Dr. Ellyn Bader

January 24, 2020 – Monthly Clinical Call, Creating Change in Couples Therapy, Ellyn Bader & Tammy Van Hinte

Video

Summary of Call

What Stood Out Most for Lauren

The information that Tammy put together here is a really helpful way of breaking down some of what Ellyn does in the process of working with couples. Learning about some of these nuances may make it easier to see how Ellyn is putting interventions together and why. With Ellyn’s other discussions here about the Developmental Model on the whole, this call is a fantastic window into big-picture ideas and nuanced ways of applying the Developmental Model.

Background in the Developmental Model

The Developmental Model is based in psychological growth rather than pathology. It also recognizes that each partner is coming from a different background and bringing their own coping mechanisms (ineffective or not) into a new relationship. The Developmental Model also provides not only a way to see where the couple is in this moment, but a roadmap for basic stages of development where the therapist can hold a view of the possibilities for where the couple can move and grow.

Leadership

The idea that the therapist is a therapeutic leader is central in the Developmental Model. Leadership sets the tone for the session. Couples very frequently enter therapy at a place where they are telling the therapist everything that is not right and often blaming their partner for many of the problems. The Developmental Model provides a lens through which the therapist can see not only where there are places where more development and work would be helpful, but also to recognize what they are already doing well. These can be large or small things. For example, perhaps a partner is able to take responsibility for their part in a certain conflict, or maybe one partner actually allows another to finish a sentence before interrupting. Both matter and both are stepping stones toward change as their negative cycles begin to shift.

Individual Change

The Developmental Model also focuses on individual accountability. That is that each partner is responsible for their own part in what is occurring in the relationship. Changes each person makes within themselves lead to change in the whole couples relationship system.

Getting off to a Powerful Start

The therapist establishing themselves as a leader is key. This does not mean that therapist has control over every interaction in the session, but rather that the therapist can hold in mind the general direction of therapy through asking questions about whether each partner is in therapy to strengthen their relationship, make a decision, or to learn how to separate. If the couple is in therapy to strengthen their relationship, getting a sense of their ideal relationship and noticing what they could start or stop doing to move in that direction is very important. This allows the therapist to be active rather than just reactive. This also involves getting the couple’s attention. Particularly with couples who are arguing or fighting a lot, it is important that they know that they will need to be doing the work. The therapist is there is a guide, but couples will experience lasting change only if they are committed to doing the work themselves.

Reasons Why Relationships Fail

Ellyn explains that one reason that relationships fail is because of a lack of support, either internally having difficulty supporting what it is that each person really wants for themselves, or externally through family and friends. Ellyn also states that most people lack capacities that they did not get when they were developing. So later when these individuals are then trying to create their own relationships, a lot of the same capacities can be missing. But often people are not aware of what they are missing because they have developed a sense of what is “normal” based on what they have experienced. There is also very often a repetitive re-triggering of past trauma, which can be very detrimental if there is not some type of repair, and people often do not have the skills to effectively repair. Also, it takes a lot of skills to be in a successful interdependent relationship and a lot of people are missing these skills.

Effective Couples Therapist Skills

Ellyn highlights skills of a very effective therapeutic leader, including being able to keep momentum, being skilled at aligning with each partner (rather than being perceived as being on one person’s side), managing aggression and volatility very quickly to help prevent or minimize reinjury, focusing on areas where there is a lot of therapeutic
leverage, and more.

Creating Autonomous Goals

Setting autonomous goals is very important here because these are goals where one partner can work on changing something within or about themselves and their reactions, and this is independent of what their partner chooses to do. A lot of couples will try to say that they did not do what they agreed to because of something their partner did. For example, someone could say that they did not do the dishes because their partner came home late, so it didn’t matter that they did not do the dishes. This is a good time to continue emphasizing the difference between what one partner does and what the other partner is doing. This enables each partner to learn to take responsibility for their element in change. Lauren (who is writing this summary) adds that for some partners, blaming the other is easier and this can be a way out of feeling the tension or uncomfortable reactions to not doing what they agreed to. It helps to be able to highlight for each partner that they are agreeing to do whatever their goal is regardless of what their partner actually does. This also means that therapy is not dependent on the least motivated partner in order for the more motivated partner to agree to make change. Often, when partners are waiting for the other person to make change, the least motivated partner may not do so, and then the more motivated partner gives up as well. Patterns of Intervening to Create Change.

Tammy Van Hinte noticed that there was a gap between theoretical knowledge and being able to apply the Developmental Model in the nuanced way that Ellyn does in sessions. Tammy created a very comprehensive handout about this, which is available at the top of this page. Tammy also highlights that she has noticed that it is important not only to have it set of skills, but to apply them in a similar order to what Ellyn is using. Tammy uses the example of a carpenter who has a hammer, a nail, and a saw, but must use these tools in the right order in order to build a construction.

Holding Three Processes

Tammy highlights that she has noticed that Ellyn holds several pieces in mind that the same time: the process between the two partners, the process within each of the partners, and her own reaction. And Ellyn agrees with this. She also highlights that even if she does not immediately or directly articulate her own internal reaction, she is aware of that and finds some way to weave that into the intervention in some way. Another example is if Ellyn is feeling fear, she will find some way to determine if the partner is also feeling fear. She is mindful, though, to avoid countertransference. With more experience and practice, it becomes easier to notice the difference between something that may need to be addressed compared to a countertransference reaction. Tammy also highlights during the call that she has recognized in the past that when she is reactive to something, she has identified that this may mean that there is something coming up for her, but now also realizes that it could be an indicator of something that is actually going on in the mind of the other partner and can sometimes be something to ask about.

Internal Checks

Tammy talks about how she has recognized a very vital part about checking on aclient’s internal experience: sometimes partners appear calm when, in fact, they are not calm on the inside. Tammy states that there have been couples who did a wonderful job with the Initiator-Inquirer Process and then went home and had a very difficult time there because they were reacting internally and not sharing these feelings because of a desire to really do what was asked of them. Tammy now asks were directly about each person’s internal experience. Lauren (who is writing this summary) also had many similar experiences before recognizing the need to check more directly, even if dysregulation is not observable.

When Clients Appear to Be Disconnected from Their Own Emotional Experiences When a client is very disconnected from their own internal experience or emotions, Ellyn highlights that this often means that they have very low differentiation. A big piece of differentiation is being able to be aware of their own internal experience, define it, and express it. This beginning stage of differentiation can be very slow for some people. It can be helpful for these partners to learn to identify their feelings through the use of feeling faces (using handouts and posters that are widely available) and Ellyn also recommends that these clients attend group therapy because they can see others identifying their emotions. Ellyn has also experienced that some individuals can grow in this way very quickly (identifying their own internal experience), where others can take quite a bit of time to learn these skills.

Developmental Assists

Ellyn uses the term “developmental assist” to identify when she is using an intervention that is specifically designed to help a client see the next step in their development within the Developmental Model. For example, Tammy highlights that when a partner is coming in with very little knowledge of how to identify their own internal experience or name their emotions, Ellyn is saying that she would start where they are in the process and move forward from there. This is where Ellyn explained the idea of a “developmental assist” in that it is an intervention designed to move a client one step further along the developmental process, rather than starting too far ahead of them. This keeps the work right near the growth edge, so they are continually growing while being able to make changes that are within their capacities, rather than too far ahead of them.

Lauren (who is writing this summary) also adds that if a developmental assist is too far ahead of a client, they will struggle to do it, which indicates that they could benefit from a smaller step. For example, if a therapist is asking a client to express to their partner what they were feeling about the conversation around what to make for dinner the night before and they freeze, it may become clear through further therapeutic discussion that they do not know how to identify those feelings and/or have a concern or assumption about their partner’s reaction that is getting in the way of their ability to express their feelings. This would mean that there is more developmental work to be done related to these earlier steps before being able to make the one that would enable them to tell their partner directly what they were experiencing.

Positive Strokes

Ellyn and Tammy also discussed the importance of positive strokes. This involves recognizing that a partner just did something well that they had not been able to do before. In being able to go back and specifically recognized what happened, why it was important (because they used a certain skill or did something much better than they had before), and acknowledges that they took a risk to do something different. Lauren also adds that it takes time to create new habits, so each positive stroke about each growth fully actually helps a client begin and continue to rewire their brain so that rather than reacting in the old way, with practice and repeatedly acknowledgment that they are doing something differently, they begin to default to the new way, rather than what they had learned before that was actually ineffective for them. Each positive stroke helps to highlight that new pathway or reaction. While practice doesn’t generally make perfect, as the old adage goes, practice does help to make change and heal while
making the new habit or reaction something that happens most of the time, even if we all recognize that no one is perfect. Also, if a reaction is better the vast majority of the time, it’s often easier to repair a hurt when an old reaction occurs.

Positive Strokes and Nudges

After giving positive stroke, the next step is to continue giving those positive strokes and also add a nudge to where they are trying to go next. Ellyn gives an example where a wife had become more able to tell her husband what she wanted and Ellyn asked her to tell him sometime over the next week that she not only wanted to go on a date night, but also to tell him where it was that she wanted to go. Ellyn states that this is going to be a risk for her. Also note that some positive strokes are followed by nudges and others are not. Be sure to continue giving lots of positive strokes without nudges too!

3 Reasons Couples Come to Therapy

A lot of couples come to sessions because they are looking to strengthen their relationship in some way, grow, or change. Others come in because they are looking to make a decision (such as whether or not to have another child or whether or not to move across the country). Still others are coming in for sessions to figure out how to dissolve the relationship or to separate.

Developmental Stages

Ellyn believes that couples can develop through normal and predictable stages and sometimes this development gets stuck, and the longer they are stuck, the more symptoms we may see in therapy office. Also, the more individual development each partner has before they come together, the easier the couple development may be. Also, when the couple develops, the individuals will develop as well. Ellyn highlights that she has seen this a lot because individuals take more healthy risks in their own life when they are also growing in their relationship. The developmental stages are based in Margaret Mahler’s work in early childhood development. One of the key developmental stages is learning that one person is different from another, as in “there is someone else in the world who is not me.”

Around 1:02, you can see Ellyn show a sequence of diagrams to show the degree of overlapping, separation, or coming together between each individual person and how they see themselves compared to the “we” of the relationship.

Common Stages for Adults Entering Couples Therapy

1. Symbiotic-Symbiotic couples have a very difficult time managing conflict, often being angry or hostile or avoiding conflict altogether. They are not able to effectively manage the tension of having difficult discussions. If you have a couple that has been together for more than two years and they are still in the stage, this is what Ellyn calls arrested development. This results from chronic failed differentiation.

2. Symbiotic-Differentiating couples are also common when one partner is beginning to learn how to express what they want, wish for, or desire and recognize that their partner may want something different (the differentiating partner), while the other partner remained symbiotic, pulling for the differentiating one to be more like them.

3. Symbiotic-Practicing couples are where one partner (the practicing one) is really focused on something outside of the relationship (hobbies or other activities), rather than dealing with the tension of the relationship itself. This can also be paired with a partner who is symbiotic, or pulling for more of that sameness that feels more comfortable. This combination can be troublesome when the practicing partner actually skips differentiation because going outside of the tension of the marriage (through pursuing other activities, for example) is much easier than managing conflict or having differences. In this case, the symbiotic partner often reports feeling abandoned because the partner is just not present in the way that they would like.

4. Differentiating-Differentiating partners can be a lot of fun in the therapy office because they are often putting a lot of work into therapy and recognizing who they are, what matters, and what they would like to work out.

Some Keys to Consider for Treatment

In addition to being an effective leader, some other things that are important to consider include where the couple is stuck (or where their development is arrested), what are the main sources of their pain or disappointment, how is the couple hurting themselves or each other, and how far off course are they really considering their age (because someone who is 20 has different life and relationship experiences compared to someone who is 50) and how long they have been together.

For more detail about each of the developmental stages, consider listening to this call: https://www.couplesinstitutetraining.com/sep-27-2019/

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