Nathen's Miraculous Escape

I created this outline of the categories of moments that therapists are to intervene in as a learning aid and a reference. Every line is a direct quote from Johnson’s The Practice of Emotionally Focused Couple Therapy. All typographical errors are mine.

• Stage 1:The de-escalation of negative cycles of interaction
  • Steps 1 & 2:The delineation of conflict issues and the identification of the negative interaction cycle that maintains the couple’s distress and precludes secure bonding.
    • As one partner tells his or her story of the relationship and the problems in the relationship, strong emotional responses interrupt the narrative. At this point, partners usually exhibit nonverbal signs of strong affect–crying, flushing red, turning away, biting the lips, clenching the fists–and the flow of the narrative or dialogue is interrupted. The task here is to focus on and acknowledge the affect, thereby creating a secure base in the therapy session for such experiencing.
    • As one partner tells his or her story, the lack of emotion is very marked. Dramatic and often traumatic events are reported from a detached stance, as if they had happened to someone else. The incongruity between what is being said and the manner in which it is reported–in a sense, emotion that is conspicuous by its absence–grabs the therapist’s attention. The task here is to explore the lack of engagement in the personal experience and what this signifies concerning the couple’s engagement in, and definition of, the relationship.
    • During moments of intense affect, partners articulate beliefs concerning themselves, the other partner or their relationship that appear rigidly organized and/or destructive in the present context. These beliefs are often stated as definitions of identity. The self, the other, the relationship or relationships in general are defined and declared to be constituted in a particular way. The partners often convey the meanings that they have given to key relational events in terms that preclude the possibility of change, or the development of any new perspective or information. The task here is to reflect and elucidate such beliefs and begin to frame them as part of the destructive cycle that controls the couple’s relationship.
    • Particular attachment issues are identified, but are not owned, or are responded to in ways that block resolution of such issues; for example a wife blames her partner for being a “workaholic” but does not seem willing to focus on her own sense of abandonment and loss. The task here is to beging to focus on such issues and frame them as central to the ongoing problem in the couple’s relationship.
    • In the first session, the therapist particularly notes position markers, that is, comments or responses that appear to define power or control and closeness–distance in the relationship. These markers occur in dialogue between the therapist and each partner, in the dialogue between the partners, as well as in the stories of the relationship that each partner tells. The task here is for the therapist to get a clear picture of the postion each partner’s perception of and emotional responses to such positions.
    • The therapist also notes negative cycle markers. By far the most common cycle in distressed couples is some form of pursue/criticize-withdraw/avoid. However, withdraw-withdraw cycles, where both partners are relatively disengaged, and volitile attack-attack cycles are also seen. In withdraw-withdraw cycles, the story the couple tells often makes it clear that this cycle has developed from the pursue-withdraw pattern; by the time they come for therapy, however, the pursuer has also begun to disengage and withdraw. The couple tells the therapist about, and enacts, the manner in which the positions they take with each other interconnect to create negative self-reinforcing patterns in the relationship. The therapist tracks and clarifies such cycles. The task is to become clear about what the cycle is and to frame it in such a way that the couple finds it relevant and true to their experience. They can then begin to integrate it into their way of thinking about the relationship. Individual responses are placed in the expanded context of the cycle.
    • The therapist particularly notes they way the partners interact when there is an opportunity for positive contact and emotional engagement, particularly how that contact is blocked. This illustrates how the attachment insecurities of each partner are played out in the interaction. The task is to note if and how the couple makes positive contact, and to note and explore exits from such contact, such as when one partner reaches for the other and the other rapidly shifts to an inaccessible position. If such contact is created in the first sessions, the task is to focus on it and acknowledge it as part of the strength of the relationship.
  • Steps 3 & 4:Accessing the unacknowledged feelings underlying interactional positions, and reframing the problems in terms of the negative cycle and these underlying feelings and attachment needs.
    • One of the partners expresses the reactive secondary emotions that make up a large part of a distressed couple’s interactions. This is often anger or frustration that is expressed in the process of blaming the other or justifying the self. The task here is first to acknowledge and validate these secondary responses, but them to engage with the client in the process of exploring specific experiences and eliciting emotions that are minimized, discounted, or avoided. This can occur as the partner tells the therapist the story of the relationship and the distress in the relationship, or as he or she recounts a particular incident that is particularly relevant to how he or she perceives the relationship. It can also occur as a couple interacts in front of the therapist in the session.
    • One of the partners exhibits nonverbal behavior in response to his or her partner that is noteworthy doe to its incongruity, intensity, or effect on the interaction. As a wife complains and weeps, for example, a husband taps his foot and frowns with apparent impatience. His wife then looks at him and lapses into silence. In another couple, a wife states that she is going to leave the relationship and the husband begins to laugh and talk about possible summer holidays. The task here is for the therapist to slow down the process of interaction and focus attention on the emotion implicit in the nonverbal behavior.
    • A partner begins to explore his or her emotional responses in the session, and to encounter a new, alive sense of how he or she experiences this relationship, or to symbolize this experience in a new way, but exits from this process rapidly, often becoming caught up in the negative interaction cycle with the partner. The other partner may also discount this experience and elicit the usual fight-flight response, which then takes precedence over the beginning exploration. The therapist’s task is to redirect the process in the session back to the exploration and help the partner engage in it more fully.
    • The couple exhibits the interactional cycle that has been identified in Step 2. The partners themselves may now identify the interaction as part of the cycle, or the therapist may comment on it. The task now is to focus on one person’s position in the interaction and how this person experiences the other partner and his or her own compelling emotions in this interaction.
• Stage 2:Restructuring key interactions; changing interactional positions.
  • Step 5:Promoting identification of disowned attachment needs and aspects of self and integrating these into the relationship.
    • The emotional responses accessed by a partner in Step 3 are experienced or referred to by the client in the session. These emotions are now more easily identified and symbolized by this person and related to his or her interactional position in the couple’s cycle–such as when the therapist asks a withdrawing partner what is happening for him, and he replies in a congruent manner: “I just give up. I’ll never make it with her, I feel small and scared. So then I back off, go away.” The task here is to validate the emotion and the action it evokes, which is to withdraw and protect the self, and to help the partner further differentiate this experience and to own it.
    • A partner begins to explore, in a new and alive way, his or her underlying feelings, but is interrupted by the partner, or exits from the process into abstract cognition or general descriptive comments. The task is for the therapist to redirect the process and, if necessary, block the other partner’s involvement in the emotional experience.
  • Step 6:Promoting acceptance of the partner’s experience and new ways of interacting.
    • One of the partners, in Step 5, reaches a sense of closure or synthesis of his or her underlying emotion with the therapist and is able to clearly relate this experience to his or her habitual responses to the other partner. The therapist then requests that this person share this synthesis with the other partner and he or she does so, in an engaged manner. The focus in this sharing is on self, not other. The task in Step 6 is to support the other parther to hear, process, and respond to this sharing, so that this new experience can become part of, and begin to reshape, the couple’s interactions. There is no reason why the observing spouse should be particularly open to, or trusting of, this shift in the way this partner presents him- or herself in the relationship. On the contrary, such partners have had years of disappointment and negative experiences, which mediate against such responsiveness. If the therapist is not present, this lack of responsiveness to such sharing becomes a potentially aversive experience for the partner who is opening up. This results in a reinitiation of the negative cycle and a return by this partner to his or her more constricted position in the interaction. From a systemic point of view, the therapist promotes and expands this shift in the pattern of interactions, this new kind of dialogue, so that it is not simply inundated by or subsumed in the more established pattern, but in fact begins to reorganize that pattern.
  • Step 7:Facilitating the expression of needs and wants and creating emotional engagement.
    • A partner reiterates or further expands the emotional experience encountered in Step 5, but does not symbolize the needs and wants implicit in this experience. The task for the therapist is to help this partner formulate the needs and wants arising out of this experience, and to encourage the expression of these formulations to the other partner.
    • A partner spontaneously begins to state needs and wants to the therapist, but does not address these to the other partner, or exits from this process of sharing into a less pertinent or unfocused dialogue. The task for the therapist is to redirect the process of sharing toward the other partner, or back to a more pertinent focus, and support this person in sharing his or her desires with the other spouse.
• Stage 3: Consolidation and integration
  • Step 8:Facilitating the emergence of new solutions to old issues and problems.
    • In the later part of the process of reengagement, a partner begins to own his or her part in, or perspective on, the pragmatic issues in the relationship. This perspective is now more proactive and opens up new possibilities for problem solving. For example, a husband states that he understands his wife’s concerns over finances and is ready to take care of this, so he has arranged to deposit an amount of money each month in the family account. He then intends to run his business on his own terms, without his wife’s interference. The task for the therapist is to support the reengaging partner’s initiative, while helping the other spouse to be open and to respond to such actions. The therapist also helps the couple to articulate the effect this problem-solving process has on the relationship and on the pattern of the couple’s interactions.
    • When both partners have completed Step 7–that is, most often after the more critical partner has completed the softening process–the couple begins to discuss long-standing life dilemmas and/or decisions that in the past have been a source of alienation (such as whether to have another child). Such issues have not been resolved due to the conflict in the relationship, but also because the significance of certain issues is often intricately tied to the way in which the relationship is defined. For example, how much money to invest in a cottage may well be a very minor problem by the end of therapy, despite the fact that it has fueled many ongoing arguments over the years. This is because the cottage no longer represents a valued refuge from the marriage for the wife, or a symbol of imminent separation for her husband. Very significant decisions, such as whether to have a child, are most often flooded with attachment significance. For example, a wife can let go of her defiant position and admit that in fact she does want to have a family only after working through her fears about relying on her husband and a previous incident in which she was ill, vulnerable, and did not experience him as responsive to her needs. The task for the therapist is to facilitate discussion and exploration while allowing the couple to find their own solutions. The therapist’s focus is on how the dialogue about such issues can be a source of intimacy and contact, as well as on how to help the couple confront obstacles to positive responding.
  • Step 9:Consolidating the new positions the partners take with each other.
    • The couple is able, in the session, to enact new positions and new positive cycles, as well as relate incidents of such cycles occurring outside of therapy. The contact between the couple is now obviously and tangibly different from the negative interactional pattern seen in the first sessions. The task for the therapist is to highlight these changes and to relate them to the security of the relationship, its future health, and the expanded sense of self of each of the partners. By symbolizing and heightening the changes the couple has made, the therapist helps the couple formulate these changes in palpable and concrete terms, thus enabling the couple to integrate them into their view of the relationship.
    • The couple suggests that they do not need the therapist anymore and are able to be specific about the changes they have each made, as well as how these changes have affected their relationship. They also express fears about not having the “safety net” of the therapy sessions. The task is to validate the couple’s strengths and ability to sculpt their relationship to fit their evolving needs, as well as to reassure them and leave them equipped to deal with any reoccurrence of the negative cycle. The therapist also fosters their commitment to maintaining emotional engagement and a positive bond.