5. Techniques - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Out of the Monkey Trap, Breaking Negative Cycles for Relationships and Therapy
Chapter 5: TECHNIQUES
by Ronald Mah





Many therapeutic techniques or strategies can serve to interrupt the pattern of dysfunction in an individual, a relationship within a couple or family.  Straight-forward instruction, also called straight directives inform, encourage, or order the individual, partners, or family members to interact in a new fashion.  Direction may be for the individuals to take behaviors or communication directly from the therapy room into their interactions at home.  Sometimes, the therapist may become very active in directing activity in the session.  For example, "Psychodramatic sculpture is a technique by which the individual molds the partner into a shape and expression and then includes the sculptor.  It is especially effective with couples because it breaks the couples' expectations of therapy as problem- and content-oriented by asking for active, creative participation.  The therapist remains in charge, taking an authoritative role, not as expert advisor but as the director of the sculpture.  Directions that discourage talking provide clues to the couples' intimacy that are seldom obvious in talk therapy (Leveton, 2000)" (Leveton, 2005, page 57).

Leveton (page 59-60) described a psychodramatic technique called doubling.  Unvoiced communication is brought to the surface.  Leveton speaks in the first person using "I" to prompt one partner in speaking to the other.  The doubled partner can hear the therapist but not the other partner.  The partner repeats exactly what the therapist double says. The client who has trouble with repeating the communication or disputes the ideas prompted may have an internal conflict.  No response or a neutral, disinterested response may indicate that the therapist double is not in tune with the partner.  The intuition and insight of the therapist is critical to helping the partner voice inner thoughts or feelings otherwise hidden or withheld.  For example, the therapist becomes aware that Carlos has resorted to blaming and being defensive again.  Seeking to interrupt the pattern, the therapist moves and sits next to Carlos.  The therapist tells Carlos, "I'm going to say out loud some things that you, may be feeling or thinking but holding back. If what I say feels right, then say it out loud to Ingrid.  You understand?"  Carlos agrees. The therapist as Carlos' double says, "When you blame me, I feel like you don't care about my feelings.  I want to know that you care."

An individual may have difficulty being comfortable with his or her emotional processes.  A common technique to avoid the intensity and vulnerability of feelings utilizes intellectual processes.  The individual rather than allowing his or her feelings to potentially overwhelm him or her, keeps everything on a supposedly logical or rational plane.  Instead of empathizing with or acknowledging another person's or the partner's feelings, the pseudo-logical individual analyzes the other's words or actions.  As the individual determines and asserts the other's expression as not rational, he or she adroitly avoids both acknowledging the others and his or her own feelings.  This common division of psychological chores- of feelings and thought is destructive under the stress and demands of an intimate relationship.  The therapist can use doubling depending on therapeutic and the rapport and relationship established with the clients.  A skillful therapist can be more assertive using a technique such as doubling.  "The therapist's self-knowledge, confidence, and sensitivity to the couple's responses are what determines this therapist's timing and particular choices of action techniques.  Another therapist or the same therapist with another couple may not have chosen to risk being perceived as intrusive or presumptive (Leveton, 2000) and would have introduced such work by asking permission in a more formal way (Fisher, 2002)" (Leveton, 2005, page 59-60).  The spontaneous interactions between the two people would cause them to continue going into their pathological routines.  The therapist actively intervening through doubling or making a sculpture of their relationship interrupts the stuck routines of negativity.  

Another intervention that can interrupt the process is to externalize the problem.  It can help the individual, the partners, or family members:

"embody the problem they see before them- i.e. give it human characteristics, such as a shape, a colour and, crucially, a will of its own;

locate it outside the self- somewhere 'out there', and then;

plan a strategy for counteracting the ways in which the problem tries to make the client miserable" (Campbell, 1999, page 80).

The problem or important issue may be termed for example, "the Ugliness."  Ugliness intrudes when the individuals shift from casual conversation, discourse, information sharing, disagreement, and animated impassioned conflict without hateful and hurtful communication.  The therapist can ask the involved participants how Ugliness sneaks into the conversation, what the early signs may be, and how it pushes into their relationship.

Carlos said that Ugliness is like a sneaky little mole on his skin.  He said it starts to itch slightly and without even thinking about it, he starts to scratch it.  It starts to spread and be more noticeable.  Even though, he knows it's happening and getting more intense he tries to ignore it.  Next thing, Ingrid reaches over and scratches it.  Carlos said that he tries to turn it away from her but she does not seem to notice and rubs against the sore spot.  Ingrid sees Ugliness as an evil gremlin that crawls up from the back of her neck.  She starts to feel it clinging onto her back- her shoulder blades.  It gets bigger and begins to point out Carlos' bad behavior- "There he is pulling away," says Ugliness.  Pretty soon Ugliness makes her see only ugly things and say ugly things.  The therapist had the partners continue describing Ugliness and how it gets into their interactions.  In subsequent sessions, when the partners started to argue or get animated, first the therapist and eventually, either partner would invoke the metaphor.  "Your mole starting to itch, Carlos?" "How's the gremlin doing, Ingrid?"  Or "Did Ugliness just show up?"

By externalizing the problem or issue, individuals undo the identification of the other person as the problem.  They can ally with one another against their mutual enemy.  Anticipating how the problem arises, intensifies, and takes over allows individuals together to plan countermeasures for healthier relationship functioning.  Each person can empower the other person to give warnings of the problem's emergence.  "I think you're itching your ugly mole."  "Is your ugly gremlin starting to act up?"  As antagonists, individuals would likely interpret this feedback or questions as accusatory.   However, as collaborators and allies against the scourge of their intimacy, they become more able to work through being defensive and step up and join up together.

continue to Chapter 6
ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
(510) 614-5641 or (510) 582-5788
fax: (510) 889-6553
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