2. Judge - Referee - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Another problematic role for the therapist occurs when the individual, partners, or family members ask him or her to make judgments regarding behavioral propriety.  Therapy, especially couple and family therapy would function like a courtroom.  The individual, partners, or family members- Carson and Vee for example, may recruit the therapist to agree with them and give legitimacy to grievances brought against the other's behavior, whether that person or persons are in the sessions or are only know to the therapist from the client's descriptions.  Therapy duplicates the couple's dynamic of ongoing disputes except that there now is a judge to play to.  The couple's dynamics have become a competition for dominance or pre-eminence.  Has it become a power struggle for survival between Carson and Vee?  The therapist can take pad of paper or a small white board and draw a simple mountain with a stick figure on top of it, narrating, "Sometimes and for some people, they think there's only room on top of the mountain for one set of feelings, one way to think, one way to interpret, or one perspective only."  Then the therapist can draw a couple of lines from the stick figure arcing off of the mountaintop into the valley.  "And when that happens, the result is a battle up there and someone's feelings or thoughts have to go.  Then someone gets tossed off of the mountaintop," and the therapist can draw another stick figure failing headfirst down towards the ground.  "Is that you Carson getting tossed or are you the tosser?  Or Vee, is it you on top of the mountain, and Carson on the rocks below?"  Interestingly in couple therapy, often both partners identify themselves as the falling figure.

While both partners often agree that they have frequent battles for the mountaintop and it has become dysfunctional, they may quickly shift the battle for the mountaintop to a therapy battle for the therapist's blessing.  Essentially, the self-righteous wanting to be "right" or the "good guy" asserts a moral supremacy that must condemn the other person in or outside of the therapy session.  Only now, they want the therapist to judge who should stay on top of the mountain and who gets tossed onto the rocks below.  This is easy and tempting for the therapist to judge favorably when working with an individual client speaking of an unknown, unseen, and unexperienced other person not in the session.  In individual therapy without the other's presence, someone such as Carson or Vee makes it easy for the therapist to bless one's claim to the mountaintop.  Extending the mountaintop metaphor, the therapist can assert that there is space on top for two sets of feelings, or thoughts, or interpretations, or if that is impossible, the other partner's feelings, or thoughts, or interpretations can be held on another mountain.  What!?  Both Carson and Vee can stay on the mountaintop.  If he or she enjoys the adulation, the therapist may be susceptible to being held as King Therapist Solomon.  Sometimes, therapy starts with one person with or without the expressed intent to have the partner eventually join to create couple therapy.  For example, if Vee initiates therapy alone and then asks Carson to join in.  When therapy shifts from working with an individual to adding his or her partner, the therapist needs to be aware of a tendency to align with the first individual.  This can occur from the initial telephone conversation to schedule therapy.  Having possibly already heard the case against the partner, prejudice may be likely.  This becomes more than a clinical issue as it has ethical implications.  The California Association of Marriage and Family Therapists (CAMFT) Ethical Standards include 1.14 POTENTIAL CONFLICTS: (2008) "Marriage and family therapists carefully consider potential conflicts when providing concurrent or sequential individual, couple, family, and group treatment, and will take reasonable care to avoid or minimize such conflicts."  Couple or family therapy may be conducted with greater integrity if upon sensing partners or family members activating a competitive dynamic and recruitment, the therapist immediately expose that and therapeutically investigate its origins.

The therapist should also be aware of a default competitive dynamic whereby males in a heterosexual relationship might have a cultural advantage.  Operating from a stance of therapeutic neutrality, which assumes equality between the two partners, may reinforce inequity.  Carson may have dominant power in the relationship that prejudice any conflict between him and Vee in his favor.  Siegenhaler and Boss (1998) directly challenge the assertion of a need to maintain therapeutic neutrality.  Siegenhaler and Boss assert that therapist neutrality in certain cases is not recommended and may be dangerous.  "Feminist family therapy maintains the belief that individuals need to be held accountable for their abusive behaviors.  You allude that any alliance against the labeled member may leave that individual isolated and feeling betrayed.  The danger, you state, then of violations of neutrality is that some members feel blamed, leading to unproductive therapy.  Accountability and confrontation of the abuse are not a condemnation of a human being, rather it can be a condemnation of unacceptable and in some cases, unlawful behaviors.  The primary treatment focus then must be the changing of the abusive behaviors, since change is necessary.  Collusion and neutrality are not possible and in fact must be avoided at all costs.  As long as we maintain neutrality as beneficial to the therapy process the presence of power differentials are supported and we produce therapists who are dangerous to the individuals and families they treat.  When abuse is present the therapist must take the position that the behavior is unacceptable.  Neutrality is not a therapeutic option" (page 334-335)

Siegenhaler and Boss believe abuse occurs with disempowerment and socially constructed gender roles.  Therapy that does not directly address this gives permission for the behavior to persist.  Women are then kept down in a disadvantaged and disempowered status in relationships and in the larger world.  This harms relationships, couples, and families.  They further assert that remaining neutral is not possible.  They recommend that the therapist do personal work to become aware of any biases he or she may hold.  It may be ethical and therapeutic to let clients know of any biases or strong feelings that may be relevant to the couple's situation.  Feminist family therapy includes examination of the power and status of men and women and men within multiple contexts.  These include family-of-origin experiences, various cultural influences, faith, society, and vocational situations.  Gender is important to consider in most of not all therapy.  Siegenhaler and Boss recommend that the therapist maintain gender-flexible expectations.  That is, the therapist should be aware of potential gender issues but not assume them to be pertinent to all clients.  Both members of a couple need to be held accountable for their relationship and responsible for growth and change, while being sensitive to how females have by cultural training, restricted power which may qualify their capability to enact change.  Neutrality in couple therapy assumes the existence of equality between heterosexual partners that may validate a standard of male dominant to female inferior power.

The therapist needs to find effective roles to direct therapy and effective models of therapy for each individual, couple, or family. Individuals, couples, and families look to the therapist to make something happen between or among them or between self and another that will be different from what has been already happening.  The therapist may find that switching between the role of a moderator and that of a mediator useful for couples and families.  If Carson and Vee are able to communicate relatively effectively, the therapist may only need moderation or mediation as opposed to guidance, interpretation, direction, and psychoeducation.  The therapist may also be mediating between conflicting perspectives and personas for an individual client.  Sexton (2007) in "The therapist as a moderator and mediator in successful therapeutic change" says "…the therapist is like a moderator variable in the therapy equation.  Moderators have an independent influence on the outcome (short and long term) by adding something important to aid in accomplishing the desired outcomes.  The therapist brings certain characteristics, techniques and abilities that will have a positive or negative impact on the therapy being done.  These factors may be characteristics such as empathy, openness, respect (among others) that are hypothesized to contribute to positive outcomes.  Therapists can also be moderators in the specific characteristics or style they bring to therapy.  Directive styles may, for example, be a good addition to certain systemic family therapies (i.e. functional family therapy, multisystemic therapy).  Directiveness would be a therapist characteristic that adds to the effectiveness of a particular model and it may contribute to many different models…The therapist is also a mediator within the therapeutic process.  As a mediator, the contribution of the therapist to successful client outcomes is in the interaction between the therapist and client, the therapist and the goals and techniques of the type of therapy being delivered.  As a mediator, the goals of therapy are successful only because the therapist is or behaves in particular ways, with particular clients, in particular therapeutic situations, and within certain specific therapeutic processes.  Without the alignment of the goals of the therapy, the therapist and the client the useful mechanisms of change within the therapy go unrealized" (page 106).

There will be situations in therapy where the therapist moderate the process, keeping the individual, couple, or family on task and focused on relevant issues, and stopping clients from wandering off towards unfruitful areas.  When the process is essentially working or progressing, then moderating the therapy may be sufficient.  The therapist would be helping maintain the flow of the interactions, which remain productive as long as they do not get off track.  An animated, passionate, or confused individual can easily get off track in the emotionality of therapy.  With two intensely upset individuals such as Carson and Vee, either one, both, the therapist, and therapy can be diverted to fruitless if not destructive areas.  In individual therapy, key interactions to attend to may be between the therapist and the client, but also between aspects or personas within the individual.  However, most therapy often includes times when the process is stuck, toxic, or simply unproductive. The therapist need to step in and mediate problematic dynamics between partners, among family members, or between and among emotions, thoughts, perspectives, and other intrapsychic dynamics within an individual.  Therapeutic mediation may include stopping interactions, giving interpretations, asking questions, creating communication scenarios for clients, and other therapist-directed interventions.  What Carson and Vee already do or habitually do has been proven to be unsuccessful or unproductive and requires interruption- possibly mediation.  

The therapist needs to vigilantly hold a key role, but be ready to shift roles as needed.  Ordinarily, the therapist may avoid taking the position of a judge and attempt holding neutrality when moderating or mediating the partners or family members' interactions (or conflicting feelings or thoughts in an individual).  However the therapist can be co-opted into becoming the secret partner with one member of the couple or family (or favored persona).  This happens when a therapist repeatedly aligns with one individual (Carson or Vee) to re-enforce or support his or her needs and behavior against the partner (Vee or Carson) or other family member.  If the therapist is unaware of frequent alignment with one partner or family, the other person or persons can feel shut out.  Or, an important persona or feeling within an individual is shut out without due attention.  An individual may already have this anxiety or experience from prior relationships and be triggered by therapist's betrayal.  However, aligning purposefully and overtly with one individual (or persona, feeling, or thought) may be highly therapeutic when he or she (or it) does not otherwise feel support.  The therapist may judiciously choose to align with Carson at certain times, while aligning with Vee other times to facilitate therapy.  Clinical judgment and art is needed to guide this type of intervention and to do so interchangeably with one individual and then the other.  This is particularly beneficial when a client has trouble articulating his or her deeper feelings and the therapist simultaneously "translates" and confirms those feelings.  Since both partners often have similar problems articulating feelings, the therapist can go from one to the other aligning with each partners' fundamental needs.  Likewise for various family members.  Also, likewise for conflicting feelings, perspectives, or personas in the individual.  

The therapist can judge and label egregious behavior by any individual (Carson in some situations, and Vee in other situations) as inappropriate or ineffective, while still validating the emotional and psychological needs of each individual (or persona).  Another type of therapeutically appropriate partnership or alignment would be to partner with the relationship, couple, or family as the entity or unit against the negative behavior of any individual members or aspect of personality.  As the relationship's advocate, the therapist critiques and sanctions any individual's harmful behavior.  The therapist become somewhat like a referee.  The therapist/referee allows the individual, partners, or family members to interact freely except for stepping in when one or the other strikes "a low blow" or otherwise violate either implicit or explicit codes of relationship interactions.  The individual, couple, or family may request this type of therapist role.  The individual may ask to be called on and challenged when messing up, or the couple or family may seek the therapist interrupting their negative interactions as or before they get out of hand.  It would be up to the therapist as to how to balance such a request versus therapeutic assessment of the adequacy of that role for the dynamics of the individual, couple, or family.

ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
phone: (510) 614-5641
fax: (510) 889-6553
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