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Archive for the ‘Therapy’ Category

Therapeutic Mediation: An Alternative to Costly Litigation

Susan Heitler, Ph.D.

4500 East 9th Avenue, Suite 660-S, Denver, CO 80220

(303) 388-4211, drheitler@gmail.comju

For permission to reproduce this article please contact the author. C Susan Heitler, 1998.

Psychologists and lawyers work in similar businesses. Helping people to resolve their conflicts is a central mission of both professions.

Psychologists like myself apply our skills primarily to personal rather than business realms–to individuals’ struggles between conflicting fears, desires and values, and to the conflicts that bring tensions to couples and families. My own specialty is work with high-conflict couples. I work with married couples, and also with couples in pre-marital and post-divorce (co-parenting) relationships. My goals as therapist are usually three-fold: to guide settlement of the disputes that have driven couples apart, to facilitate healing from their mutual past hurts, and to teach the skills that can enable them to dialogue more cooperatively in the future. This three-pronged therapy process enables most couples to transition from fighting to comfortable partnership.

Lawyers tend to handle business and government-related conflicts, though many also address domestic, criminal, and other issues. Similar principles of conflict resolution pertain, however, whether the arena is personal, family, economic, or political, and whether the entities involved are intimate spouses, competing business people, corporations, or even nations. In all these realms, the pathway from hostility to mutually satisfying resolution requires similar steps.

I recently shared an enlightening conversation about similarities between psychological and legal professional work with a judge from New York. This judge’s reputation for effectiveness in settlement conferences, and for efficiently moving her cases through litigation, is legendary. The secrets to her success, she reported, lie in three basic principles:

  • Make sure the litigants are present in the trial.
  • Ask the lawyers to leave.
  • Get the litigants to talk to one another.

For example, in one trial, the judge explained, she postponed the case until both litigants, not just their lawyers, were present. She then went so far as to instruct the litigants to go out together for lunch before the trial would proceed. In this way she enabled the litigants to talk to each other, and in the cooperative tone essential to constructive dialogue.

Lawyers sometimes feed an adversarial climate, which is part of what prompts this judge to ask lawyers to take a back seat to direct litigant-to-litigant dialogue. On the other hand, lawyers can and often do facilitate conflict resolution. To help clients face their adversaries in settlement conferences in a manner that yields productive dialogue and satisfying outcomes, lawyers, like psychologists, need expertise in techniques of collaborative problem-solving.

The following case presents three such tools:

  • healing techniques, so that hurt and anger are diminished. Only then can cooperativeproblem solving replace rancor, tensions, fault-finding, and blame.
  • a conflict resolution strategy that can enable people in disagreement to talk directly with one another, and to end up with a mutually agreeable plan of action.
  • the rules of cooperative dialogue that can enable adversaries to talk productively.

While these techniques come from the toolbox of a psychotherapist, they hopefully can prove equally useful for resolving disputes in legal settings.

Therapeutic mediation.

Therapeutic denotes a process that leads from emotional distress to emotional relief. The goal of a therapeutic process is restoration of a sense of well-being.

Mediation refers to a process by which a third party assists two antagonistic parties to discuss and resolve issues in dispute. A resolution is an agreement upon a plan of action which is acceptable to both parties because it is fully responsive to the concerns of both parties.

The term therapeutic mediation thus implies a twofold goal: emotional healing plus agreement on a plan of action.

The case

The following case was referred to me by a lawyer who wanted to see if the case could be settled without going to trial. The lawyers client, Mrs. A, had limited income, minimal social support, and significant emotional vulnerability. Her lawyer felt that a lengthy court process, whatever the outcome, would be too costly in time, money, and emotional drain to be worth any potential gains. In addition, he intuited that even a ruling in his client’s favor might not adequately resolve the complex emotions the situation had aroused for her. The referring lawyer also expressed compassion for the other litigant, Mr. B., a young lawyer whose career would suffer if the case went to trial. The lawyer therefore had suggested that a therapist might be able to help the litigants come to a mutually agreeable settlement. If a therapeutic settlement process did not prove satisfactory, his client then could pursue traditional legal options.

Mrs. A wanted to file a malpractice lawsuit against her prior divorce lawyer, Mr. B. The charges would have included

  • substandard professional performance
  • sexual harassment
  • a fee dispute; Mrs. A. was refusing to pay Mr. B’s bill for his legal services.

The dilemma Mrs. A., a divorced mother of four, had struggled for many months with strong resentments. She felt that her divorce court proceedings had unfairly given her less than her due. Her current lawyer (who had referred the case to me) confirmed to me that what his client had received was in fact sub-standard. He agreed that her substandard settlement had probably resulted from less than fully competent legal representation from her former lawyer.

To bring closure to her negative feelings about her divorce proceedings, Mrs. A wanted a way to reprimand Mr. B, her former lawyer. She also was refusing to pay his bill. Mr. B., meanwhile, was suing his former client (Mrs. A.) for non-payment for his services.

Treatment format and outcome

I seated the two litigants in identical chairs placed at right angles to each other with a small table between them. I sat facing them, the third point in an equilateral triangle. This circular arrangement feels avoids positioning any of us head-on or face-to-face, which would have a more combative feel. Note that the mediator needs to be seated equidistant from the two disputants, not closer to one than to the other. The architecture of the seating arrangement conveys messages about fairness, power, and alliances and therefore merits serious attention.

I usually schedule psychotherapy sessions for 45 minutes. Therapeutic mediation cases generally need somewhat longer sessions, i.e., 60 to 90 minutes. In this case, one 60 minute session was sufficient for the case to reach full closure. The case ended with mutually acceptable settlement of all the issues, emotional, financial, and legal. Furthermore, both parties left feeling fully resolved. This sense of closure meant there would be no further court appeals or enforcement problems.

What happened in that 60 minute black box? Our discussions included two main processes:

  • · A therapeutic process. Healing is necessary after a wrongful action that has resulted in either party feeling victimized. Truth-telling, apology, and reconciliation relieve emotional distress in the injured party in response to hearing repentance from the harm-doer.
  • · A conflict resolution process. We created a plan of action that addressed and resolved the elements in dispute. Note that conflict resolution is synonymous with collaborative problem solving. When conflicts are addressed cooperatively, fighting converts to shared problem-solving.

Therapeutic techniques for facilitating emotional healing

Technique #1: Piecing together the puzzle.

This first technique in the healing process requires litigants cooperatively to piece together the full puzzle of what happened.1 To accomplish a mutual clarification of what has happened, each participant needs to verbalize what s/he felt, thought, and did at each point during the controversial event.

Note how this process departs from adversarial dispute settlement. In an adversarial conflict parties cannot acknowledge what they have done that perhaps proved problematic, and especially cannot openly admit mistakes. Open disclosure of errors works against their best interests. Prudent litigants withhold and deny information. Anything they say about actions that with hindsight proved to have been misguided can be used against them. A collaborate process, by contrast, requires that both people offer full disclosure in order to build a consensual understanding of what has happened.

Mr. B. and Mrs. A. agreed that their lawyer/client relationship had become too personally intimate. Mr. B and Mrs. A. had become quite fond of one another in the course of their legal work together. While they had not progressed to the point of sexual relations, Mr. B. had become emotionally involved with his client to a point of losing objectivity on the case. Mrs. A enjoyed their sessions together but gradually became anxious as she began to realize that her focus had been more on the lawyer-patient relationship than on the legal matters involved. Moreover, in enjoying their emotional closeness, Mr. B. had in fact fallen behind in his preparations for trial. Significant time in their sessions together had been siphoned from business to personal matters.

As the trial date approached, Mr. B felt increasingly unready to represent his client in court. He suggested a settlement proposal at the last minute to prevent the case from going to trial. His proposed settlement however dismayed his client. Mrs. A felt that the  proposal sold short her needs, fell far below her expectations, and did not meet the standards to which she by law was entitled.

Mr. B and Mrs. A. then began to argue. Rather than escalate the arguing, and feeling emotionally over-involved, Mr. B. withdrew from the case. A week before the trial, he asked one of his partners to take over the case.

Agreement on these facts completed the process of piecing together the puzzle of what had happened. Verbalizing and validating the truth is inherently therapeutic. Hearing Mr. B. acknowledge the attraction and affection he had experienced toward her felt reassuring. Interestingly, however, what brought Mrs. A. the most emotional relief proved to be hearing Mr. B acknowledge aloud the events that had transpired. As she put it, “Now I know I wasn’t in some never-never world.”

Therapeutic Technique #2 Apologies

After Mr. B and Mrs. A had both agreed upon the facts of what had transpired, the next step was to issue apologies. Apologies remove the toxic sting from mistaken interactions. A fully effective apology includes the following five elements2:

  • Acknowledgment of the troubling action and its impact on the other.

In this case, this first goal was accomplished in technique number

1, putting together the puzzle pieces of what happened.

  • Expression of regret for the suffering that was incurred.

Mr. B. needed to say, “I’m sorry that our relationship proved harmful instead of helpful. I’m sorry also that your case turned out to have a disappointing outcome, disappointing for both of us.”

  • Statement of non-intentionality, e.g., “I didn’t intent to hurt you.” Explanation of the circumstances can further help to clarify how and why the upsetting interaction unintentionally occurred.

“I didn’t intend for your settlement to come out beneath what you had hoped for. I wanted only the best for you.”

  • Restitution for damages.

The damages in this case involved primarily legal charges for work that Mrs. A felt had been substandard.

  • Learning. A plan to prevent recurrences of similar events in the future turns the negative event into a positive opportunity for learning and for preventing similar or worse mishaps in the future.

Mr. B initially resisted offering an apology. While he did acknowledge that he had erred in becoming emotionally over-involved, in falling behind in his case preparation, and in succumbing to angry bickering with regard to his settlement offer proposal, the words “I’m sorry” felt beyond what he could offer. To help him, I asked Mrs. A. to return for a few moments to the waiting room while I spoke alone with Mr. B. In private we addressed Mr. B’s fears about acknowledging his mistakes.

Thoroughly trained in the adversarial system, Mr. B’s primary concern was that admitting errors might make him more liable to a grievance suit. We discussed the alternative view, that inability to admit errors would even more certainly bring about a grievance. He agreed.

Mr. B then admitted that in his personal life as well he did not feel that he knew how to apologize. I coached him. We practiced several attempts, the first several of which were in fact quite inadequate. By the time I invited Mrs. A to rejoin us, however, Mr. B was able to offer an apology– stilted, but nonetheless adequately effective.

Mr. B admitted, “I feel sorry that my affection for you ended up interfering with the work I did for you. I’m especially sorry that you ended up feeling like the settlement suffered as a result. I feel badly about all of it.” This apology, even more than the acknowledgment of what had happened, proved intensely powerful for Mrs. A.

Next, Mrs. A needed to be able to take responsibility for her part. “I wasn’t a total victim in our interactions,” Mrs. A acknowledged. “Even though you were the professional, I see now that both of us became over-involved emotionally in each other. I kept coming to our meetings even though I knew you weren’t taking adquate care of my case. I kept scheduling meetings with you because I was getting something out of our relationship. After so many years in an abusive marriage I soaked in your affections. I felt renewed by our time together. I wasn’t just a victim. I chose to continue our contacts.”

Note that while both parties acknowledged and apologized for their errors, the errors and apportionment of responsibility were not presumed to be equal. It may be true that it takes two to tango, but in many interactions the damaging event is less like a tango and more like the interaction between a robber and a bank teller. A professional such as Mr. B., a lawyer, bears a higher proportion of responsibility than the client for what transpires in a professional/client interaction. One vital role of the judge or mediator is to insure that apportionment of responsibility is proper.

In this regard, a mediator needs an understanding of the relevant law. Mediating does not mean meeting in the middle. Fair does not mean attributing equal responsibility. Fair means encouraging each party to take appropriate responsibility for his/her parts in the problem. And fair means in accordance with the relevant law.

Conflict resolution proceeds most smoothly if it is preceded by emotional healing. So far we have seen the following therapeutic (healing) elements of this mediation:

  • Truth via the puzzle making technique for agreeing on the facts of the distressing event.
  • Reconciliation via acknowledging mistakes and expressing apologies for suffering.

Conflict resolution

Collaborative conflict resolution is a process of finding mutually agreeable outcomes to situations in which apparent differences spark tensions. This process involves three main steps.3

  • Express initial positions
  • Explore underlying concerns
  • Create win-win solutions.

Step One: Express initial positions

Conflict resolution begins by clarifying the differences, that is, by stating the initial positions of each party. Positions generally are expressed as a preferred course of action, that is, as the outcome solutions that each party initially believes that s/he wants. Mrs. A wanted Mr. B punished. Mr. B. wanted his fees paid.

Step Two: Explore the underlying concerns.

In a therapeutic mediation (or other collaborative settlement process) neither side needs to convince the other of the rightness of their position or to establish domination in any fashion. Instead, after expressing their initial positions both sides join together to explore the underlying concerns which have given rise to each of their respective positions.

It can be helpful to picture the underlying concerns of both parties as being listed on one list–not on a Party A list and a Party B list. Two lists foster either/or, mine versus yours, thinking. The problem will be considered resolved when a solution has been devised that is responsive to all of the concerns, so both parties need to be thinking from the outset of solutions responsive to the other person’s concerns as well as to their own.

Exploring underlying concerns departs significantly from what typically occurs in adversarial dispute settlement. In an adversarial dialogue, the parties’ discussion tends to remain focused on positions. Parties engage in a tug of war over their positions, each insisting on the rightness of their own viewpoint and the wrongness of the other. Positional bargaining is a term coined by Fisher and Ury to describe this adversarial dispute process.

Locked in battle over initial positions.—“My way.” “No. My way.”–participants in positional bargaining generally end up settling the fight on the basis of power. Coercive power determines which side will win. Power to convince the other to relinquish their position or to convince a third party to declare one side the victor decides the outcome. The power that enables one side to prevail can come from any number of sources–for instance, ability to argue more persuasively, more potent financial or other resources, or ability to threaten enough damage that the other gives up.. War is the ultimate expression of positional bargaining.

By contrast, in collaborative dispute settlement, participants benefit most by striving to understand each other’s concerns. Parties need not insist on their concerns, and need not convince the other of the rightness of their concerns, because both parties define success as finding solutions responsive to all of their concerns. Similarly, parties do not benefit from the adversarial positional bargaining strategy of disparaging or dismissing the other’s concerns. The more fully the opposing parties attain mutual understanding, the more effectively they will then, in step three, be able to create mutually acceptable solutions.

What were Mrs. A and Mr. B’s underlying concerns? Mrs. A’s underlying concerns centered on two questions. These concerns focused on issues that could not have been explored in an adversarial court process. For closure and healing, however, these questions were of prime import.

  • Had Mr. B really thought that she was as attractive and likeable as he had seemed to indicate?
  • Did he still find her attractive and likeable?

Mrs. A then tensed again, indicating a further concern. As she began to speak, she needed guidance in order to express her own fears, not what she didn’t like about Mr. B. Initially angry, as verbalized her concerns instead of criticizing Mr. B, her tone of voice switched from accusatory to tentative.

“I feel I was done a disservice. I’m afraid I wasn’t represented adequately.”

Mr. B was able to respond by acknowledging the validity of Mrs. A’s concern. “I probably didn’t do enough preparation on the case,” he admitted sadly. “I feel terrible that I probably did cause stress for you by withdrawing at the last minute. At the same time, withdrawing felt like the most professional action I could take at that point.”

Mr. B’s heartfelt response to these concerns again engendered significant relief for Mrs. A. His success in part was due to his use of the words “At the same time.” These words, like the word “and,” signal addition. If instead he had said, “But…”, he would have erased his validation of Mrs. A’s concerns. In that case, his explanation of his reasoning in withdrawing would have sounded like an excuse rather than like additional information.

Mrs. A continued, listing one other major concern. She had felt abandoned. Abandonment, like attachment, raises potent emotions.

Fortunately, Mr. B again was able to acknowledge the truth in Mrs. A’s experience, even if he did also see his “abandonment” of her as having been the best choice he could make at that time. “In a sense I did abandon you. I did drop out of the case. At the same time I want you to know that the reason I dropped out is because I was off track. I couldn’t represent you adequately because I was so emotionally involved. Our arguing felt more like a fight between a married couple than like counsel advising a client. That’s why I dropped out. I was hoping to get you more objective representation.”

By validating Mrs. A’s concerns about having been abandoned, and then adding information about his thinking in withdrawing from the case, Mr. B. lifted a last emotional burden from Mrs. A. Mrs. A felt relieved, accepting Mr. B’s distinction between abandonment and his having departed as an action taken with her best interests in mind. Mr. B’s then explained his primary remaining concern.

Mr. B felt that while he had erred in many ways, he also had put many hours of genuine legal work into the case and wanted remuneration for these. Mrs. A in turn was able to acknowledge that while he had not succeeded in obtaining a positive outcome for her, Mr. B had accomplished significant hours of pre-trial fact-finding.

Mrs. A and Mr. B thus succeeded in expressing each of their concerns, and also in conveying to each other that the concerns had been heard and understood.

Step Three: Creating win-win solutions.

The third and final step in the three step conflict resolution process, creating solutions, often proves the simplest, provided concerns have been fully delineated in the prior step.

Most of the necessary solutions in this case had already occurred via information sharing, apology, and the building of new understandings (e.g., of why the abandonment had happened). Most of the more potent emotions had already eased. The fee dispute was about the only issue that remained. With so much mutual understanding and a resumption of at least some good will, the fee issues turned out to be fairly easy to resolve.

Mrs. A and Mr. B each expressed their views of the fee situation. Within a matter of minutes, and with very little guidance from the mediator, they were able to come up with a fee agreement that both of them felt would be fair. The agreement took into consideration Mr. B’s concerns–the time that he had put into the case–and also Mrs. A’s– the reality that he had not completed the task.

A solution is a plan of action. Because most disputes involve multiple concerns, the solution generally turns out to be a solution set rather than a simple one-dimensional plan. The solution set to this dispute, for instance, included

  • acknowledgments from both parties of their mistakes
  • apologies, particularly from the professional, the lawyer, to his client
  • validation from the lawyer to his client of positive regard for her
  • agreement on decreased but not totally eliminated fees

Rules of Procedure

The rules of cooperative procedure differ significantly from those of adversarial dispute settlement. Both processes do, however, rely upon distinct rules. Collaborative dialogue requires the following procedural guidelines:

  • The rule of talking: Talk about yourself, or ask about the other; but do not talk about the other.

Each person needs to express his or her own feelings and thoughts. Each can ask about the other person’s feelings and thoughts. Neither is allowed to speak about what the other thinks, feels, is trying to do, or about their character. Instead participants are to use their air time to express their own thoughts, feelings, and concerns.

In adversarial dialogue, by contrast, significant air time goes to accusations, interpretations, and misinterpretations of the other person. These crossovers,4 that is, verbalizations about the other instead of about themselves, escalate ill will, defensiveness, and divisiveness. They are totally contrary to a spirit of cooperation.

Fisher and Ury5 state a related rule when they advise “Talk about the problem, not the person.” Finger-pointing of any kind is almost invariably counter-productive.

The rule for talking contrasts distinctly with procedure in adversarial settings. There blame, accusation, criticism, and attribution of negative motives to the other are generally considered fair play. In collaborative settlement, these negative tactics are out of bounds.

  • The rule of listening: Listen to learn.

Listening for what is useful, for what makes sense in what the other says, leads to consensus building. By contrast, listening to criticize what the other says increases tensions and halts cooperative problem-solving.

This rule may sound rather like a kindergarten rule. Doesn’t everyone listen to learn? Not so, particularly in an adversarial settlement system. In adversarial legal argument, participants listen primarily for what is wrong with what the other person has said in order to discredit the other’s input.

A key sign of listening dismissively rather than in cooperatively is the word but. As suggested above, the word but, or it’s close cousin Yes, but, expresses disagreement. But indicates that the prior speaker’s points are being pushed aside, not integrated into a shared data base. But indicates that a dialogue is polarizing, not building additively toward consensus.

  • The rule of climate control.

If either party’s emotions begin to escalate, both parties need to briefly disengage. Each needs to be responsible for regaining a state of relative calm before resuming the dialogue.

While expressing feelings is important, angry dialogue almost always leads away from resolution. To stay on pathways that lead to increased understanding, participants need to express their angry feelings in words, following the rule of talking. They need to verbalize, “I am feeling frustrated,” not dramatize, their feelings. Acting out feelings with loud voices, critical voice tones, or accusatory language generally dooms cooperation.

Anger often results from violation of the rules of talking and listening. When someone speaks accusatively, or shows no evidence of listening, the other party is likely to feel irritation rising. At the same time, anger increases the risks of further talking and listening violations. Inflammatory comments and poor listening escalate emotion; escalated emotions invite more inflammatory comments and blocked listening.

When tempers warm up, pausing the discussion momentarily so that everyone can cool down is advisable. Emotional escalations are incompatible with cooperative dialogue because as anger increases listening, analytic ability, and creative thinking all decrease. A heated environment consequently almost always proves unproductive.

With these three basic rules of collaborative procedure–one rule of talking, one rule of listening, and one rule of emotional tone–what results can participants expect? Combined with therapeutic elements like mutual truth-telling and apologies, plus passage through the three steps of collaborative conflict resolution, the three rules of collaborative procedure insure:

  • a streamlined dispute resolution process.
  • a sense of closure within both participants
  • a feeling that justice has been done.

Justice

What does the word justice mean in this context? In the legal system, the word justice too often has become synonymous with punishment, particularly after misbehavior. By contrast, Mrs. A. left with a strong sense of justice having been done, but not because any punishment had been levied. Rather, her sense of justice came from

  • having received recognition that she had been correct in her understandings of what had transpired between her and Mr. B
  • Mr. B’s admission that he had erred in his professional responsibilities
  • his having apologized for and even learned from these errors
  • restitution. Reduction of her lawyer’s fee, the remainder of which Mrs. A now would willingly pay, served as restitution for Mrs. A.

A brief look at what skilled parents do when their children misbehave may help to clarify the ineffectiveness of equating justice with punishment. Skilled parents regard discipline as a process for teaching their disciples. Punishment is tempting in response to wrong-doings. Wrongdoings elicit anger, and anger engenders an impulse to strike out to hurt the other. Punishment, however, is relatively ineffective as a teaching device because it creates anxiety, low self-esteem, and resentment–all of which generally impede learning. Problem-solving and promoting learning are more effective as well as equally just responses to misbehavior.

Thus if the purpose of justice is to set the stage for better behavior for the future, not simply to obtain an eye for an eye, we need to be wary of too simply equating justice and punishment.

Requirements and risks

For therapeutic mediation to succeed, both parties (and their lawyers) need enough emotional maturity to be able to abide by the procedural rules. They need to be able to acknowledge their errors, not lock into a blaming stance. They need to be able to express genuine regret for the outcomes of their mistakes. They also need to be motivated by basically good intentions, not by greed or other impulses that impel them to seek more than their fair due. Without these capabilities and/or firm guidance from the mediating professional, a therapeutic process will not succeed.

Second, some litigants tend to ask for more than they deserve; others may be too quick to give up on matters of import to them so as to end the conflict as quickly as possible. A mediator needs sensitivity to unfinished emotional agendas and skills at flushing these out. Mediators also need always to bear in mind legal standards of what would constitute a fair outcome, lest an agreed-upon settlement in fact be less than fair by law.

Lastly, if therapeutic mediation should work out poorly in a given case, the adversarial system would be the fall back alternative. Can admissions of guilt established in a failed therapeutic mediation endanger a client’s case? This question needs to be monitored by the legal community to be certain that adequate safeguards protect clients who chose to attempt therapeutic settlement.

Limitations

Therapeutic mediation only works with parties who are seeking a fair settlement. Parties who have all-or-nothing, I-win/you-lose, goals, those who hold rigid unrealistic expectations of what justice should look like in their case, or those who are using the court system to bludgeon less powerful opposition into submission to their demands are unlikely to be willing participants in cooperative procedures.

Litigants who are locked in an I’m right/You’re wrong mode will find this system of justice unsatisfying. People who are locked in a blaming stance escalate their anger when asked to take responsibility for any portion of the distressing event. With these individuals, this method is likely to increase hostilities instead of proving therapeutic.

Closing Overview

The vast majority of dilemmas that clients bring to lawyers are addressed in settlement conferences rather than in court. Therapeutic mediation techniques–which exchange blaming, fault-finding and punishing for truth-telling, reconciliation via apologies, and cooperative problemsolving–are ideal for these cases. Therapeutic mediation can heal emotional injuries, settle disputes, and bring justice to aggrieved parties– with added bonuses of dramatic efficiency and long-lasting effectiveness. For lawyers and judges to add therapeutic mediation to their repertoire, however, they need to make a major cognitive switch from adversarial to cooperative thinking, and to change significantly their rules of procedure.

To conclude, the following chart summarizes the vast array of differences between traditional adversarial settlement of disputes, and a therapeutic mediation.

Two Settlement Processes:

A Comparative Analysis

Adversarial Settlement

Therapeutic Mediation Adversarial Settlement
1 Defines the dilemma as a problem to be solved and/or injuries that need restitution and healing. Defines the dilemma as a question of who is right and who is wrong.
2 Assumes that both sides are basically well-intended and have legitimate concerns. Assumes wrong-doing and negative intentions on the part of at least one party.
3 Expects to conclude with a win-win mutually agreeable plan of action. Expects to conclude each issue with one side winning and the other losing.
4 Regards feelings as keys to understanding underlying concerns. Regards feelings as intrusions into a rational process, or as a means to manipulate the court to obtain a specific outcome.
5 Focuses on clarifying what happened in order to better understand

  • the initial positions
  • both sides’ underlying concerns
  • a plan of action responsive to all of these concerns.
Invites participants to present their view of what happened to convince the court to choose their preferred solution.

Skips clarifying underlying concerns; instead encourages positional bargaining.

6 Expects participants to speak for themselves, articulating their own thoughts, feelings, and preferences. Expects lawyers to speak for their clients.

Clients watch.

7 Expects empathy to increase as participants air their feelings and hear the other’s feelings. Information exchanges result in decreased polarization. Perpetuates blaming and fixed viewpoints. Does not expect participants to be open to new information or to experience increased empathy. Information exchanges result in increased polarization.
8 Helps participants to piece together a shared and non-blaming understanding of what happened. Expects judge/jury to guess a middle ground explanation between two opposing airbrushed and extreme versions of what happened.
9 Fosters agreement. “Yes, that’s what happened.” Fosters argument. “No, you’re wrong. I’m right.”
10 Expects a process of taking responsibility. Encourages each side to own responsibility for its contribution to what happened rather than to attribute fault to the other. Expects a process of attributing fault. Encourages each side to present itself as the victim and the other as the villain. Each side exonerates him/herself and blames the other.
11 Blames mistakes, misunderstandings, misperceptions, or a system problem. Blames people.
12 Utilizes apologies for healing and reconciliation. Fosters denial of responsibility rather than acknowledgment of mistakes or concern for the other’s injury.
13 Expects participants to create solutions. Emphasizes healing and problem-solving. Expects the judge to create solutions. Emphasizes burdens and punishments.
14 Fosters learning, re-instatement of cooperation, and return of normalcy. Fosters defensiveness, blaming, and continued resentments.
15 Responsive to emotional concerns as well as monetary and legal issues. Responsive primarily to factual, monetary, and legal issues.
16 Yields emotional relief and closure. Leaves reservoirs of ill-will.
17 Expects process to be brief. Expects process to be long, with extensive preparation, delays from the filing of unlimited number of motions, subpoenas, etc, plus lengthy wait for court date.
18 Minimizes expenses. Uses one mediator and two consulting lawyers. Minimal court costs. Engenders high expenses in time, money, bad publicity, and negative impact on ability to do business during the period of dispute.
19 Requires close adherence to rules of constructive collaborative dialogue. Requires close adherence to rules of evidence and courtroom procedures.
20 Results in a decision that feels fair to all participants. Results in a decision that feels fair to the judge/jury, with one or more litigants likely to feel unhappy with the outcome.
21 Yields a plan of action with high likelihood of fulfillment. Further court involvement unlikely to be requested. Yields significant likelihood of non-compliance and/or appeals, both necessitating further court involvement.

Summary by

Susan Heitler, Ph.D.

For permission to reproduce, please contact drheitler@gmail.com.

Treating High-Conflict Couples

Susan Heitler, Ph.D.

University of Denver, School of Professional Psychology

1. Define conflict levels Conflict may be expressed in anxious tension, depression, disengagement (for fear of fights), and passive-aggressive or addictive behavior, as well as in overt anger, deprecating or demanding words and tone of voice or, in the extreme, physical violence. High conflict refers to the frequency with which a couple locks into oppositional stances and also to the intensity of anger expressed in disagreements.

2. Obtain requisite therapist skills. In addition to traditional therapy skills, a high conflict couple psychotherapist, like a professional mediator, needs referee skills for insuring that the couple=s dialogue stays safe plus expert knowledge of the steps of conflict resolution.

3. Arrange the therapy room for symmetry and interaction. Place the three chairs in an equilateral triangle. Rollers on the therapist=s chair are preferable so that the therapist can roll closer to the couple or to one or the other partners for interventions, and roll back when the couple=s dialogue flows cooperatively. Do not seat the couple side by side on a sofa as this arrangement encourages the couple to talk to the therapist rather than to each other.

4. Obtain a three-fold diagnostic picture. Include:

X  A history of each individual=s symptoms and any personality disorder. Accelerate this assessment by having each partner fill out a symptom checklist before beginning treatment. If the symptom checklist or your interview questions suggest anger outbursts, obtain detailed individual reports of exactly what has happened, bearing in mind the tendency to minimize and deny rages, emotional abuse, and physical violence (Holtzworth-Munroe et al., 1995).

X  A laundry list of conflicts about which the couple fights and

X  An initial assessment of communication and conflict resolution skills and deficits.

This three-fold diagnostic work-up organizes diagnostic information to correspond to the three main strands of treatment: Eliminate symptoms (excessive anger, depression, etc). Resolve each conflict on the laundry list, and in the process of resolving the conflicts, gain understanding of the central problematic relationships of childhood and their re-enactments in the marriage (Lewis, J., 1997). Build skills so the partners learn to resolve conflicts without angry fighting.

5. Note contraindications for couple therapy.

X  Unwillingness to agree that verbal and physical violence are out-of-bounds, at home and in the therapy session.

X  Poor impulse control, or other signs that therapy may be unsafe.

X  Reprisals for talking openly about concerns in the sessions.

X A paranoid-like blaming stance with a rigidly-held set of beliefs about the other (a fixed ideational system), ego-syntonic controlling behavior, and projection.

If these symptoms can be addressed with individual treatment and/or medication, subsequent couple treatment may be productive. Also, individual therapy for the healthier partner often can help him/her to cope more effectively with the spouse.

6 Audiotape the treatment sessions. Listening to the tape can be assigned as homework to accelerate and consolidate learning. Taping is contraindicated, however, if potential court involvement could result in the tapes being used as evidence detrimental to either participant.

7. Insure safety. Early in treatment teach disengagement/reengagement routines to prevent hurtful fights. See Time Out Routines for Emotional Safety at Home. Practice these routines in the session. Inquire intermittently about the couple=s experiences with their exit routines to insure their plan is fully effective.

8. Intervene immediately if anger escalates in a session. Redirect the outburst to you, away from the spouse, by engaging the angry person in dialogue. If the angry partner continues to escalate, stand between the two spouses and/or ask the receiving spouse to step out for a few moments. Simplifying the situation by having one partner leave enables tempers to deescalate and calm to return. If an angry spouse threatens to leave the session, agree, inviting him/her to return when s/he feels calmer. Thank him/her for demonstrating self-awareness and self-control.

After an angry outburst, reiterate the angry person=s underlying concerns in a quiet voice so that dialogue resumes in a calm mode and the angry person knows s/he is being heard. Detoxify the incident by reframing the contents of the outburst in non-blaming language and by discussing any hurt feelings that may have resulted from the outburst.

9. Initiate a collaborative set. Create a shared perspective on the part of each spouse that they are mutually responsible for the problems in the relationship, and that they both need to change themselves in the relationship is going to improve (Christensen et al., 1995). To transition from conflict to cooperation, develop face-saving explanations for the conflicts:

X  Define the last comfortable phase of marriage, and then identify external or developmental stresses that may subsequently have overloaded the system (e.g., arrival of children, illness, financial setbacks).

X   Explain the role of insufficient communication and conflict resolution skills.

X  Identify conflict resolution models in each spouse=s family of origin. Explain that you speak French if your parents spoke French, and that you are likely to argue if you grew up in a household where adults fought about differences. Alleviate parent-blaming by looking compassionately at parents= family of origin histories.

10. Begin by setting agendas. In the initial session, ask what each spouse wants to accomplish overall from therapy. Begin each subsequent session by asking what each spouse wants to focus on in that session. e.g., skills, a difficult feeling or issue, an argument from the prior week.

Close sessions by summarizing progress on each agenda item. Connect side issues to the focal concerns. In general, in a 45-50 minute session, one main conflict can be brought to resolution and one main skill improved.

11. Address symptoms immediately. Symptoms that disrupt personal or couple functioning need to be addressed early in treatment, particularly if they pose safety concerns and/or interfere with treatment. If violence is involved, immediate steps must be taken to remove guns from the home, to assure the woman escape options, to address impacts of alcohol and drugs on safety, to teach the husband ways of stopping himself when he begins to anger, to insure that both understand the high danger of even Aminor@ violence (e.g., a minor push can cause a major head injury), and to implement a temporary separation if violence risk is high. Firmly adopt the stance that no violent acts are acceptable (Holtzworth-Munroe et al., 1995).

12. Explain that a symptom is a solution, or a by-product of a solution, to a conflict (Heitler, 1993):

Anger may serve as a means of coercion in couples who settle their differences by means of dominant-submissive, winner-loser, strategies. Anger expresses frustration when stances have polarized and defensiveness has replaced listening. Anger energizes increased voice volumes in order to be heard or to have one=s viewpoint prevail. It also may serve to prevent discussion of hidden behavior (e.g., gambling, an affair, drugs).

Other symptoms commonly occur in high conflict couples. Anxiety arises when conflicts hover unaddressed. Depression is the by-product of dominant-submissive conflict resolution, that is, of submitting to the preferences or will of the other. Addictive and obsessive-compulsive disorders (including eating disorders and hypochondria) indicate attempts to escape from conflicts by means of distraction.

Symptoms generally can be removed by readdressing conflicts with healthier dialogue patterns. Augmenting the couple treatment format with individual therapy sessions and/or additional symptom removal treatment strategies (e.g., medications) may be necessary. Wherever possible, one therapist for the full system is preferable to having different therapists for the individual and the couple work (two therapists will tend to pull the couple apart). On the other hand, it is vital to utilize referrals for additional specialized treatments such as medication or treatment for substance abuse.

13. Teach about anger. Explain that when we are angry, we may feel like we are Aseeing red.@ Rather than attacking when we see red, as if we are bulls, we can interpret the red as a stop sign. Anger tells us to stop, look to identify the difficulty, listen to our and to our partner=s concerns, and then choose a safe route for continuing. Angry feelings enable us to identify problems; angry actions, however, seldom effectively ameliorate problems.

14. Resolve current disputes. Once flagrant symptoms have been sufficiently calmed, guide conflicts through the three stages of conflict resolution:

X  Express initial positions. Be sure that both spouses speak up and both listen to the other.

X  Explore underlying concerns. Be sure both spouses talk about their own thoughts and feelings, not about their partner=s, and that both listen to absorb, not to criticize.

X  Design a mutually satisfying plan of action, a solution set responsive to all the concerns of both spouses (Heitler, 1992).

15. Utilize the four S=s that are essential in conflict resolution (Heitler, 1997):

X  Specifics lead to resolution; generalities breed misunderstandings.

X  Short segments means that for conflicts to move toward resolution, participants need to speak a paragraph at a time, not multiple pages. Lengthy monologues lose data and drain energy from dialogue. For spouses who ramble, suggest a three-sentence rule.

X  Symmetry of air time gives a sense of fairness and equal power.

X  Summaries consolidate understanding and propel conflict resolution forward.

16. Have spouses talk with each other, not through you. High conflict couples need to learn to talk with each other when they have differences. To redirect comments when the partners are speaking to you instead of with each other, look at the listener rather than the speaker, or use a hand or head gesture to indicate that the partners are to talk each other. On the other hand, however, funneling the dialogue through you can be a way to de-escalate tensions when anger is escalating. Similarly, when a couple=s dialogue skills are poor or when you are running out of time in a session, having the spouses speak to you may speed up the conflict resolution process.

17. Identify core concerns. Hot spots in a dialogue indicate strongly felt concerns. As you discuss conflicts, certain underlying concerns will surface repeatedly, raising strong feelings each time. Luborsky et al (1986) call these transference issues–such as AI don=t want to be controlled,@ or APeople disappoint me by not doing what they should,@– core conflictual themes. I call them core concerns.

Note where spouses= core concerns dovetail, repeatedly reengaging the other=s central concerns in what Wachtel (1993) calls vicious cycles. For instance, her thought AI can=t seem to please him@ and resultant depressive withdrawal may interact with his AI never get the affection I want@ and angry complaining stance. Her depressive withdrawal triggers his anger; his angry complaints trigger her withdrawal. Establish new solutions for these concerns, replacing negative cycles with positive ones. (e.g., she greets him warmly when he comes home from work; he expresses appreciation for her dinner).

18. Depth dive to access family of origin roots of core concerns. As Norcross (1986) explains, deeper concerns are less accessible to conscious thought, and generally arise from historically earlier life experiences. See the accompanying protocol for the steps involved in a depth dive visualization (Heitler, 1995). During a depth dive, the non-diving spouse listens, holding his/her comments for the discussion after the depth dive.

19. Allow only healthy communication.

X  Prevent poor skills by prompting spouses before they speak. For example, to prompt effective listening, suggest, AWhat makes sense to you in what your spouse just said?@

X  If you did not succeed with prevention, rectify skill errors by inviting a re-do.

X  Alternatively, serve as translator, converting provocative comments into better form. For instance, after an accusatory AYou don=t do your part in keeping up the house,@ pull your chair next to the speaker and reiterate for him/her, AI feel like I=m doing more than my share.@

X  Repeat frequently simple iterations of basic communication rules, e.g., AYou can talk about yourself or ask about the other; it=s out of bounds to talk about the other.@

AWhat=s right, what makes sense, what=s useful in what your partner is saying?@

20. Coach communication skills. Design practice exercises to consolidate the essential skills:

X Insightful self-expression. Good spousal communicating involves expressing one=s own concerns and feelings instead of criticizing the other. Explain the difference between selfexpression and Acrossovers@ (my term for crossing the boundary between self and other by talking about what you think the other is thinking or feeling or telling them what to do). Practice self-expressive when-you=s (AWhen you left early, I felt rejected.@). Emphasize that the subject of a when-you is the pronoun I.

X  Digestive listening. Instead of listening like an adversary for what=s wrong with what the other is saying, cooperative partners listen to learn, to sponge in what makes sense in what their partner says. ABut . .@ indicates that the prior comments are being deleted, not digested.

X  Bilateral listening. Hearing both self and other so that both partners= viewpoints count. Bilateral listening contrasts with either/or thinking and the belief that if one person is right the other is wrong.

21. Convert blame after upsets to apologies and learning. Teach the couple to piece together the puzzle of what happened, with each spouse describing his/her own feelings, thoughts, actions, and mistakes. Attribute the problem to a Amis-@, e.g., a misunderstanding, mistake, miscommunication. Guide apologies, with each spouse owning his part in the difficulties. Conclude with each having learned something that will help to prevent future similar upsets.

5. Terminate therapy when the symptoms have been ameliorated, the conflicts resolved, and dialogue is consistently cooperative.

Time Out Routines for Emotional Safety at Home

Initiate time outs when either of you

X  Feels too upset or negative to talk constructively.

X  Senses that the other is getting too emotional to dialogue constructively.

To initiate a time out

X  Use a non-verbal signal, such as sports signals.

X  Go to separate spaces immediately, without any further discussion.

X  Self-soothe, by doing something pleasant.

X  Write in a journal if it feels helpful, but write primarily about yourself, not your partner.

To reengage

X  Wait until you both have regained normal humor.

X  Reengage first in normal activity before you attempt to talk again about a difficult subject.

X  If a difficult subject again provokes unconstructive discussion, save it for therapy.

Exit rules

X  No door slamming or parting comments.

X  NEVER block the other from leaving, or pursue the other when they need to disengage.

X  As soon as the going gets even a little bit hot, keep cool and exit. Prevention is preferable to destruction.

Protocol for Depth Dive Technique

for Exploring and Loosening Transference Reactions

I. Point of entry

X  When one partner shows a strong emotion or excessive response suggestive of a transference reaction or core concern

X  Instruct him/her to close eyes and focus on the feeling.

II. The dive

X  Say, AAs you focus on that feeling, allow a similar scene from your past to emerge, a scene in which you felt a similar feeling. Notice who you see, what they are doing, and how you responded then.@

X  Ask, AWhat elements feel to you the same as in the present situation?@

X  Ask, AAnd what in the present situation is different?@ And then, ASeeing these differences, what new options exist for you now?@

III. Debriefing

X  Have patient open eyes, and digest aloud the experience.

X  Clarify that the emotional response made sense in its originating circumstance. Since the present has elements in common with the original circumstance it is understandable that the response was similar.

X  Begin to experiment with the new response options available now that the patient understands the ways in which the present situation differs from the past.

Key Words

anger

conflict

blame

communication

dialogue

marriage

couple

conflict resolution

bilateral listening

depth dive

skills

coaching

listening

References and Readings

Christensen, A., Jacobson, N.S., & Babcock, J. (1995). Integrative behavioral couple therapy. In N.S. Jacobson & A.S. Gurman (Eds.), Clinical handbook of couple therapy (pp.31-64). New York: Guilford.

Heitler, S. (1992). Working with couples in conflict (audiotape). New York: Norton.

Heitler, S. (1993). From conflict to resolution. New York: Norton.

Heitler, S. (1995). The angry couple: Conflict-focused treatment (video) In video series, L. Schein (Ed.) Assessment and treatment of psychological disorders. New York: Newbridge.

Heitler, S. (1997). The power of two. Oakland, CA: New Harbinger.

Holtzworth-Munroe, A., Beatty, S.B., & Anglin, K. (1995) The assessment and treatment of marital violence: An introduction for the marital therapist. In N.S. Jacobson & A.S. Gurman, Clinical handbook of couple therapy (pp. 317-339). New York: Guilford.

Lewis, J.M. (1997). Marriage as a search for healing. New York: Brunner Mazel.

Luborsky, L., Crits-Christoph, P. & Mellon, J. (1986). Advent of objective measures of the transference concept. Journal of Consulting and Clinical Psychology, 54, 39-47.

Norcross, J. (1986). In J.O. Prochaska (Ed.), Integrative dimensions for psychotherapy. International Journal of Eclectic Psychotherapy, 5, 256-274.

Wachtel, P. (1993) Therapeutic communication. New York: Guilford.

Therapists as Experts in Conflict Resolution

Susan Heitler, Ph.D.           www.therapyhelp.com                     January, 2009

Couples entering therapy typically list conflict resolution as one of their main treatment goals. For successful treatment, they want their therapist to guide them to safe and satisfying resolution of the topics that have generated their tensions.

Therapists need conflict resolution expertise to be able to lead their clients effectively and efficiently through the steps of the win-win waltz.

Couples themselves also need this expertise so they can make shared decisions cooperatively, resolve their differences, and clean up after upsets on their own.

The Win-Win Waltz

Step One: Express initial positions.

She: I want to renovate our house.

He: No way.

Step Two: Clarify the underlying concerns

She: It’s so dark and gloomy; I’d love to brighten it.

He: I’m panicked about spending a fortune that we don’t have.

Step Three: Create win-win solutions responsive to all the concern.

She: Let’s invite a group of friends over for a house-painting weekend. We could paint the walls white, plus some yellow, or peach, or lime!

He: We can afford paint. The colors sound a bit fruity but fun. As long as all we need to buy is paint, let’s do it!

The three steps to win-win solutions may seem obvious. Yet, most emotional disturbances stem from missteps along this sequence.

For instance, disengaged couples, that is, couples who have “grown apart,” typically fail to take the first of the three steps. Fearing conflict, they avoid launching discussions.

Argumentative couples take the first step but then draw battle lines. Instead of exploring the concerns underlying each of their preferences, they engage in power struggles, fighting a tug-of-war over whose initial position shall prevail. In mediation language, they get stuck in positional bargaining. They need to learn to explore underlying concerns, and to think in terms of “yes, and” instead of either/or, “but…” and who is right and who is wrong.

Personal character patterns each have characteristic conflict patterns. Narcissists make unilateral decisions, forgetting that partnership involves two people. People with depressive tendencies bow excessively to the desires of the other, insufficiently considering their own concerns.  Therapists therefore need to coach narcissists on including their partner in decision-making, and to teach people with depression to add their concerns to decision dialogue.

For more articles, books and other resources by Susan Heitler, see www.therapyhelp.com..

For internet-based marriage-skills learning for couples–and for therapists–see http://poweroftwomarriage.com.

On Borderlines and Narcissistics: A Marriage Skills Alternative to Pathologization

By Susan Heitler, Ph.D., author, From Conflict to Resolution

www.therapyhelp.com

For therapy with the so-called personality disorders of borderlines and narcissists, a non-pathologizing orientation can be helpful. These are folks who function in a borderline or narcissistic matter, that is, in a way that is emotionally stormy and ‘all about me.’ In both syndromes, the folks are not sick; they are unskilled, and as a result they make very difficult marriage partners.

In this regard, it is important to note that there are alternatives to the notion, which fits for some but by no means all borderline and narcissistic folks, that their problem is too much childhood suffering and pain. Too much success, especially success at getting one’s way by ignoring others’ concerns while expecting others to respond to one’s own, can create these disorders with or without what we usually think of as emotional injuries.

What folks sometimes refer to as “spoiled” kids, emotional kids who always get their way because they have overpowered their parents with their intense emotional storms, are at risk for becoming borderlines. Specially talented kids, at the same time, are at risk for what I call “tall man syndrome,” i.e., becoming narcissists. They are at risk for feeling so talented or tall or smart that what they want seems to them, and often to others as well, as far more important than what others want.

In other words, borderline and narcissistic syndromes are patterns of response to situations in which what they want feels sacred and what others want, irrelevant.

This model of personality disorders, based on conflict resolution theory, (see From Conflict to Resolution by Susan Heitler) leads to a practical treatment response. Teach narcissists and borderlines to listen and become responsive to others’ concerns, teach them win-win conflict resolution, and they will learn to function with emotional health and personal maturity.

A key part of the skill set narcissists and borderline personalities need to learn, in order to do win-win conflict resolution, is emotional self-regulation. After years of pitching fits to get what they want, they typically need much coaching to learn to recognize anger as it begins to arise, remove themselves from the situation, self-soothe, and then return in a calm problem-solving mode to find win-win solutions.

This treatment approach requires first that the therapist become an expert in conflict resolution, and then that the therapist become a great coach for conveying the skills to clients. For a free download on Therapist as Conflict Resolution coach, go to www.therapyhelp.com.

In sum, with enough confrontation on their old ways of powering over others, plus coaching in win-win skills, borderlines and narcissists who want to grow up can become great folks with normal to excellent potential for partnership.

Helping Two I’s and a We: Interweaving Individual and Couple Treatments

Helping Two I’s, and a We:

A Conflict-Focused Framework for Integrating Individual and Couple Treatment

Most therapists describe themselves as eclectic, drawing on various treatment strategies depending on the nature of the problem they confront in that session. Effective clinicians tend to develop a broad range of treatment intervention strategies plus skills for working at various levels of the system—individual, couple, and family. Treatment that attempts to be comprehensive and integrative, however, risks becoming disorganized, ad hoc, and even unethical.

Conflict-focused thinking offers useful antidotes to these risks because the theory covers such a broad range of treatment aspects. Conflict-focused theory defines emotional and marital health, explains why various pathological symptoms emerge, explains why various treatment interventions return pathological conditions to states of well-being, and suggests additional new treatment options. The theory integrates psychodynamic and behavioral components under one overarching set of conceptualizations. Lastly, its applicability to multiple levels of functioning–individual, couple, and family—makes it particularly useful for attempts to integrate individual and couple treatment formats.

This paper explores how conflict-focused theory contributes to three dilemmas that arise when treatment includes both individual and couple treatment formats. (a) How does a conflict-focused treatment framework provide theoretical integration to keep treatment coherent and systematic? (b) Who should be in the treatment room when? And (c) What ethical issues does dual formats raise, and how can these be addressed?

REVIEW OF THE LITERATURE

Research has solidly confirmed the importance of treating the couple relationship when individuals who are married seek psychotherapy. (depression, alcohol, side effects that are iatrogenic)

At the same time, clinical experience clarifies that couple therapy at times needs to be augmented with individual sessions. For instance, when individuals in a couple present with long-standing emotional difficulties, one or both may need extended individual work to become mature, emotionally resilient, marriage partners. When emotional health of partners is asymmetrical, one spouse may feel impatient with sitting through extended but essential interventions that the other needs in order to move forward—and the more needy partner may feel blamed if interventions are asymmetrically focused on him/her.. Resistance to change may be higher when the partner is watching. Issues that a spouse was unwilling to explore in view of the other may be possible to address only in the privacy of individual work. And when issues outside the marriage, such as relationships with work colleagues or with a difficult boss, prove to be the source of emotional dysfunction that is contaminating the relationship, individual sessions may prove both the most efficient and effective treatment format .

Yet a third treatment option is to utilize individual therapeutic interventions with both partners present in the treatment room. Within couple sessions, for instance, brief individual depth explorations of each partner’s transference issues gives one spouse essential insight while the other gains new empathy for his/her partner. (Research examples, including my work)

A conflict-focused conceptual framework provides an integrative theoretical structure plus pragmatic interventions for multi-faceted individual, couple, and individual-in-couple treatment.

KEY CONCEPTS IN CONFLICT-FOCUSED THINKING

A comprehensive psychotherapy theory needs to account for why symptoms have developed, how they can be alleviated, and how similar emotional distress symptoms can be prevented in the future. A good theoretical map thereby gives the therapist clarity about where s/he is going, options as to which routes will get there, and guidance about what to do next when treatment feels stuck. Psychotherapy theory then helps the therapist to keep treatment well-organized, cohesive, efficient, and forward moving.

Conflict-focused thinking utilizes one conceptual map to guide both individual and couple interventions. The same structure can also guide full family treatment when it is appropriate to include children and/or grandparents in treatment sessions.

(1) Sources of emotional distress: Conflict-focused conceptualizations begin with a single basic assumption: Conflict, within or between people, lies at the core of emotional distress. If I want to go outside to enjoy the late afternoon sunshine, and I also feel that I have to stay in and finish writing this paper, I am likely to experience some form of emotional tension from this intrapsychic conflict. If a mother wants to start serving dinner and her children insist on continuing to play outside, she and they are likely to experience tensions and distress from the interpersonal conflict. Distress may also be evoked by a conflict with circumstances. For example, if I want to go outside— perhaps I have an urgent need for fresh air to alleviate a headache from indoor stuffiness- but the temperature outside has dropped too low and wind and hail would make a walk impossible, my frustration results similarly from conflict.

(2) Sources of clinical symtoms. Poorly handled conflicts result in clinical symptoms such as depression, anxiety, excessive anger, or obsessive-compulsive and addictive behaviors.

While the above examples illustrate conflicts that most people would find initially emotionally uncomfortable, and then would resolve in routinely adequate ways, symptoms and psychopathology emerge when conflicts are poorly handled. For instance, if I decide to take a quick break, absorb a few minutes of fresh air, and then return to my computer—a healthy win-win solution–my work will proceed all the more quickly from the brief rejuvenating exposure to the sun. By contrast, heading outdoors to the neglect of work may be part of a procrastination pattern that undermines my ability to succeed in work ventures. Similarly, inability to allow myself simple gratification could result in a neurotic pattern of constricted living, leading eventually to early burnout and depression. Hovering in indecision might be characteristic of a generalized anxious picture. And if my style were to avoid conflicts altogether, I might get up and fix a gin and tonic or eat a plate of cookies instead of either pursuing my writing or fresh air.

(3) Conflict resolution patterns and psychopathology each pattern of pathology is associated with a specific dysfunctional pattern of conflict resolution. That is, while winwin conflict resolution alleviates distress, one-sided (win-lose) patterns of conflict settlements create anger and/or depression. Hovering conflict with no settlement invites extended anxiety. Escape attempts to avoid conflict can result in addictions and/or obsessive-compulsive behaviors. (Chart)

(4) Inner and interpersonal congruence. The same conflict handling patterns yield the same heath and/or psychopathology whether the conflict takes place in intrapsychical or interpersonal realms. In the conflict suggested earlier between a mother and her insistent children, for instance, if the children get their way by dint of loud insistent voices that overwhelm the mother, this solution indicates a dominant submissive conflict resolution pattern. The children’s dominance is implemented via anger, one form of pathology when used inappropriately, and in this case a sign of collapsed hierarchy as well. Their mother is likely to experience some degree of depression, the price of playing the submissive role in dominant-submissive conflict resolution patterns. If both parties utilize anger, fighting will erupt, another sign of dysfunction. If the conflict is avoided, anxiety may hover. Or, an escape route such as the mother smoking or drinking rather than facing the contest of wills, may offer tempting distraction. Because the same patterns of conflict resolution create the same symptoms of pathology whether the conflict is internal or interpersonal, these understandings enable treatment in both realms to be guided by the same conceptual framework.

(Chart-five modes of c-r, and associated symptoms)

(5) Win-win resolution of conflict alleviates emotional distress. In the above mother-child conflict, a neighbor might come by, hears the ruckus, and say to the children, “Hurry inside for dinner; I have a surprise for you after you finish!” Excited by this invitation, the children comply with their mother’s wish, and at the same time get what they want, which is to have fun. That is, effective conflict resolution, responsive to the concerns of both sides, brings a return of emotional well-being.

(6) Effective conflict resolution skills can prevent similar subsequent distress. The mother in the above example needs parenting know-how and an accompanying shift to a more authoritative and empowered parenting stance. She then would be able, for instance, to set up routines with her children that enable them to come on time for dinner without power struggles. In general, effective conflict resolution skills depend first on a foundation of effective dialogue skills, generally referred to as communication skills, and second , on master of win-win conflict resolution patterns. In addition, parent-child interactions require expertise in win-win interactions in which one participant is an authority figure and the other a dependent.

(7) Healthy functioning depends upon skills, each of which can be seen as specific elements of effective conflict resolution. For instance, failure to listen to one’s feelings, a common “neurotic” habit addressed particularly well by existential/humanist treatments, is a failure in one of the elements of conflict resolution. In the second step of effective conflict resolution, exploration of underlying concerns, feelings must be heeded, not suppressed, because feelings are the keys that unlock the doors to understanding specific concerns.

(8) The basic communication skills are the vehicles by which one travels the pathways of conflict resolution. Similarly, a tendency to blame, characteristic of paranoid and borderline conflict resolution patterns, violates one of the basic communication rules, that is, one can talk about one’s own thoughts and feelings, or ask about the other’s, but talking about the other is out of bounds. Blaming blocks capacity for insight, that is, for exploration of underlying concerns. Blaming also engenders defensiveness in the other person, again derailing effective collaborative information sharing.

(9) Effective treatment generally aims to accomplish three goals::

  • Alleviation of symptoms such as anger, fighting, depression, anxiety, or obsessive-compulsive disorders.
  • Resolution of current conflicts, internal and interpersonal
  • Improvement in communication and conflict resolution patterns for prevention of subsequent symptoms and distress.

(10) Progress toward these three goals can be organized in multiple ways. One method, which I refer to as the Laundry List method, (1) begins by alleviating symptoms that are interfering with ability to function at home, at work, or in treatment (e.g., excessive depression or anger), (2) then resolves one conflict a week from the laundry list of conflicts generated in the first session plus additions to the list from arguments that have emerged in the intervening week and (3) gradually introduces communication and conflict resolution skills as part of the weekly conflict resolution experience. This onthe-job training format seems to work well for many couples with the goal for each week’s session being resolution of one dispute plus coaching in one partnership dialogue skill. This treatment strategy was used in the case below.

In general, however, with regard to which goals to address when, treatment requires that (a) symptoms that interfere with functioning in the therapy session, at home, or at work must be alleviated first. (b) if communication and conflict resolution skills are too ineffective to allow for even guided conflict resolution in the sessions, initial attention must be focused on explaining basic communication guidelines and practicing these in order for subsequent interventions to be therapeutic. (c) if there is a pressing situation that is time-sensitive or that is stimulating particularly emotionally intense conflict (such as children with problems, an affair, or a financial decision) this dilemma needs immediate attention in order for the system to relax enough to be productive on other issues.

(11) To determine the specific agenda for each session—that is, what symptoms to alleviate, what conflicts to address, and/or what skills to build–each spouse needs to say what they would like to use the session for. The therapist also needs to verbalize his/her ideas about what s/he feels is important to do in the session.

(12) Within the session, choosing as session focus can lead to step one of conflict resolution, expressing the initial positions. Subsequently, the best guide to where the therapist should address his/her questions in exploring underlying concerns is to follow the flow of feelings, noting and exploring issues manifest by a furrowed brow, watering eyes, a frown, an emotional tone of voice, etc.

CASE ILLUSTRATION: Couch Potato Meets Superman

The case that will be used to illustrate the principles of integrating individual and couple work within a conflict-focused treatment was a challenging one. Brett and Marcia presented with particularly entrenched and long-standing hostilities and despair. Their home was ravaged by frequent outbursts of intense anger from both spouses; their marriage was teetering on the brink of divorce; and their teenage children were distressed by the pervasive anger and unhappiness.

Brett, a highly successful lawyer, tall, and attractive, was fed up with their household situation; his wife, also high-functioning in the business world, was a large woman who at home felt incapacitated by depression. At one point in treatment they described themselves as Couch Potato meets Superman, a reference to the reality that as Marsha had withdrawn increasingly from household participation, her husband Brett had taken over in a pattern that systems therapists refer to as an under-functioning/overfunctioning couple

Brett and Marsha’s marital problems had begun approximately eleven years ago, around the time of the birth of their third child, and had intensified during the last 4 to 5 years. During this time multiple stresses had overwhelmed the family. The last two children were just one year apart. Marsha experienced severe depression. Her father died. Marsha quit her job; Brett begining to panic about their financial situation and to fear that too much weight was on his shoulders, insisted that his wife return to work and additional schooling While Marsha later was glad she had developed solid professional skills, at the time she felt coerced into commitments she did not feel ready for. Brett also set his wife on a slim budget, which she resented as giving her no control over decisions. Meanwhile, Brett felt excluded from Marsha’s life planning. He felt she wouldn’t show him her game plan–not understanding that in fact she didn’t know what she wanted from life other than that she didn’t like having decisions made for her, and also unaware of the extent to which he was engaging in paranoid-like projection of his own tendency to secretiveness.

Brett had contacted me for marriage therapy on the recommendation of their physician. Marsha had been in individual therapy for a considerable length of time. She found the sessions supportive and interesting. They tended to focus on the difficulties she had experienced growing up and sometimes also addressed her current marriage frustrations, but did not seem to create changes her current life situation or depression. The couple had also been to a marriage therapist whom they both liked, but they both felt that the sessions had not resulted in any changes, instilled renewed hope for their future, or presented a clear plan of how the sessions would lead to relationship improvements. .

Treatment in the conflict-focused format consisted of x sessions extending somewhat over a year and a half. X sessions were conjoint; in addition, Brett had x individual sessions, and Marsha had x. The goals of treatment were (1) alleviation of both spouses’ presenting problems–anger, depression, and generalized distress (2) resolution of the specific marital conflicts that kept recurring with ever-increasing frustration and hostility for both spouses and (3) either establishment of a more cooperative home environment or dissolution of the marriage.

Treatment concluded with the couple having decided to stay together. They had attained relatively cooperative if not fully affectionate functioning. Both spouses had grown significantly in understanding and accepting themselves and each other more fully. At the same time, they both felt more skilled with the cooperative partnership skills they had gained in treatment. While their improvements felt still somewhat fledgling and fragile to me, realities of a new job for Brett and vacations for all of us forced us into a somewhat early but nonetheless successful termination. In a follow-up phone call two years subsequent to their treatment, the couple’s gains were holding with continued gradual improvement in family solidarity.

To explain how and when individual and couple treatment components each contributed to treatment progress, I will separated the tri-partite braid of therapeutic interventions into its three main components: alleviation of symptoms, resolution of current conflicts, and improvement in conflict resolution patterns. Each of these components included a diversity of interventions: psychodynamic family of origin exploration, behavioral changes, cognitive restructuring, and systemic changes in alliances, power relationships, division of labor, and closeness and distance patterns between the spouses. All of these interventions were guided by the overarching conceptual framework of helping the couple resolve their conflicts and improve their conflict resolution patterns.

Alleviation of symptoms

The main presenting problem of this couple was ongoing animosity, generally handled with sullen avoidance of each other, and periodically punctuated by loud and vituperative arguments. In addition to a pervasive negative tone between the partners, there was virtually no positive interaction—no smiles, no occasional affectionate interchanges, and very little civil dialogue beyond essential information exchanges. There had been no sexual intimacy for at least a year.

Brett’s presenting problems (as per a self-report problem checklist): anger, depression, sleep difficulties, irritability, , plus marital tension, arguments, emotional distance, and communicaiton problems. The primary symptomatic focus for him, however, was anger.

Marcia’s presenting problems (from the same checklist): the same as her husband’s plus anxiety and weight gain. The primary symptom focus of our treatment was depression.

Which interventions to do when presents major dilemmas in this kind of multiproblem case. In general, I begin with restoration of hope. Explaining to a couple that their problems have to do with inadequacies in their skills at talking together when they have differences offers the optimistic perspective that skills can be learned and progress therefore could occur. Their anger, depression, and anxieties were by-products of insufficient conflict resolution patterns. Adding the historical perspective that the arrival of a third child seems to have been the time period when the family slipped onto overload led to the revelation that decisions about Marsha continuing to work at that point had tipped the scales. Brett at that time had suddenly felt panic about financial issues. Marcia felt forced into accepting a job she did not want to have to take. The couple’s dominant-submissive decision making pattern at that time, fueled by Brett’s anxiety about finances and Marsha’s lifelong tendency to take an outwardly compliant, inwardly angry, stance, resulted in Marsha’s increasing depression.

Eliminating Marsha’s depression would take three forms of intervention:

1. Antidepressant medication, to change the biochemical energy levels.

2. Individual treatment to help Marsha break free of the depressive stance she had learned as a coping mechanism in childhood.

3. Couple treatment to insure that Marsha’s movement from passive-aggressive and helpless “couch potato” into active participation in the family would be greeted by a more accepting and less controlling stance from Brett. Continued crticial and coercive behavior from him would otherwise undermine and make unsafe any growth from Marsha.

At the same time, eliminating Brett’s angry, critical and domineering behavior also would take three components:

1. Antidepressant medication which seems to attenuate anger as well as depressive reactions.

2. Individual treatment in which Brett could be confronted on his anger, rage outbursts, and controlling and critical behaviors, could understand the costs of this method of trying to get his needs and desires met, could be aided with learning to read his projections, and eased into a cooperative, as as opposed to hostile/controlling partnering stance.

Reciprocal interlocking pathologies: Marsha’s depressive collapse felt to Brett that she was withdrawing affection from him, which she was, and also resulted in her no longer carrying her share of at home division of labor. Her depression triggered anger and abandonment depression in Brett. His anger and frustration in turn continued to fuel her depression. Eleven years later Brett and Marsha’s Brett’s anger and coercive style of family leadership continued to be locked into a reciprocal interaction cycle with Marsha’s social, emotional, and functional depressive withdrawal. Both spouses repeatedly pointed fingers at the other as the causitive agent; neither seemed willing to observe their part in the cycle or to recognize anything they might do differently that might lead to change…

What, from a conflict-focused perspecctive, would have to change for this relationship to become a healthy one? Basically the couple would have to change from dominant-submissive interactions to collaborative partnership, beginning with a change from finger-pointing to each taking personal responsibility for their own behaviors. These skills would take considerable time to build with this couple however. In the meanwhile, medications could offer a helpful treatment boost.

Medications looked important because in order to talk cooperatively with each other spouses each need to be operating from a reasonable normal emotional zone. Brett acted angry and felt depressed; Marsha acted depressed and felt perpetually angry. I encouraged them both to avail themselves of antidepressant medication. Unfortunately, however, Brett insisted that he did not want or need to use medication. Thus one of the first conflicts we needed to address emerged as a patient-therapist conflict.

Resistance to therapist suggestions is one of the indicators for an individual session. Changing one’s mind can feel like loss of face; eliminating the audience decreases this potential shame factor. Resistance to medications then can be handled with the same basic conflict resolution patterns as conflicts between spouses. I needed to hear Brett’s underlying concerns; he needed to hear mine, and together we could map a consensus solution responsive to all of both of our concerns. (his concerns and mine)

Medications helped Brett in fact more than they helped Marsha. Antidepressant medication reduced Brett’s ever-present quickness to anger, insistent biting criticism and accusatory blame, and also his pervasive sense of hopelessness. Most relieving to me as a therapist, with medication Brett’s paranoid-like fixed beliefs that all his problems were caused by his wife relaxed enough to allow moments of self-reflection and insight into his part of the difficulties. Effective marriage therapy would have been difficult if not impossible without the individual sessions that enabled Brett to let go of his opposition to medication.

Marsha’s depressive sense of powerlessness, by contrast, was not alleviated with medication. Her depressive habits of thinking and acting (or more precisely, of passiveaggressive inaction) were too firmly entrenched. Growing up with perpetual criticism from an antagonistic father and then more recently absorbing eleven years of verbal assaults, unilateral decision-making, and domineering behavior from her husband had fixed the patterns too firmly. It gradually became clear that alleviation of this fixed depressive stance would take individual work to loosen. Depressive withdrawal and passive-aggressive inaction were the only coping mechanisms Marsha could rely on for self-protection from her husband’s hurtful comments. She couldn’t afford to give these up in his presence until she was assured that her new coping techniques would genuinely give her more safety. Individual work gave her the safety to explore her resistances to change privately and to begin to explore change options without prematurely exposing her vulnerability.

Marsha’s individual treatment sessions utilized the conflict-focused understanding of depression, specifically, that depression is a disorder of power that both causes and results from dominant-submissive conflict resolution. I use the term “depressive collapse” to describe the feeling of being small and powerless that people experience as they go from normal to depressive emotional states. (exs from sessions)

Symptom removal and resistance to change are probably the two main reasons I o schedule individual sessions within a treatment that includes individual and couple treatment components. Skills can and generally need to be learned together, coordinating both partners’ growth, unless resistances prove too strong. And most conflicts benefit from both parties there to be brought to resolution, though shuttle diplomacy, as we will see later in this article, is sometimes also an important option. Symptom reduction, by contrast, often seems to benefit from the simpler focus (one participant at a time) and lack of audience of one-on-one treatment.

Resolution of current conflicts

As part of the assessment and history-taking in a first session I routinely ask couples to generate together, taking turns, a list of their unresolved conflicts, that is, a list of the issues they argue about or avoid discussing. Marsha and Brett listed their disagreements in two ways, first as specific conflicts, and then, in subsequent sessions, in more metaphorical terms. The metaphors most clearly illuminate the underlying transference concerns that tended to recur in a variety of conflict situations.

1. Finances: Marsha resented her husband’s control of all the money he earned, excluding her from input on how this would be used, which she experienced as controlling and as not treating her as part of the family.

2. Housekeeping: Brett resented that the house was not kept more neatly. He particularly resented the appearance of the refrigerator. Marsha resented that one day Brett had emptied the contents of the refrigerator and then told her to clean it.

3. No sex in a year

4. Feeling left out. Marsha gave the example of Brett telling her he was going to take the children to MacDonald’s, and then in fact going with them to a nice restaurant and not inviting her.

5. Brett similarly felt unappreciated and rejected, and that his wife didn’t care about him.

6. Brett felt he was doing the peddling for both of them.

7. Marsha, using a similar bicycle metaphor, felt that she pedals hard but he’s looking down a different road and doesn’t see her attempts to please him.

In order to resolve each of these issues, each conflict had to be guided through the three steps of conflict resolution: .The bulk of each session would go to exploring step two, the underlying concerns. For example the specific conflict about the refrigerator began with Brett wanting his wife to clean the refrigerator, and Marsha agreeing that it needed cleaning but not wanting to undertake the task.

Concerns need to be explored with adequate specificity, symmetry, depth, and breadth. For instance….

Gradually “core concerns” emerge from this process. Core concerns is my term for the transference issues that trigger particularly strong emotional responses and that seem to recur again and again in different contexts. For instance, Marsha’s core concerns included (1) What I want doesn’t count. (2) I have to throw a fit to get what I want to be included and (3) I’m aways criticized. These concerns replicated concerns from her relationship with her father growing up. Brett’s underlying concerns centered on repetitions of frustrations he had experienced with his step mother: (1) she doesn’t really care about me (2) she doesn’t do what she should to take care of me and (3) projections of his own feelings onto his wife, especially of being continuously critical.

Clarifying these concerns to some extent resembles cognitive therapy. At the same time, linking these concerns to family of origin realities, a psychodynamic/Gestalt strategy, helps both partners to regard each other more sympathetically. Marsha’s opinions didn’t count in her family growing up, and her father, a negative and probably chronically depressed person, rained unremitting criticism on her. Her husband Brett did need to learn to listen to her more respectfully instead of making decisions unilaterally. Marsha needed to unlearn the belief that throwing fits is empowering and understand instead that fits generate return hostility. She then needed to learn to use cooperative dialogue skills in order to get herself heard in a positively empowered manner

Clarifying concerns however in itself does not complete conflict resolution. Each issue needs action plans. With regard to the refrigerator for instance, ….

Improvement in communication and conflict resolution patterns

Brett and Marsha dramatically illustrated how radically different people can function when they meet one on one with a therapist from how they interact with each other. Either alone with me appeared intelligent, thoughtful, considerate, and mature. I could readily see how an individual therapist who had not seen the couple’s interactions could easily be duped into believing that whichever partner they were talking must be the poor victim of a difficult spouse. The two together however regressed to childlike interactions, readily accusing and defending, and showing virtually no effective communication skills. Deficits in tactful talking, in open listening, and in emotional selfregulation blocked even rudimentary cooperative dialogue. Uncontrolled toxic anger spillage tainted the relationship again and again. In addition, higher level communication sequences such as bilateral decision-making, recovery from upsets with apology and learning, supporting each other vis a vis external challenges, sharing intimate self-revelations, or even enjoying or physical intimacy, playful verbal interactions or leisure activity, were virtually non-existent. Each of these deficits needing remediation.

The following examples of upsets-of –the-week illustrate how skill training needs become evident:

1. Son Peter’s birthday (shared decision-making)

2. Dinner’s ready

3. The Valentine gift (fix-it talk)

Do skills like these really need to be taught? Communication and conflict resolution patterns to some extent improve when the basic hostile stance of a couple is changed to cooperative. To sustain cooperation, however, couples in general, and this couple in particular, needed extensive coaching of cooperative partnership skills. Otherwise each time Brett did not listen to his wife, Marsha experienced another depressive collapse. Each time Marsha withheld affection in order to experience at least a modicom of power in their interactions, Brett’s abandonment anger returned. Each time a decision needed to be made, their unilateral decision-making paradigms resulted in one or the other partner feeling powerless and furious And each mishap further consolidated both partner’s antagonisms as they had no sufficient paradigms for cleaning up after upsets.

In addition to skill-building, family of origin explorations can help couples to understand their transference reactions and also the positive functions that currently dysfunctional patterns initially served. For instance, (10/1/97) Brett recalled that in his family, when his stepmother “got bitchy about something”, she would punish him for the next 24 hours. When he sensed that his wife Marsha was bothered by anything he did, Brett would react with instant anger, anticipating 24 hour punishment and striking back as he had been unable to do as a child. At the same time, he often reacted in the manner of identification with the aggressor. He recalled that, “If you didn’t do a chore my Mom would say ‘It’s not my job to keep up with you…’ and then would punish rather than helping or encouraging in any way.” Similarly, as in the refrigerator incident, Brett seemed to be hypervigilant for when Marsha would slip on doing her chores (which, when she was depressed, was frequent), and then scowl and berate her.

While understanding the family origins of these patterns can substantially decrease resistance to change, and enable old habits to be “pulled out at their roots” and thereby eliminated more comprehensively, new more sanguine responses do not necessarily miraculously appear. For example, Brett and Marsha needed both to unlearn punishing each other in response to unaccomplished chores, but also to learn to do “fix-it talk.” Fix-it talk is my term for cooperative dialogue about minor changes either of them would like to see in household routines. With fix-it talk skills, Brett could raise his a touchy topic like chores, he and Marsha could talk together constructively about each of their concerns, and they then could map a plan of action that would feel comfortable for both of them. Brett and Marsha’s treatment thus included both approaches to skill change–historical explorations of origins of poor habits and skill-building for the future.

ETHICAL CONSIDERATIONS

Treatment that combines individual and couple treatment formats raises two main types of ethical considerations: confidentiality issues and dual relationship questions.

PRINCIPLES FOR DECIDING WHEN TO USE

INDIVIDUAL VERSUS COUPLE TREATMENT FORMATS

In conflict-focused treatment framework, couple treatment is the default format. Most treatment, with most couples, proceeds primarily in that format. The following circumstances suggest, however, when a switch to one or more sessions of individual work will be helpful:

  • Assessment needs to include at least a few minutes of time during which each individual has a private opportunity to confide concerns to the therapist that s/he may have been reluctant to verbalize in front of the spouse.
  • Symptoms, e.g., excessive anger, depression, anxiety, drug or alcohol abuse,etc, generally are alleviated more easily and more comprehensively with inclusion of at least some individual work
  • When one format is not using, switch to the other.
  • When there is a lack of insight in reporting difficulties, use the couple format. The therapist needs to see the difficulties live if a patient cannot see the problems him/herself.
  • When emotional states appear fixed (e.g., a fixed blaming stance, or a fixed depressive stance), use individual sessions.
  • When resistances to treatment appear in the couple format, schedule an individual session.
  • When one partner needs an individual session, schedule a session symmetrically for the other as well.
  • Most work generally needs to occur with both partners present. That way both can change in coordination with the other, they both have the same information about healthy communications, and they both understand each other increasingly fully as a result of therapeutic explorations each has made in the other’s presence.
Resolution, Not Conflict; Dr. Heitler's blog on Psychology Today
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