Case Conceptualization
The presenting problem of Richard and Tammy is that they are contemplating divorce, even though they don’t want to consider it because they have not been getting along for several years and originally stayed together for their children. The precipitating factors are that now that their children have grown up and left the house, they don’t see the point in being together anymore because they don’t interact with each other, and when they do, it’s either to talk about the children or it ends up in an argument.
The perpetuating factors are that Tammy is experiencing some borderline issues. She seems to have some unrealistic expectations from her relationship with Richard as it stands (for example, when she blames herself for Richard not being able to get an erection or when she is berating Richard while also wanting an interaction with him). When she doesn’t get what she wants, she experiences an abandonment crisis and rejects Richard altogether. They are also experiencing some signs of splitting; they both now only see the negative side of being together. When they manage to keep the peace (not arguing while talking about the kids), they avoid discussing their problems for fear it might disturb that peace.
A predisposing factor is that their religious perspective is affecting how they view divorce—they don’t want to divorce each other, yet they feel they have no other options. Some protective factors are that Richard and Tammy clearly still care about each other. Tammy desires better interactions with Richard but struggles with how to approach them. Richard, despite saying he no longer wants the relationship, tries to reassure Tammy that his erectile dysfunction is due to stress, not a lack of attraction.
Interventions
One of the interventions I would recommend to Richard and Tammy is incorporating countertransference. With the therapist observing how the couple behaves toward them and each other, the therapist can ask relevant questions about their interactions. This approach helps the couple establish rapport with the therapist and may initiate self-reflection on how they interact with each other and with others.
The second intervention I would recommend is exploring underlying beliefs. When the couple shares an example of an argument, the therapist can ask why they feel the way they do during the argument. The therapist then guides them to reflect on past relationships and family beliefs, helping them understand how these experiences might shape their expectations and reactions in their current relationship. This allows them to gain insight into each other’s behaviors (for example, Richard’s tendency to disengage and Tammy’s confrontational style) and understand themselves better.
A third intervention for the couple is accessing memories. Memories provide meaning and allow individuals to interpret and respond efficiently. By asking the couple to recall a memory that reflects the theme or emotion under discussion, they can explore how they might be repeating observed behaviors or find ways to alter their behavior based on past experiences.