

David E Scharff and Yolanda de Varela

10 Narrative Therapy with Couples: Promoting Liberation from

Lynne V Rosen and Charley Lang

Brent Bradley and Susan M Johnson

12 Strategic and Solution-Focused Couple Therapy 194

Stephen Cheung

13 Integrative Healing Couples Therapy: A Search for

Patricia Pitta

Roberta L Nutt

SECTIONIII SPECIALISSUESFACED BYCOUPLES

15 Managing Emotional Reactivity in Couples Facing

William H Watson and Susan H McDaniel

Michele Harway and Ellen Faulk

17 Working with Couples Who Have Experienced

Amy Holtzworth-Munroe, Kahni Clements, and Coreen Farris

About the Contributors

Donald W Adams, PhD,earned his doctorate in clinical psychology

from Duke University After three years as director of Children’sService in a rural North Carolina Mental Health Center and an-other three years as director of Psychological Services at Dorothea DixHospital Inpatient Adolescent Treatment Program, he began, in 1981, fulltime private practice in Cary, North Carolina Dr Adams specialized inplay therapy and taught seminars and conducted conference workshops onchild psychotherapy in the 1980s His practice has been consistently ori-ented toward the healthy adjustment of children and families He has beenactive in the North Carolina Psychological Association and served as presi-dent in 1995/1996 He and his wife, Jo, a psychiatric nurse specialist, weretrained in PAIRS in 1993 He refocused much of his professional energy to-ward treating troubled relationships and teaching relationship skills Hehas taught many aspects of PAIRS and has been active in developing andrefining PAIRS programs He is currently the vice president of the PAIRSFoundation and serves on the executive board and steering committee ofPAIRS Dr Adams co-authored a chapter on sensuality and sexuality in

Building Intimate Relationships.

James F Alexander, PhD, is the progenitor (with B V Parsons) of tional family therapy (FFT), a nationally and internationally acclaimedand empirically demonstrated intervention model for juvenile delinquents,oppositional and conduct-disordered youth, and substance abusing youth.Since 1968, he has been on the faculty at the University of Utah He is the

func-2001 recipient of the Distinguished Award for Lifetime Contributions toFamily Therapy Research of the American Association for Marriage andFamily Therapy Dr Alexander is the author of over 90 chapters and refer-eed journal articles, two books, and over 150 convention presentations andacademic colloquia He has also presented at over 300 national and interna-tional clinical training workshops

Daniel J Alonzo, MA,is a member of the core faculty at Phillips Graduate stitute in Encino, California He is a member of the Society for the Scientific

In-Study of Sexuality (SSSS) and has presented papers at the SSSS WesternRegional Conferences and the Los Angeles SSSS Chapter He is also a mem-ber of the American Association of Sex Educators, Counselors, and Thera-pists (AASECT), and he is an AASECT Certified Sex Therapist In addition,

he is an American Association for Marriage and Family Therapy ApprovedSupervisor and a California Association of Marriage and Family TherapyCertified Supervisor, providing supervision, training, workshops, and con-sultation with mental health agencies in the Los Angeles area He has been

a California Licensed Marriage and Family Therapist for more than 13years, specializing in sexual minority mental health, couple therapy, andworking with same-sex couples

Brent Bradley, PhD,is assistant professor of counseling and director of themarriage and family therapy track in the Graduate Counseling Department

at Indiana Wesleyan University He received his doctorate in Marriage andFamily Therapy from Fuller Seminary School of Psychology in 2001 He is

a clinical member of the American Association for Marriage and FamilyTherapy Dr Bradley has published original research in emotionally fo-cused couples therapy (EFT), and actively researches, writes, and presentsthe approach

Stephen Cheung, PsyD,is an interim core faculty of clinical psychology atAntioch University in Los Angeles He is teaching Brief Therapy, FamilyTherapy, Group Therapy, and Psychological Testing Before he joined An-tioch University in 2004, Dr Cheung had been a program director andclinical psychologist at Asian Pacific Counseling and Treatment Centers(APCTC) in Los Angeles coordinating and supervising their children andadult programs for 12 years For almost three decades, he has been providing short-term and longer-term psychotherapy to a wide variety ofclients He has specialized in: Eating, Substance-related, Personality,Mood, and Anxiety Disorders; grief therapy; and psychological testing.Since 1996, he has been teaching at Phillips Graduate Institute, CaliforniaState University at Los Angeles, and Pepperdine University He has alsobeen presenting training in strategic and solution-focused brief therapy,

an integrated treatment approach to eating disorders, and psychotheraywith childhood abuse survivors in local, national, and international men-tal health conferences

Kahni Clementsreceived her BA in psychology from the University of ifornia at Los Angeles She is currently a graduate student in clinical psy-chology at Indiana University-Bloomington Her research interests arerelationship violence and couples communication interactions

Cal-Yolanda de Varela, PhD Candidate,is a clinical psychologist with a master’sdegree in educational psychology and is completing her doctorate She has

been president of the Panamanian Psychological Association, a foundingmember of the International Institute of Object Relations Therapy, and direc-tor of the Panama Satellite Program of IIORT She is author and co-author ofmany articles on object relations and on couples therapy.

Coreen Farrisreceived her BA in psychology from Brandeis University She

is a graduate student in clinical psychology at Indiana ington Her research interests are in substance use and aggression

University-Bloom-Ellen Faulk, MA, is a faculty member at Phillips Graduate Institute in cino, California She is a member of the California Association of Marriageand Family Therapists, the American Association for Marriage and FamilyTherapy, and a student member of the American Psychological Association

En-Ms Faulk provides training, workshops, and consultation for mental healthproviders on working with adult survivors of sexual abuse She has been aconsultant to the Los Angeles Police Department and the Los Angeles Fed-eral Bureau of Investigation Ms Faulk is a practicing marriage and familytherapist specializing in traumatized populations

Lori H Gordon, PhD,is founder/president/training director of the PAIRSFoundation, Inc and serves as chief executive officer of the executive board.She conducts a private clinical practice through the Family Relations Insti-tute, Falls Church, Virginia, and consults through Tequesta ConsultingServices, Ltd in Fort Lauderdale, Florida She is the author of three popular

books: Love Knots, Passage to Intimacy, and If You Really Loved Me She is also

co-author of two professional articles on the PAIRS program as well as arange of professional training curricula, articles, and materials She contin-ues to develop relationship programs through the PAIRS Foundation thatare designed to sustain healthy marriages and stable families Dr Gordontrains health care professionals and selected public worldwide to teach therange of PAIRS programs

Michele Harway, PhD, ABPP,is a member of the core faculty in the chology Department at Antioch University, Santa Barbara She is also amember of the consulting faculty at the Fielding Graduate Institute andshe maintains a private practice in Westlake Village, California Dr Har-way has written and presented extensively on domestic violence, traumasurvival, gender, and family issues She is the author or editor of eight

Psy-books including Treating the Changing Family: Handling Normative and

Un-usual Events and Spouse Abuse: Assessing & Treating Battered Women, Batterers, and Their Children (Second Edition) Active in governance of the American

Psychological Association (APA), she is past-president of the Division ofFamily Psychology and current treasurer of the Society for the Study ofMen and Masculinity She is a fellow of three divisions of APA and is also

a board-certified family psychologist (ABPP)

Amy Holtzworth-Munroe, PhD, is a professor of psychology at IndianaUniversity, Bloomington She received her doctorate in clinical psychologyfrom the University of Washington For almost 20 years, she has conductedresearch on the problem of husband violence, comparing the social skills ofviolent and nonviolent husbands and examining the marital interactions

of violent couples Her more recent research focuses on subtypes of malebatterers She has led batterer treatment groups and worked with a localdomestic violence task force to set up a batterers’ treatment program

Dr Holtzworth-Munroe teaches a couples therapy practicum for graduate

students She is past associate editor of Journal of Consulting and Clinical

Psy-chology and Cognitive Therapy and Research and a past member of NIH grant

review panels in the area of family violence

Susan M Johnson, PhD, is professor of psychology and psychiatry at tawa University and director of the Ottawa Couple and Family Institute.She received her doctorate in counseling psychology from the University ofBritish Columbia She is a registered psychologist in the province of On-

Ot-tario, Canada, and a member of the editorial board of the Journal of Marital

and Family Therapy, the Journal of Couple and Relationship Therapy, and the Journal of Family Psychology She is one of the originators and the main pro-

ponent of emotionally focused couples therapy, now one of the best dated couples’ approaches in North America

vali-Florence W Kaslow, PhD, ABPP,is in independent practice as a gist, coach, family business consultant, and mediator in Palm Beach County,Florida She is also director of the Florida Couples and Family Institute; anadjunct professor of medical psychology, Department of Psychiatry at DukeUniversity Medical School in Durham, North Carolina; and a visiting profes-sor of psychology at Florida Institute of Technology in Melbourne, Florida

psycholo-Dr Kaslow is board certified in clinical, family, and forensic psychologyfrom the American Board of Professional Psychology (ABPP), and in sexol-ogy from the American Board of Clinical Sexology Dr Kaslow is a fellow ofDivisions 12, 29, 41, 42, 43, and 46 of the American Psychological Associa-tion, the American Association for Marriage and Family Therapy (AAMFT),and other organizations She has edited, authored, or co-authored 19 booksand has contributed chapters to more than 50 other books Over 150 of herarticles have been published in professional journals here and abroad She isalso on the editorial boards of numerous journals in psychology and familypsychology Dr Kaslow has received numerous honors in psychology, familypsychology, and international psychology

Charley Lang, MA, MFT, has a private practice in Los Angeles He alsoteaches Narrative Therapy at Antioch University, Los Angeles, and super-vises the mental health staff at the AIDS Service Center in Pasadena He

produced and directed the award-winning documentary films Live to Tell:

The First Gay and Lesbian Prom in America, Battle for the Tiara, and Gay Cops: Pride Behind the Badge.

Linda Morano Lower, MS, MA, LMFT,holds masters degrees in both riage and family therapy and ascetical theology from California LutheranUniversity and Fordham University, respectively She has been in privatepractice as a marriage and family therapist for 17 years in Camarillo andWestlake Village, and she specializes in working with couples at all stages oftheir life cycles Linda lives in Camarillo, California, where, with her thera-pist husband, she is parenting two teen-aged daughters

mar-Don-David Lusterman, PhD,is the author of Infidelity: A Survival Guide and co-editor of Casebook for Integrating Family Therapy: An Ecosystemic Approach and Integrating Family Therapy: Handbook of Family Psychology and Systems The-

ory as well as several other books, book chapters, and articles He also serves

as consulting editor for the Journal of Family Psychology and is on the editorial board of The American Journal of Family Therapy He founded the program in

family counseling at Hofstra University in 1973 and served as its coordinatoruntil 1980 He was also the founding executive director of the AmericanBoard of Family Psychology (now part of the American Board of ProfessionalPsychology) and holds an ABPP Diplomate in family psychology He is a fel-low of APA’s divisions of Family Psychology, Psychotherapy, IndependentPractice, Media Psychology, and Men and Masculinity He is also a fellowand approved supervisor for the American Association for Marriage andFamily Therapy He is a charter member of the American Family TherapyAcademy on whose board he also serves Dr Lusterman is in private practice

in Baldwin, New York

C Haydee Mas, PhD, did her undergraduate work at the University ofMichigan and her graduate studies in clinical psychology at the University

of Utah where she was chairperson of the graduate student minority mittee Her research interests and publications have focused on therapist-client communication styles, FFT process studies, support systems inabusive families, as well as family communication and attributional styles

com-in families with an adolescent She is currently com-in private practice workcom-ingwith couples and families with adolescents and children, and she conductstherapy in Spanish with bilingual and bicultural clients and families

Susan H McDaniel, PhD, is professor of psychiatry and family medicine,director of the Division of Family Programs and the Wynne Center forFamily Research in Psychiatry, and associate chair of the Department ofFamily Medicine at the University of Rochester School of Medicine andDentistry in Rochester, New York She has many publications in the areas ofmedical family therapy, family-oriented primary care, and supervision andconsultation Her special areas of interest are family dynamics and genetic

testing, somatization, and gender and health She is a frequent speaker atmeetings of both health and mental health professionals Dr McDaniel isco-editor, with Thomas Campbell, MD, of the multidisciplinary journal,

Families, Systems and Health, and serves on many other journal boards She

co-authored or co-edited the following books: Systems Consultation,

Family-Oriented Primary Care, Medical Family Therapy, Integrating Family Therapy, Counseling Families with Chronic Illness, The Shared Experience of Illness, Inte- grating Family Therapy, and the Casebook for Integrating Family Therapy Some

books have been translated into several languages; an additional volume isexclusively in German

Dr McDaniel was chair of the Commission on Accreditation for Marriageand Family Therapy Education in 1998, president of the Division of FamilyPsychology of the American Psychological Association (APA) in 1999, andchair of the APA Publications and Communications Board in 2002 Dr Mc-Daniel was recognized by the APA as the 1995 Family Psychologist of theYear In 1998, she was the first psychologist to be a fellow in the PublicHealth Service Primary Care Policy Fellowship She also won the Postdoc-toral Academic Mentoring Award from her medical school in 1998, and in

2000 she received the award for Innovative Contributions to Family apy from the American Family Therapy Academy

Ther-William C Nichols, EdD, ABPP, is a marital and family therapist anddiplomate in clinical psychology, a fellow, clinical member, and approvedsupervisor of the AAMFT; a charter member of both the American FamilyTherapy Academy and the International Family Therapy Association(IFTA); and a fellow of both the American Psychological Association andthe American Psychological Society He was in full-time private practicefor nearly 25 years and taught and supervised postdoctoral, doctoral, andmasters’ students in MFT programs and postdegree professionals for 35years at Florida State University, the Merrill-Palmer Institute, and else-

where Founder and first editor of the Journal of Marital and Family Therapy,

he also edited Family Relations, and currently edits Contemporary Family

Therapy He has written or edited eight MFT and therapy books,

conceptu-alized and launched MFT accreditation, wrote the first model licensinglaws, co-wrote the national licensing examination, and chaired a state li-censing board for seven years He has been president of the AAMFT, IFTA,and the National Council on Family Relations

Roberta L Nutt, PhD, ABPP, is the founder and director of the counselingpsychology doctoral program that emphasizes family psychology andwomen’s/gender issues at Texas Women’s University She is co-author ofthe “Division 17 Principles Concerning the Counseling/Psychotherapy of

Women: Rationale and Implementation” and Bridging Separate Gender

Worlds: Why Men and Women Clash and How Therapists Can Bring Them gether Dr Nutt has written and presented extensively on gender and

To-family issues, served in a number of leadership roles in psychology includingpresident of the Family Psychology Division of APA and held offices in boththe women’s and men’s divisions She holds the ABPP diplomate in familypsychology She is currently co-chairing an APA Interdivisional Task Forcedeveloping new guidelines for psychological practice with girls and women.

Terence Patterson, EdD, ABPP, is professor and director of the doctoralprogram in counseling psychology at the University of San Francisco He is

a licensed psychologist and is board certified in family psychology with theAmerican Board of Professional Psychology His specialties are family psy-chology, ethical issues, and theoretical orientation in psychotherapy He is

on the boards of a number of professional journals and has authored Vol II

(Cognitive-Behavioral) of the Comprehensive Handbook of Psychotherapy, and the

Couple & Family Clinical Documentation Sourcebook Dr Patterson has served

as president of the Division of Family Psychology of the American logical Association and is a fellow of APA

Psycho-Thomas H Peake, PhD, ABPP,is professor and associate dean for the School

of Psychology at Florida Institute of Technology (Melbourne), and adjunctprofessor in the Department of Aging and Mental Health of the Florida In-stitute of Mental Health of the University of South Florida (Tampa) Li-censed in Virginia, Michigan, Florida, and chartered in Great Britain, he haspracticed clinical, health, and family psychology for over 15 years He is adiplomate (ABPP) in both clinical and health psychology and is an approvedsupervisor for AAMFT Dr Peake’s publication and practice areas includebooks and articles on brief psychotherapies, clinical training and supervi-sion, couples therapy, medical/health psychology, healthy aging, and a book

Cinema and Life Development: Healing Lives and Training Therapists.

Patricia Pitta, PhD, ABPP,is a board-certified family psychologist She ceived her doctorate from Fordham University and completed postdoctoraltraining in family therapy at the Center for Family Learning, Ryebrook,New York In addition, she holds a degree in pastoral formation which en-ables her to integrate spirituality with psychology For the past 10 years,

re-Dr Pitta has been a professor of psychology in the doctoral and toral training programs at St John’s University As developer of IntegrativeHealing Family Therapy, Dr Pitta has published many articles about thetheory and its applications She has also produced a video entitled “Parent-ing Your Elderly Parents” (published by APA Publications) and is the au-thor of a marital therapy manual (published by Division 42 of APA)

postdoc-Joy K Rice, PhD,is clinical professor of psychiatry and Emerita Professor

of Educational Policy and Women’s Studies at the University of Wisconsin–Madison She also maintains an active psychotherapy practice with Psychi-atric Services in Madison Her research activity includes more than 100

national and international presentations and publications on family change,

poverty, and mental health Living through Divorce: A Developmental Approach

to Divorce Therapy, written with Dr David Rice, was honored as a

Book-of-the-Month selection

Active in international psychology, Dr Rice is secretary of the tional Council of Psychologists, chair elect of the APA Committee on Inter-national Relations in Psychology, and president elect of APA Division 52,International Psychology She has received numerous awards and honors forher research and social policy work on behalf of disadvantaged families andwomen nationally and internationally She is a recipient of the EducationalPress Association Distinguished Achievement Award, a fellow of the Amer-ican Psychological Association, and is listed in Who’s Who of Women andthe World’s Who’s Who of Women

Interna-Lynne V Rosen, LCSW, is core faculty and director of the Post ModernTherapy Training Program at Phillips Graduate Institute in Encino, Cali-fornia She is interested in collaborative education and integrating her pas-sion and commitment to diversity and social justice in training andteaching contexts Ms Rosen is co-founder of Women’s Project Los Angeles(WPLA), a community-based project focused on social constructionist andfeminist ideas WPLA utilizes innovative forms of dialogue in order tobring forward new perspectives and possibilities that can lead to meaning-ful change in women’s lives She maintains a private practice and has along-standing interest in working with women who are taking their livesback from eating problems, abuse, and trauma and in working with couplesand families

David E Scharff, MD,is a psychiatrist and psychoanalyst He is co-director

of the International Psychotherapy Institute, Washington, DC Dr Scharff

is clinical professor of psychiatry at Georgetown University and at the formed Services University of the Health Sciences He is author, co-author,

Uni-and editor of 15 books including Object Relations Couples Therapy Uni-and Object

Relations Individual Therapy.

Ilene Serlin, PhD, ADTR, is a licensed psychologist and a registereddance/movement therapist Dr Serlin is a fellow of the American Psycho-logical Association, past president of Division 32 of APA, council represen-

tative from Division 32, and has served on the editorial boards of The Arts

in Psychotherapy, Journal of the American Dance Therapy Association, and the Journal of Humanistic Psychology She has taught at Saybrook Graduate

School and Research Institute, UCLA, Antioch University, and AlliantGraduate School She has consulted and worked with clergy, and is the au-

thor of: Therapy with a Borderline Nun, A Psycho-spiritual Body Approach to a

Residential Treatment of Catholic Religious, and The Last Temptation of Christ.

She is currently in private practice in San Francisco and Sonoma County,California.

Louise Bordeaux Silverstein, PhD, is associate professor at the FerkaufGraduate School of Psychology at Yeshiva University, Bronx, New York,where she has taught courses in family therapy and the social construction

of gender since 1992 Dr Silverstein is a past president of the AmericanPsychological Association’s Division of Family Psychology She is co-founder, with Dr Carl Auerbach, of the Yeshiva University FatherhoodProject, a qualitative research study of fathering from a multicultural per-spective Dr Silverstein’s publications focus on fathering, feminist theory,and the social construction of gender She is the co-editor (with Thelma

Jean Goodrich) of Feminist Family Therapy: Empowerment and Social Location and co-author with Carl F Auerbach of An Introduction to Coding and Analyz-

ing Data in Qualitative Research Dr Silverstein is a family therapist in

pri-vate practice in Brooklyn, New York

Sally D Stabb, PhD, is a licensed psychologist and associate professor ofcounseling psychology at Texas Woman’s University Her research interestsinclude women’s issues, emotion, couples, and multiculturalism Dr Stabbteaches courses in process and outcome research, qualitative research meth-ods, psychotherapy theories, professional issues, and practicum

Mark Stanton, PhD, ABPP,is professor of psychology and chair of the partment of Graduate Psychology at Azusa Pacific University He is a diplo-mate in family psychology, American Board of Professional Psychology, and

De-a licensed psychologist in the stDe-ate of CDe-aliforniDe-a He is the editor of The FDe-am-

Fam-ily Psychologist and 2005 president of the Division of FamFam-ily Psychology of the

American Psychological Association

Angela E Steep, PsyD, is a postdoctoral fellow in primary care at the versity of Oklahoma Health Sciences Center She did her intern-ship at the Medical College of Virginia, graduate work at Florida Institute

Uni-of Technology, and her undergraduate work at the University Uni-of NorthCarolina at Chapel Hill Particular areas of interest include mind-bodymedicine, medical/health psychology, primary care psychology, and motiva-tional interviewing

Robin Rose Temple, MA, MSW, CAC II,is a master teacher and trainer forthe PAIRS Foundation, where she has been teaching for eight years Sheholds post-master’s certification from the Gestalt Institute of Denver andthe Family Therapy Training Center of Colorado, which recently awardedher the Alumnus of the Year Award for her work teaching PAIRS in theFront Range of Colorado She is also certified as a Colorado addictions

counselor and contributing author to the book Bridging Intimate

Relation-ships Ms Temple has been working with families for 25 years She is a

de-voted mother of three, and she is passionate about healing relationships ofall sorts It is in her own marriage that she has learned the most about beingpart of a couple

William H Watson, PhD,is associate professor of psychiatry (psychology)and neurology at the University of Rochester School of Medicine andDentistry/Strong Memorial Hospital He is senior training faculty of theFamily Therapy Training Program and is the family psychology consultant

to the Strong Epilepsy Center Areas of interest include spirituality in chotherapy, family systems in the workplace, couples therapy, and a familysystems understanding of mind/body problems

IN THE FAIRY TALE, the Prince and Cinderella fall in love, get married, and

live happily ever after Our culture abounds with similar stories In eachcase, the story seems to end at the moment of commitment and we areseldom privy to the adjustments that the couples must make in beginning alife together And yet, the adjustment must be great or more couples wouldsucceed in celebrating their Golden Wedding Anniversary (Kreider &Fields, 2002, based on U.S Census data, cite only 5% of married couplesreach at least their 50th anniversary) The same authors report 10% of mar-ried couples divorcing within 5 years of marriage and 20% of married cou-ples divorcing within 10 years of marriage There are no parallel figures forsame-gender couples or cohabiting couples But clearly the track record isnot good

Some professionals (Nichols, Chapter 3) suggest that the first year ofmarriage (or of living together) is actually the most difficult year of a rela-tionship This makes sense: Even when the couple has a similar culturalbackground, they have grown up in different families, whose daily livinghabits may differ on the most mundane issue (how to put the roll of toiletpaper on the holder) to the somewhat more important issues (who is re-sponsible for what tasks in the home) These two individuals may have dif-ferent expectations of a relationship and different values on a wide variety

of subtle and not-so-subtle topics The differences may multiply when, inaddition, the two come from different cultural groups Faced with the com-plexities of ironing out those differences and the lack of support from theculture at large, it is not surprising that many couples simply give up.Some, however, seek out psychotherapy, often as a last-ditch effort

This book focuses on couples therapy and the interventions that mentalhealth professionals implement in helping couples develop the tools tomake a successful dyad.

Yet, many psychotherapists begin seeing couples without extensivetraining in how to do couples work The intention of this book is to fill inthose gaps in mental health professionals’ repertoire

While much of this book focuses on heterosexual couples (often ried), many of the issues we consider affect same-gender couples, as well

mar-as heterosexual cohabiting couples Because there are issues with whichsame-gender couples struggle that are unique to their relationships, wehave included a chapter that specifically addresses these couples Recogniz-ing that cultural issues are very powerful determinants of couple inter-action, we have woven cultural issues into each chapter rather than having

a separate chapter on this topic

We have considered work with couples from three perspectives: a mental one, a theoretical one, and a situational one Section I of this booklooks at couples at different stages of the life cycle, since clearly different is-sues affect them at each stage and distinct therapeutic approaches to work-ing with them are appropriate We have used McGoldrick’s life cycle stages(loosely construed) to guide us in our choices Accordingly, Section I beginswith couples at the premarital stage (Chapter 2) Gordon, Temple, andAdams describe PAIRS, a premarital counseling curriculum, extensively de-signed to include a multiplicity of interventions to assist couples as theyenter a committed relationship In Chapter 3, Nichols thoroughly exploresthe first years of commitment He includes a discussion of the nature of mar-riage, cohabitation, and commitment; an overview of the tasks of the familycycle; and issues related to psychotherapy with couples in the early stages ofthe life cycle Lower (Chapter 4) considers the difficult life transition to par-enthood and the adjustments that confront couples with young children InChapter 5, Mas and Alexander explore the four essential features of treat-ment based on clinical, research, and theoretical literature as applied to fam-ilies with adolescents Highlighting the multiplicity of differences that suchfamilies may bring into the therapy room, these authors focus on cultural di-versity issues Completing the part on life cycle stages, Peake and Steep(Chapter 6) examine novel ways to intervene with older couples capitalizing

develop-on their lived experience and using popular films and other resources as juncts to psychotherapy

ad-Section II of the book focuses on different theoretical approaches to ing with couples Silverstein (Chapter 7) considers the application of Bowenfamily systems theory to work with couples and provides a supportive femi-nist critique of the theory In Chapter 8, Patterson argues that common con-ceptualizations of cognitive-behavioral approaches to couples therapy do notalways provide an adequate integration of these two traditions Focusing onthe separate foundations of behavioral approaches on the one hand, and cog-nitive theories on the other, Patterson provides an understanding of the

work-melding of these two traditions into cognitive-behavioral couples therapy.Scharff and de Varela (Chapter 9) describe how object relations therapywould be applied to couples Shifting from more traditional approaches ofworking with couples to postmodern thinking, Rosen and Lang (Chapter10) introduce key aspects of doing narrative therapy with couples In thefirst of several integrative approaches to working with couples, Bradleyand Johnson (Chapter 11) present emotionally-focused therapy, an inte-gration of collaborative client-centered, gestalt, systems approaches, con-structivist thinking, and understandings derived from attachment theoryand the empirical literature Cheung (Chapter 12) proposes the integration

of strategic family therapy and solution-focused approaches to workingwith couples In Chapter 13, Pitta describes integrative healing couplestherapy that uses psychodynamic, behavioral, communication, and sys-temic theories in understanding the couple’s functioning Concluding thispart, Nutt (Chapter 14) describes feminist and contextual approaches toworking with couples

Section III approaches couples’ interventions from the perspective ofcommon presentations in therapy Thus, Watson and McDaniel (Chapter15) describe the work with couples who are confronting medical concerns.The interface of the biological and the emotional provide the framework fortheir work in medical settings In Chapter 16, Harway and Faulk considerhow a history of sexual abuse in one member of the couple may affect theoverall couple’s functioning and may lead to difficult therapeutic concerns

A common concern in couples therapy is the existence of physical violence.Holtzworth-Munroe, Clements, and Farris (Chapter 17) discuss the implica-tions of intervening with these types of couples Addiction is another diffi-cult issue that couples bring with them into therapy Stanton (Chapter 18)reviews key elements of couples therapy for the treatment of addictive be-haviors Infidelity is said to affect a large number of couples and presentsparticular challenges In Chapter 19, Lusterman explores issues related toworking with couples who have been touched by infidelity and proposes aneffective model for intervention Psychotherapists are often uncomfortablewith exploring spiritual issues in therapy Yet, spiritual and religious differ-ences, like other forms of cultural difference, contribute to some couples’dissatisfaction with their relationship Serlin (Chapter 20) considers how tointerweave spiritual concerns in the course of psychotherapy While couplescomprised of two same-sex partners share many of the same issues as het-erosexual partners, Alonzo (Chapter 21) describes some unique issues forgay or lesbian couples Kaslow (Chapter 22) examines the impact of socio-economic factors on couples’ functioning and describes some approaches toworking with money issues in therapy

Not all couples presenting for psychotherapy are there to improve thecouple’s bond Some couples initiate therapy to provide a smoother transi-tion to divorce, while other couples initiate therapy in the hopes of sav-ing their relationship but ultimately decide instead to focus on marital

dissolution Rice (Chapter 23) considers special issues in working with vorcing couples.

di-Finally, while many of the chapters interweave empirical informationwith clinical information, in Chapter 24, we consider what the research has

to tell us about the nature of couples functioning and the effectiveness ofour interventions Stabb reviews both the literature on well-functioningand dysfunctional couples and research that elucidates what is useful incouples therapy interventions Chapter 25 summarizes the multiplicity ofthreads that have been developed in the many outstanding contributions tothis volume

Couples therapy can be challenging work Nonetheless, since couplesand families provide the major building blocks of our society, the work that

we do in shoring up the foundations has impact beyond those we touch rectly As we know from systems theories, the concentric circles of involve-ment of the individuals who comprise our families and couples, within thelarger context of our communities and cultures, makes our impact ricochetfrom its point of impact to the entire pond As such, couples therapists havethe possibility of being change agents at a much wider scale than they mayhave believed Good training in doing couples work thus becomes critical

S E C T I O N I

LIFE CYCLE STAGES

C H A P T E R 2

Premarital Counseling from the

PAIRS PerspectiveLori H Gordon, Robin Rose Temple, and Donald W Adams

THE PREMARITAL COUPLE treads a challenging path between falling in

love and solidifying a commitment Premarital couples seek sional help to prevent or to understand and resolve relationship diffi-culties that may have arisen even before marriage The status andcircumstances of premarital couples seeking help vary from the young-and-inexperienced to the previously married (with or without children) tolong-term cohabiters who have not committed to marriage The premaritalcouple is wise to be cautious Statistics tell us that the likelihood they willfind happiness and longevity in marriage is despairingly low whereas 90%

profes-of couples married during the years 1945 to 1949 made it to their 10-yearanniversary Forty years later, barely 70% of those married during theyears 1985 to 1989 celebrated a decade of wedded bliss—and the statisticscontinue to decrease (Fleming, 2003)

Premarital couples seek assurance that they can create a lifelong mate partnership Each partner needs accurate concepts, conducive atti-tudes, technical knowledge and skills, and practiced competencies tosustain a loving relationship As in ballroom dancing, the couple relation-ship gains best through co-learning, by acquiring and practicing these in-timate relationship skills together The couple needs to acquire high levels

inti-of skill to continue dancing lovingly in the face inti-of changing family lifewith its unrelenting and often discouraging economic, domestic, andparental responsibilities The counselor, who wishes to effectively offersuch knowledge and skills to couples, needs to undertake relevant profes-sional training Such training is not yet established in most graduate clini-cal programs

A BOU T P R AC T ICA L A P P L ICAT ION O F

PAIRS has been experienced by tens of thousands of couples, manywho were on the brink of divorce (DeMaria, 1998); and by tens of thou-sands of individuals, wanting to develop skills to prevent a repeat of thedevastation of relationship breakup Gordon’s self-help book for couples

and individuals, Passage to Intimacy (1993), presents the main ideas and

ex-ercises of PAIRS that can be learned at home and practiced outside theclassroom Incisive descriptions and thoughtful discussions by PAIRSMaster Teachers, a review of research about PAIRS, and critical issues

such as the PAIRS Ethics Code for teachers are brought together in

Build-ing Intimate Relationships: BridgBuild-ing Treatment, Education and Enrichment through the PAIRS Program (DeMaria & Hannah, 2003) The PAIRS experi-

ence significantly increases relationship satisfaction, sustainable love,and commitment

A central tenet of PAIRS is that sustained intimacy is required to maintain a

lasting marriage When intimacy, the deep emotional experience of loving

connection, is lost, the ground the marriage is built on becomes shaky.Good will is then lost and the desire (and ability) to solve problems, over-come obstacles, and persist in the face of fear and uncertainty, quicklyerodes With its emphasis on intimacy, PAIRS goes to the heart and theheat of the matter Once couples learn to create, re-create, and sustainintimacy, many premarital and marital issues, such as commitment, coop-eration, fidelity, and creative management of differences, are much morequickly resolved

PAIRS is designed to (1) realign attitudes and beliefs about love and lationships and about marriage and family life; (2) train and evolve eachpartner’s self-knowledge, emotional literacy, and emotional efficacy; and(3) change ineffective behaviors that diminish intimacy by teaching thosebehaviors and skills that increase intimacy and relationship enhance-ment The PAIRS curriculum is a theory-based, cohesive, orchestratedbody of concepts and practical activities that is a powerful technology for change PAIRS has, thus far, proven effective in every population,

re-including disadvantaged youth, middle and high schools, foreign tures, entire families, business groups, faith-based adult education, sepa-rated and divorcing couples, premarital couples, and devitalized couples

A PTP is a licensed mental health professional who has been trained in thePAIRS professional training program PTPs have had more than 100 hours

of direct experience with the PAIRS concepts and training exercises ing their training, PTPs personally experience the full range of PAIRS exer-cises, usually with their partners After training, most PTPs teach, practice,and internalize the PAIRS concepts and tools In OFFICE PAIRS, the PTPpersonally and directly helps the couple learn PAIRS competencies, prac-tice them under an experienced eye, and apply them outside the office andobtain feedback on their “homework.”

Dur-When working with a premarital couple, the PTP holds in heart andmind an awareness of what is necessary to be an effective partner as well asthose skills, attitudes, and strategies couples need to assure an ongoing sat-isfying relationship, conducive to family permanence These competenciesfocus on three areas: (1) emotional literacy; (2) conjoint partner skills forbuilding and maintaining intimacy; and (3) practical knowledge, strategies,and attitudes for sustaining positive marriage and family life Tables 2.1,2.2, and 2.3 list these competencies

The PTP holds these competencies in heart and mind as a standard forwhat is needed to sustain couple satisfaction When couples seek counsel-ing, the PTP notes which of these competencies are missing and developspriorities and strategies for offering knowledge and training in what isneeded Effectively addressing what is missing with interventions, new un-derstandings, and the teaching of new skills, especially for the premaritalcouple, can prevent years of confusion, misery, and probable later familydisintegration Without training in new competencies, the couple cannotadvance far During the early romantic “illusion” stage of a relationship,moments of hurt, misunderstanding, noting differences, or use of poweroften trigger doubts and fears about the relationship Those couples inearly relationships coming for counseling are typically experiencing chal-lenges to illusions of perfect fit and unconditional love This is the optimaltime to develop the knowledge, skills, and strategies needed to build a solidrelationship rather than an illusory one

Table 2.2

PAIRS Competencies: Conjoint Couple Skills to Create and Maintain Intimacy

1 Confide in one another regularly with emotional openness and empathic listening.

2 Complain to one another regularly (without attacking) including requests for change Can listen to complaints without defensiveness

3 Resolve differences and conflicts by seeking to learn rather than to prevail Use fair

fighting that involves confiding, empathic listening, complaining with requests for change, and contracting, effective win-win solutions, all without manipulation and dirty fighting

4 Agree on areas of autonomy, areas of consultation, and areas of mutually shared ership and decision making.

own-5 Clarify hidden assumptions and unspoken expectations to minimize misperception and misunderstanding

6 Help one another heal pains and disappointments, resolve emotional allergies, and clarify hidden assumptions Conjointly heal and resolve emotional allergy infinity loops

7 Meet basic needs for sensuality, appropriate sexuality, physical closeness, bonding, and intellectual and emotional sharing with one another

8 Follow clear, equal, negotiated boundaries regarding what is private and not shared with others outside the relationship

9 Initiate change when the status quo (division of roles, responsibilities, and privileges)

is not satisfactory Follow through on negotiated changes.

Table 2.1

PAIRS Competencies: Emotional Literacy

1 Comfortable with the names and manifestations of the five basic emotions, i.e., pain, fear, anger, love, and joy Identifies and expresses these emotions and can listen em- pathically to them.

2 Recognizes defensive overreactions as emotional allergies based on painful

memo-ries Takes responsibility to reduce, control, and change inappropriate responses

3 Recognizes being emotionally open vs emotionally closed When feeling attacked, threatened, or denied, evaluates reality by checking out speaker ’s meaning and in- tent, rather than assuming and reacting defensively via rationalizing-explaining- justifying, withdrawing, avoiding, or fighting back

4 Expresses pain, fear, and anger without attacking or blaming.

5 Listens without interjecting self-concerns Creates and maintains emotional safety for others

6 Uses anger constructively to assert self, set limits, define boundaries, and effectively solve problems Expresses anger appropriately and safely to release suppressed emotions

7 Believes in one’s own value Feels lovable and good enough without having to be fect Accepts having healthy needs and actively pursues getting them met, including the biological needs for physical closeness and emotional openness in an intimate relationship

per-8 Experiences and expresses emotions of a type and at an intensity that appropriately fits and that sustains action in accord with one’s purpose, intention, and circum- stances (emotional efficacy).

T H E PA I R S P R E M A R I TA L A SSE SS M E N T

The format Gordon developed for the PAIRS premarital assessment begins

with a two-hour joint interview with couples to explore their history

to-gether, establish the context of their relationship, and set initial goals andplans for the assessment It involves questions such as:

• How did you meet?

• What drew you together?

2 Choose play, pleasure, recreation, creativity, and humor for the relationship to ance the necessary duties and hard work required to maintain the relationship, home, family, and economic security.

bal-3 Express important hurt, fear, or irritation directly to each other in words, asking to be

heard and understood with empathy Recognize that what is lef t unsaid in a

relation-ship is of ten more harmful than what is said.

4 Seek forgiveness for hurts inflicted in the relationship by taking responsibility for transgressions, repairing and restoring damages, and expressing regret for pain ex- perienced by partner Partner, in believing the pain is understood, feels assured that transgressions will not easily reoccur, restores trust and forgives Let go of grudges and choose to forgive.

5 Give up being right Invite and express diversity Welcome differences as sources of vigor, perspective, and healthy growth of a relationship Choose to learn from each other.

6 Choose trust, truth, mutual respect, and fidelity as the foundation of a lasting, loving relationship.

7 Extend goodwill and positive intent Do what is pleasing and satisfying to partner Choose to engage in caring behaviors Be a good leader or a good follower as each fits.

8 Know each other ’s pleasure and pain buttons Refrain from triggering negative reactions.

9 Develop a strong sense of “ we.” Have intentional rituals, customs, and styles that create a unique relationship and family identity

10 Encourage connecting to friends and community to assure each has adequate omy, independence, and breathing room Balance the intense closeness and needful interdependence that is at the center of a permanent passionate relationship.

auton-11 Maintain active connections with extended family and other couples and families to provide community, perspective, and support for the relationship and family.

12 Regularly express gratitude, appreciations, blessings, wishes, hopes, and dreams Positive expressions focus couple and family on desire, fulfillment, and happiness, rather than on victimization, deprivation, scarcity, outrage, or despair.

• What made you decide to commit to this relationship?

• What are family responses and reactions to this relationship and yourreactions to each other’s families?

• What are you seeking from this counseling?

• What are your questions of the counselor?

• What are your vocations and how does your work and work cation styles affect your relationship particularly during times of stress.This longer session is needed to grasp the fabric and playing field of therelationship The 50-minute hour simply cannot build the trust, connected-ness, and collaboration needed for this initial inquiry

communi-Next schedule two-hour individual interviews with each partner: This

time provides an opportunity to discuss what might be uncomfortable toshare in a joint session These sessions gather the individual social andemotional histories—family conditioning, early beginnings, models fromthe parental marriage, sibling relationships, decisions and experiences re-garding love, trust, caring, criticism, competition, power, communicationstyles, and marital role expectations, including their hopes for the future

as well as fears Beliefs, expectations, experiences, and life decisions thatmight affect the couple’s relationship are tracked, including invisible loy-alties, changes through time in previous relationships, a history of previ-ous marriages or engagements and what led to their dissolution, children,job changes, communication and power impasses, disappointments andhow they were handled, and personal hopes and dreams The individualsessions generate an attitude of openness and growing curiosity on thepart of each participant about unique histories, and the conditioning eachhas brought to the relationship including how differing styles and expec-tations may mesh or clash These individual sessions open windows tonew understandings that have not previously been realized or considered

Next, a two-hour joint interview for feedback is scheduled The PTP

in-quires about and carefully listens to new thoughts or questions that mayhave arisen from their exploration of issues The PTP then reviews perti-nent data that has been collected and offers specific significant relation-ship concepts and skills as applicable, such as the PAIRS Dialogue Guide, acommunication tool for complaining without blaming Or a listening skill

Or an exercise designed to uncover mind reading Or hidden expectations

that in PAIRS are called Love Knots, such as, “If you loved me, you would

know ” A nonblaming attitude is maintained throughout Humor, asappropriate, is often included along with pertinent wisdom and insights.The PTP relabels and reframes many past behaviors and intentions, point-ing out how blame is often not the issue The PTP demonstrates how enor-mous misunderstandings have often arisen from a lack of information,which if asked for and then given, would clarify misperceptions and hid-den assumptions

In this joint session and, if needed, in one additional joint session, the PTPprovides possible explanations of issues that have become tangled or diffi-cult in the relationship The PTP then discusses formats for acquiring spe-cific relationship knowledge, relationship skills, or specific competencies foremotional literacy These formats might include PAIRS courses and/or OF-FICE PAIRS counseling sessions These suggestions may also include books

to read, specific exercises to practice, and brief workshops to attend thathave proven to be effective

MOR E A BOU T R E C OM M E N DAT IONS

Very often PTPs recommend and encourage premarital couples to pate in the four-month PAIRS Relationship Mastery Course developed forthe specific purpose of practicing, improving, and sustaining healthy mar-riage relationships This semester-long course is recommended because itnot only fully addresses relationship fundamentals, it also addresses emo-tional literacy, understanding one’s history and oneself, as well as ad-vanced topics such as pleasure (sensuality and sexuality) and relationshipreconstruction

partici-Alternatively, when appropriate and available, the PTP may recommendthat the premarital couple attend one of the shorter PAIRS programs Theseinclude the one-day PAIRS JumpStart, If You Really Love Me , and theJewish, Catholic, or Christian PrePAIRS programs; the two-day Passage toIntimacy Workshop; or the three-day Christian PAIRS or PAIRS First pro-grams The PAIRS website, www.pairs.com, provides descriptions, sched-ules, and location information about these programs The short programscontain a careful selection of pieces from the full PAIRS curriculum tailored

to specific target groups Most of the short courses begin with ing the PAIRS Relationship Road Map, learning basic communication andconfiding skills as well as how to complain constructively to effect helpfulchange Each program adds further PAIRS pieces that are appropriate for itspurpose The PrePAIRS and PAIRS First programs were originally designedfor couples in the early years of relationship commitment These courses arehighly appropriate for premarital couples seeking to strengthen their rela-tionship through learning intimate relationship fundamentals

understand-The premarital couple with moderately high ego strengths, emotionalliteracy, and openness to learning often finds that the 6- to 10-hour as-sessment, by itself with the new insights and brief but specific skills andconcepts offered, is sufficient to gain renewed confidence in the relation-ship and in plans to marry The PTP may also recommend one of theshorter PAIRS workshops to provide elaboration, practice, and consolida-tion of the new concepts, skills, and strategies that have been developed inthe assessment An invitation is issued for them to return when needarises in the future, indicating the PTP’s interest and availability as well

as the normal inevitability of the need for continuing attention to thework of a relationship.

For the majority of premarital couples (considering that about half of allmarriages end in divorce) and especially for those who are emotionally illit-erate, ignorant about successful relationships, and unskilled at intimacy,PTPs routinely recommend the 120-hour Relationship Mastery Course Thisprogram affords the breadth, depth, time, and practice needed to change de-structive attitudes and behaviors This Mastery Course is recommended forthose who already have complex issues, are possibly in mutual allergy, may

be embarking on a second or third marriage, or are on the verge of breakupbut not ready to give up Typically, the PTP will remain available to the as-sessment couple for evening 90-minute office sessions to oversee extra prac-

tice with the PAIRS skills during their participation in the course, and then again after the course for any “RePAIRS” that may be needed to refresh the

concepts, practice the tools, or help the couple get quickly unstuck shouldthey again become negatively entangled

When a course or workshop is not immediately available, the PTP maycounsel premarital couples in need of more training via OFFICE PAIRS untilthey can participate in a PAIRS program The PTP selects concepts, exercises,and experiences thought to be most cogent to their missing competenciesand then teaches these in a series of 90-minute sessions In locations wherethere are no available PAIRS courses or workshops and when a couple cannottravel to one in another location, the PTP may contract to lead the couplethrough the content of one of the shorter PAIRS curriculums in a defined se-ries of 90-minute sessions When engaging a PAIRS curriculum, each pur-

chases a participant’s handbook for the selected course and a copy of The

Passage to Intimacy book, which provides a deeper presentation of the ideas,

skills, or attitudes under study In such OFFICE PAIRS activities, couples ceive homework assignments and are expected to practice daily the skillsthey are learning OFFICE PAIRS is not undertaken lightly Teaching theseskills is usually easier and more natural in a group setting than in the office

re-T H E PA I R S R E L Are-T IONSH I P M A Sre-T E RY C OU R SE

The full PAIRS curriculum is divided into six main sections:

1 Communication and problem solving;

2 Clarifying assumptions;

3 My history and unique self;

4 Emotional reeducation, emotional literacy, and bonding;

5 Pleasure—sensuality and sexuality; and

6 Contracting—clarifying expectations

The following summary highlights specific PAIRS exercises and key cepts in italic

con-C OMMUNICATION AND P ROBLEM S OLVING

PAIRS begins with a presentation of the Relationship Roadmap, the basic PAIRS

model of how relationships succeed or become stuck and fail Couples learn of

the essential role of confiding in intimacy and then how to listen and speak in ways that deepen their level of confiding They are taught the Daily Tempera-

ture Reading, in which they are expected to confide in one another each day

sharing Appreciations, New Information, Puzzles, Complaints with Requestfor Change, and Wishes, Hopes, and Dreams Participants then read and

practice Virginia Satir’s (1988) The New Peoplemaking and discover how the

style one uses can be a far greater problem than the actual issue under cussion When stressed and communicating in stress styles (Blaming, Placat-ing, Computing, and Distracting), the underlying problem goes unresolved

dis-Couples are then taught the Leveling Style of Communication practiced in the

congruent position (face to face, hands in hands), which is a foundation forthe subsequent confiding work in the course They cultivate the skill to slow

down communication using Empathic Shared Meaning, taking turns being the

speaker and the listener with feedback to assure understanding They nextlearn how to confide a negative reaction to their partner’s behavior all the

way through in safety using the PAIRS Dialogue Guide The Dialogue Guide

leads the speaker through a sequence of 18 “I-Statement” sentence stems garding this negative reaction Maintaining eye contact, holding hands whilethey speak, giving verbatim feedback, and not answering the complaint orintrojecting defensiveness helps couples to stay connected to one anotherand avoid misunderstandings They discover how to speak so that the otherperson really wants to listen, and how to listen with empathy so that theother feels deeply heard and understood

re-One of the many paradoxes of PAIRS is how direct and skillful ment of conflict builds greater closeness, trust, and confidence in the rela-tionship Couples are taught safe and structured ways to move into theintense emotion regarding a conflict as a first step toward resolving an issue

engage-The Emotional Jug is one of the core metaphors of PAIRS When emotions are

cut off or suppressed, it is as if they are poured into a jug and stopped upwith a cork—a cork that becomes the “stiff upper lip” of indifference Part-ners are taught how to safely remove the cork and “blow their lid.” An initialexpression of anger quickly gives way to more vulnerable feelings like fear,pain, or grief, which is followed by relief and then gratitude for their part-ners’ listening and acceptance This process can occur relatively quicklywhen couples master the tools and are not fearful of each other’s emotions

By learning how to express fully one’s fear, pain, and anger in safe and destructive ways, and to do so in the arms of their beloved, and/or with thesupport of peers, the bond between intimate partners powerfully deepens

non-The Emptying the Jug Exercise is also taught as a prenegotiation release and as

an emotional confiding tool that may be used like the Daily TemperatureReading

The PAIRS anger and conflict management tools were adapted largely

from the work of George Bach (Bach & Wyden, 1969) They include the Anger

Rituals (the Haircut, and the Vesuvius) in which one partner asks permission

of the other to vent in a time-limited fashion with as much intensity as ispresent The Anger Rituals help to contain anger in those who explode or

speak caustically and to give permission to be angry and assertive to those

who rarely allow themselves to do this Once suppressed emotions around

an issue are released, couples can then productively engage the Fair Fight for

Change, another Bach ritual adapted by PAIRS for use as a structured

negoti-ation Here, couples learn to fight for the relationship, rather than againsttheir partner Peer couple coaches guide the partners through the fight for-mat, prohibit dirty fighting, and enable reflective evaluation of the partners’emerging healthy fight styles Peer coaches learn as much about the FairFight process when coaching as they do when negotiating their own issues

Through a Shared Art Exercise in class and Follow-the-Leader Dates as

home-work, issues related to power and control, leadership and followership, ibility versus rigidity of power roles, as well as the impact of unspokenassumptions are all brought to the surface and examined Couples discoverthat they can remain connected while disagreeing and that they can growcloser through successfully addressing their differences A potent sense of

flex-“we,” a sense of shared competence, higher self-esteem, and greater erosity and goodwill ensue from safely and successfully finding a real, mu-tually satisfying, win-win solution to conflict

gen-C LARIFYING A SSUMPTIONS

Partners’ expectations of one another, conscious or unconscious, are largelyformed by long-past experiences Unspoken assumptions and hidden ex-

pectations lead to great misunderstanding A Mind Reading tool is taught for

respectfully checking out assumptions rather than proceeding withoutknowing what is true for the partner or with mind reading without permis-sion To help couples become more aware of their hidden assumptions,

Gordon catalogued the common Love Knots, or unexamined beliefs, that otage intimate relationships (See If You Really Loved Me , Gordon, 1996.)

sab-Couples learn to recognize knots and to untangle them so that they lose theirpower to sabotage the relationship

M Y H ISTORY AND U NIQUE S ELF

A study of family systems, through psychodramas enacting Family Systems

Factories and what happens with the addition of children (Dyad-Triad) leads

into the study of each person’s own family of origin Genograms, a

three-generation family map, allows exploration of influences in the family oforigin and reveals the invisible rules, scripts, and loyalties that may be af-fecting current relationship Participants also revisit their personal history

through Guided Visualizations and Intensive Journaling to discover the impact

of early messages and past decisions, especially regarding love, adequacy,

and worth They uncover their Revolving Ledgers, the emotional bills of

debts owed from the past that, as they walk through the revolving door oflife, they hand to whomever is there Participants identify intense over-reactions to relatively minor behaviors of their partner that indicate the

presence of Emotional Allergies (another concept unique to PAIRS) These

al-lergies are acute sensitivities to whatever now reminds a person of pain orthreats from the past Allergic responses are accompanied in the present byprotective reactions (ideas and emotions) and protective behaviors thatwere used to manage the pain long ago

Tools for healing allergies and past painful experience include the

Heal-ing the Ledger Exercise and the Museum Tour of Past Hurts and ments Here, partners confide previous painful or frightening experiences

Disappoint-to one another This confiding helps the listener Disappoint-to understand and havemore compassion for the partner, and it helps the speaker to express painsafely to a comforting, validating, and supportive partner Partners areshown how to hold each other in a nurturing way, while they are express-

ing and releasing old pain Participants may use the Letting Go of Grudges

Letter as a journaling and/or confiding tool, for finding relief and freedom

in working through grudges (hurts held in angry resentment to protectfrom risking being hurt again) Through these experiences, participantsclear up misunderstandings of one another by reclaiming their personalhistory rather than continuing to project and blame their partner They re-connect with suppressed early experiences and decisions that have beeninterfering with their ability to trust or be intimate with their partner Part-ners also learn they can help to heal instead of hurt one another

Couples also find that Emotional Allergy Infinity Loops underlie many of

their unresolved conflicts Such a loop occurs when a person’s behavior

triggers an emotionally allergic reaction in his or her partner The partner’s

allergic reaction then triggers an allergic reaction in the first partner,whose reactive behavior then retriggers the second, and so on, ad infini-tum In the throes of an Emotional Allergy Infinity Loop, each partneroften re-experiences the worst pains of childhood and the helpless reac-tions of a small child Typically each feels, “if it is like this, then I cannot behere!” Each forgets to see his or her partner as a friend and experiences the partner instead as the enemy Each becomes lost in a reactive state ofbelieving the worst about self and partner and of using primitive protectiveactions Devastating distance can grow

Couples now develop concepts and a language to understand and explainwhat they are experiencing when they are conjointly in the grip of suchemotional intensity As participants begin to understand and discuss theirLove Knots, Early Scripts and Decisions, Ledgers, Grudges, Emotional Al-lergies, and Emotional Allergy Infinity Loops, they become capable of tak-ing responsibility for their own reactions, rather than blaming the other

Couples are helped to strategize together to devise “emergency exit ramps”from their loops and to work together to escape those slippery slopes.Through empathy for the partner’s “child responses” and revision of beliefsabout the meaning of the partner’s behavior, the Emotional Allergy Infinity

Loop can be transformed into a Loop of Vulnerability and Empathy (LOVE).

To help see their unique self and inherent personality differences, ipants rate themselves on the Meyers-Briggs type indicator (Kiersey-Bates).Through the use of exercises to illuminate the differences between the poles

partic-of the four basic personality preference scales, couples begin to see howmany of their disagreements and conflicts are better understood as differ-ing styles of decision making, problem solving, information gathering, andstyle of interaction Differences, which had appeared to be threatening andperceived as personal attacks, can now be reframed as temperament differ-ences This often allows individuals to accept their own preferences andstyles, and helps couples approach their personality differences with asense of humor and even with compassion, instead of frustration, resent-ment, or fear Additionally, couples begin to appreciate how their differ-ences can be complementary in accomplishing life tasks together

Participants also learn the “PARTS of Self,” a system of classifying andunderstanding the various aspects of their own unique personality Drawnfrom the work of Virginia Satir, participants learn to identify and give mean-ingful names to their subpersonalities, usually names of renowned figures

in culture, history, or literature Disowned or suppressed PARTS of a son’s psyche tend to act outside of a person’s control Coming to know anddiscover the positive value in each PART of Self allows each person to bettercoordinate, utilize, and, if necessary, transform these PARTS so that they areacting in harmony with personal goals and life choices Their PARTS can beperceived as resources In a series of PARTS parties, classmates act out thePARTS of one individual, and later the PARTS of a couple The PARTS partyplayers help individuals or couples discover new and more creative combina-tions of PARTS that the couple can use in conflict and stress or even romance.Following these PARTS parties, individuals and couples explore their owninner cast of characters and experiment with ways to rearrange the PARTSthey tend to use the most In doing so, they discover how to better use alltheir resources and uncover new possibilities for interactions with their part-ners that are more harmonious and productive

per-E MOTIONAL R EEDUCATION , E MOTIONAL L ITERACY , AND B ONDING

PAIRS dives even more deeply into emotion via the PAIRS Bonding

Week-end Workshop PAIRS adapted the New Identity Process (Casriel, 1972) to

the couple orientation of PAIRS, calling it Bonding Work Casriel, a

renowned specialist in the treatment of drug and alcohol addiction intherapeutic communities, originally developed this expressive process to

treat character disorders Paul MacLean’s (1973) A Triune Concept of the

Brain and Behavior is presented as a model to understand emotional

mem-ory that, when activated, does not know time and place and is experienced

as reoccurring now Participants learn several different positions for ing their partner while he or she is expressing intense emotions Partici-pants learn how to progress from less intense emotions to more intenseexpression, to the reexperiencing of emotions in full measure In this in-tense emotionally open state, emotional reeducation can occur Once indi-viduals have emptied old pain, they become open to receive positive,comforting, and affirming messages about themselves from their partnersand the group When ready, they are assisted in construction affirmations

hold-of their own value, rights, and entitlements They replace old or toxicchoices with new, healthy attitudes and decisions

During this process, couples develop deep empathy and compassion forone another They discover that, not only can they handle their partners’ in-tense emotions, but they can also offer their partner comfort through hold-ing and touch when they are in pain Over the course of this weekend,participants commonly lose their fear of both their own and their partners’emotional intensity They experience directly and observe in others how anintimate relationship generates intense emotions about bonding, belonging,needing one another, never leaving, and being loved for oneself They learnthat the expression of these powerfully intense emotions cements theirbond at the deepest of levels and can restore passion to their relationship

The culmination of this workshop is the Death and Loss experience in

which participants enact saying goodbye to their deceased loved one Theyare led to speak what would need to be expressed to say goodbye Musicand the use of carefully chosen sentence stems make this an emotionallycharged and deeply meaningful exercise for partners They experience thedepth of their bond in the “experience” of losing one another throughdeath This exercise also allows communication about the meaning of their

lives together Rest-of-life wish-baskets are shared between partners.

P LEASURE —S ENSUALITY AND S EXUALITY

Couples explore how they can expand the range of pleasure that they sharetogether PAIRS recognizes three special biological needs (sources of pleas-

ure) that require physical touch met by the married couple: Sensuality,

Sexual-ity, and Bonding The Pleasure Weekend Workshop is devoted to removing

barriers to pleasure and enhancing skills and understandings that enablecouples greater pleasure, joy, and fun through stimulation of the senses,touch, and physical closeness Same gender groups explore: (1) early experi-ences and messages that have impacted one’s development as a sensual andsexual being; (2) playful exploration of gender differences in romantic turnons and turn offs; and (3) sexual saboteurs and stereotypes, myths, and fal-lacies about sex Cross-gender conversations and guided visualizationsabout early experiences with sex development help generate more empathic

understanding between partners and more acceptance for their biologicallybased differences.

Sprinkled throughout the weekend are exercises designed to open the five

senses, as well as guided massages where couples practice giving and ing pleasuring touch with feedback The Guided Face Caress and Foot Massage

receiv-are among the most enjoyable moments of the entire PAIRS program

Along with these sensual exercises, an explicit film on lovemaking isshown that re-focuses the couple on intimacy and pleasure, and helps to re-lieve performance anxieties Participants fill out detailed and explicit in-ventories to help identify romantic, sensual, and sexual preferences,dissatisfactions, and wishes for change Couples are guided through a safeprocess in which they share their pleasure inventories with each other anddiscuss their reactions and feedback Often, a lack of communication or abuildup of resentment or fear of hurting or embarrassing one another hasblocked giving and receiving pleasure freely Sensual and sexual pleasuredates (McCarthy & McCarthy, 1990), which are assigned for homework,give couples permission to experiment in new and creative ways with bothgiving and receiving pleasure Couples usually leave the weekend with arenewed sense of hope and excitement about their sex life, and frequentlydescribe breakthroughs in the following weeks from having been able toenjoy each other based on leveling about their physical and sexual needsand preferences

The roots of jealousy—the downside of natural sexual possessivness—are examined Participants are shown how the Web of Jealousy, comprised of

fear, shame, pain, guilt, and rage, negatively affects self-esteem and trust.Jealous reactive behaviors to stem the pain and control outcomes often

make matters worse, creating a Jealousy Infinity Loop Through a Jealousy

Journaling Exercise with guided discussions with partner, couples come to

understand one another’s jealous reactions and vulnerabilities to jealousreactions Betrayal and love triangles are discussed The essential steps toprevent jealousy are presented using guidelines developed by Shirley Glass(2003)

C ONTRACTING —C LARIFYING E XPECTATIONS

Based on Clifford Sager’s work (1976), the PAIRS curriculum culminates in

an integration and application of all the tools and concepts learned in the

proceeding months toward a revised relationship contract To prepare for the

Contracting Weekend, the Powergram (Stuart, 1980) is examined as a model

for understanding how power is shared and decisions are made in each lationship Using this model, couples address where and how to change thedivision of power and responsibilities so that both are satisfied with theirdegree of input, influence, and responsibility, and areas of autonomy in de-

re-cision making Couples use the Museum Tour of Past Dere-cisions, to review and

learn from past decisions about which there may remain a residue of sentment or hurt