2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43
The topic I want to touch briefly on here is the practical aspects of starting couples therapy. I will outline some of the questions that I ask myself during the initial consultation with each married couple.
When a couple comes to my office for their first consultation, I usually ask them, "How can I help you?" I note how they sit down, who speaks first, who is in control. I watch my reactions to each of them and to both of them like a conjugal dyad.
My first challenge is to listen carefully, looking for a way to form an alliance with each of them and with the couple as a marital system. I want to create a potential space in which each of them will be safe, because the appearance in the therapist's office is an experience of vulnerability.
I wonder at what stage in their development is each partner and their paired relationship? I also strive to find out when, in the course of the evolution of their marriage, those situational or developmental conflicts arose that began to threaten the very foundations of their relationship.
It is always important to be interested in the history of acquaintance, courtship and marriage. The history of courtship is critical information, it shows what attracted them to each other, brought them together, how well they functioned in the beginning. In addition, the memories of the beginning of the relationship are a reminder to the couple of how they fell in love with each other, of the potential for empathy and caring for each other, which they initially had, but are now lost due to the difficulties that have arisen.
What is the family history of each spouse and the personal history of their development in the family? Collecting data on the parental family of each partner, I try to understand what are the unconscious assumptions and fantasies shared by a pair of desires and fears, what are their transferences to each other. I want to know about their children, and if there are no children, then I want to know about that as well. I try to look at the family from a broad perspective that includes grandparents and sometimes even great-grandparents. Which figures from their extended family have played an important role in their development, for example, in whose honor they were named?
Hearing their stories about their family stories, I will correlate this information with the conflicts between them that led them to seek help. This is necessary in order to identify those "lost affects" that led to splits both within each of them and between them. Usually, these splits take the form of compulsive repetitions that destroy relationships.
I also want to grasp, tune in to those unconscious forces that operate within each of them and between them. During the initial consultation, I try to pay attention to the protections of each individual and their general protections. At some point, when I feel that it is appropriate and safe, I make a comment or interpretation to test the hypothesis that I have, and also to test the couple's ability to withstand the interpretation.
To help the couple integrate their intrapsychic and interpersonal conflicts, it is necessary to rely on the working model of the couple as a patient, which we begin to formulate at the beginning of treatment. There are a number of questions that I think about during the sessions, and which I invite you to think about.
Who spoke first, who seems more vulnerable?
Which of the two made the decision to see a couples therapist? Why did the other partner come too?
Which partner is complaining?
Who is active and who is passive? Does the locus of control shift from one partner to another during the interview?
What is the main complaint of each partner and what do they want from the therapy experience?
What are they still hoping for?
What brought these people together when their relationship was just beginning?
What feelings did they have for each other at the beginning of their relationship? To what extent do these feelings persist to this day?
Does it feel like they're in tune with each other?
To what extent was the couple able to survive the loss of illusion when the idealization of each other was gone? How did this affect their relationship?
Do each of them feel that they deserve love?
Did the couple manage to form a sense of "we"?
Does it feel like their romance is still going on? If not, when do they feel it broke off?
What is each partner's ability for intimacy and empathy, and what blocks this ability?
Have they been able to separate from their parental families? If not, how severe is this problem for each of them?
Were they able to help each other in separation from their parents? What reasons might one of the partners have for not supporting the separation of the other?
How does each partner experience their identity?
With whom in their parental families did they identify? Is there a counter-identification with one of the parents?
Do they idealize each other, parents or other influential figures in some way?
Have they been able to handle anger and hatred?
How capable is a couple of resolving conflicts? How capable a couple is to learn this?
To what extent have the couple managed to achieve a satisfying sexual relationship?
What conflicts are expressed in sex?
To what extent is love in this marital system capable of containing hatred?
Is there a sexual identity problem in any of the partners?
If the family has children, how do spouses cope with caring for them and raising them? What is their potential for collaboration in parenting?
What are their individual loss stories? Do they have a common history of losses?
What is being re-enacted in their relationship, and how does this relate to the families of origin of each spouse?
Can you trace the transferences from one spouse to another in their development?
What do you see as their strengths and weaknesses?
What are their "lost" affects that were too painful during their development?
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