2. Foundations for Couples/Relationships - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
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2. Foundations for Couples/Relationships

Therapist Resources > Therapy Books > DownRelRabbitHole- Assessment

Down the Relationship Rabbit Hole, Assessment and Strategy for Therapy

The individual client often is in search of relationship health and fulfillment.  It may be a relationship with an inner child, a false sense of self, a demanding idealized self-image, or other internalized intrapsychic relationship.  The couple's relationship is a specific and special relationship.  Monogamy, life-long commitment, and a depth of intimacy often characterize the couple's relationship.  The couple's relationship is one of many intimate relationships.  Other potentially intimate relationships may involve a hierarchical relationship such as teacher and student, parent and child, coach and player, mentor and mentee, and supervisor and supervisee.  On the other hand, other potentially intimate relationships may be egalitarian such as friends, co-workers, teammates, siblings, and of course, couples in many modern American mainstream cultures.  Therapy itself is an intimate relationship between therapist and client with hierarchical qualities.  Intimacy is both a process and an outcome.  The process involves particular interpersonal dynamics. Gore, et al (2006) discusses intimacy.  "Reis and Shaver (1988) define intimacy as 'an interpersonal process that involves communication of personal feelings and information to another person who responds warmly and sympathetically' (p. 375).  According to this model, the development of intimacy begins with disclosure of emotional or personal information by one of the partners.  Revealing emotional and private information about oneself communicates trust, liking for the partner, and commitment to increased intimacy in the relationship (Altman & Taylor, 1973; Collins & Miller, 1994; Derlega, Metts, Petronio, & Margulis, 1993).  Emotional self-disclosures also reveal centrally important aspects of the self, allowing the partner to verify and validate these self-views (Reis & Patrick, 1996).  As a result, emotional disclosures are more strongly associated with relationship development and intimacy than are factual or behavioral disclosures (Goodstein & Reinecker, 1974; see Dindia, 2000 for a review). (Laurenceau, Barrett, & Pietromonaco, 1998; Lippert & Prager, 2001)" (page 83-84)

Self-disclosure affects the relationship depending in part on the other person's response.  The relationship is enhanced when there are mutual behaviors that communicate understanding (a clear perception of the speaker's core self), validation (respect and acceptance), and caring (affection and liking of the speaker).  The nature and quality of the response may be more important than the self-disclosure to building intimacy.  Whether the individual, couple, or family in treatment has or is familiar with a hierarchical relationship or an egalitarian relationship, the condition of the relationship and quality of intimacy is the starting point of the therapy.  Each individual has his or her personal history and brings strengths and weaknesses, aptitude and inhibitions, ease and discomfort with intimacy and relationships.  At the same time, the therapist must establish a relationship and level of intimacy with an individual and with each member of the couple or family and the couple or family as a whole.  This may be very challenging if the ability to achieve relationship and intimacy is a core problem for one or more members of the couple or family.  The individual client or one or more members' inability to form an intimate relationship with each other may be duplicated with an inability to bond with the therapist.  This may result from attachment issues as Carnelley and Rowe (2007) propose.  "…adults with a secure global attachment style generally feel comfortable with closeness and interdependence in relationships.  They believe they are worthy of love and see others as trustworthy and dependable.  Adults with a preoccupied global attachment style are mistrusting that close others will meet their emotional needs.  Preoccupied individuals crave intimacy but simultaneously fear rejection.  Individuals with a dismissing-avoidant global attachment style, on the other hand, are not comfortable with intimacy and interdependence in relationships and believe that others are generally not trustworthy or dependable.  Finally, adults with a fearful-avoidant global attachment style believe that they are unworthy of love and fear abandonment.  They find it hard to trust and depend on relationship partners and have a negative view of themselves and others." (page 307-08)

The individual, couple, or family's relationship and the therapy (including developing rapport with the therapist) may be difficult, because of affect regulation patterns that are embedded from family of origin experiences.  Childhood abuse or emotional neglect, for example may preclude readily secure attachment to a partner, family members, and to the therapist.  Individuals with negative attachment experiences would have difficulty with partner and other intimate relationships and moving toward a global secure attachment pattern.  Individuals may be intellectually aware of these issues but still have trouble not responding negatively to familiar triggers and to develop the following capabilities.  In order to have any intimate mutual relationship (spousal, friendship, therapeutic, etc.), each individual must have certain capabilities, which serve as the foundations to the relationship.  The therapist can assess each person and each member of the couple or family for these five capacities:

1. Trust

2. Be Vulnerable

3. Self-Express (Expressive Communication):

a. Introspective

b. Insightful

c. Connected to Own Feelings/Process

d. Articulate

4. Empathize (Receptive Communication):

a. Listen

b. Understand

c. Relate/Identify

5. Invest

Individually, as a couple, or as a family, each of these five foundations may be severely damaged or compromised.  The damage is often why the individual, couple, or family can come to therapy.  An individual may have limited abilities due to extensive dysfunctional experiences.  He or she may have been inadequately supported or discouraged due to cultural backgrounds.  A person's ability to have a therapeutic relationship with a therapist is sometimes also compromised because of deficiencies in one or more areas.  A self-referred (essentially, accepting or acculturated to therapy) individual, especially an adult may know he or she needs to trust, have to be vulnerable, express himself or herself, be available to input, and is invested.  A mandated or coerced teen… or the mandated or coerced partner in the couple's relationship or child forced into therapy often is not!  In addition, there may be issues around match or mismatch of gender, ethnicity, sexual orientation, social class, and age of the therapist that bring up harmful transference issues that destabilize the clients' ability to form these foundations.  A client, individually or in a couple or family often

does not trust from having been violated and betrayed many times,

fears vulnerability from having been hurt over and over,

expresses dysfunctionally (in terms of American therapeutic culture); he or she may avoid introspection, have poor insight, often are disconnected and even fearful of own feelings, articulate very poorly,

is self-focused in order to survive (often self-righteously), and is consequently dismissive of the other's feelings; he or she may listen to argue or dispute… or rationalize egocentrically,

and cannot identify, fearing identification with the partner causing him or her to lose his or her own "righteousness."

The therapist needs to assess how much strength is there in the individual or each member's ability (or, whether there is personal or cultural permission) in each of the foundation areas: to trust, be vulnerable with, self-express to, empathize with, and invest in the other and the relationship?  How much damage has occurred to these foundations?  How culturally or familially foreign are these foundations to each partner?  How much ability and willingness (personal or cultural permission) is there to risk each, any, and all of the five?  This assessment and other assessments lead to the goals and process of therapy.  Any concerns in the five foundations of an intimate relationship need to be addressed between the therapist and the client, and between both partners in the couple or among each member of a family in therapy.  From this initial assessment, the therapist may direct therapy to build upon each of the foundations.

Therapy itself is an intimate professional relationship that requires essentially the same foundations as any other intimate relationship.  As discussed in "Therapy Interruptus and Clinical Practice, Building Client Investment from First Contact through the First Session" (Mah, 2013), establishing the therapeutic relationship between the client(s) and the therapist, involves the therapist establishing connection, credibility, and control.  The therapeutic relationship develops simultaneously through the development of the five foundations with the client or both partners and the couple.  Therapeutic intimacy may be essential to fostering the intimate relationship of the couple or family as well, as healthy intrapsychic relationships.  The same problems in any of the five foundations of relationship in an individual outside of therapy may negatively predict the necessary intimate therapeutic relationship with the therapist.  While the therapist may experience challenges with rapport building with the client in individual therapy, the one-on-one dyadic therapeutic relationship is arguably simpler to establish than within the couple or family therapy context.  Couple therapy demands establishing and managing two dyadic client-therapist relationships in order to facilitate the partner-partner dyadic relationship, i.e. the couple.  Family therapy involves multiple dyadic relationships.

3056 Castro Valley Blvd., #82
Castro Valley, CA 94546
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
office: (510) 582-5788
fax: (510) 889-6553
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