Introduction
For this reflective analysis, we will examine two different therapy theories and provide a general summary of each. After discussing the theories, we will look at the similarities and differences between the two. The next section will discuss the strengths and weaknesses of the theories in relation to couples therapy. Using the knowledge collected from these theories, we will then apply what we’ve learned to figure out which therapy theory would work best for the couple seeking therapeutic assistance. We will provide a case conceptualization to better identify what problems the couple is facing and consider the different kinds of factors that might be making these problems difficult to manage. We will then come up with assessment questions to ask the couple to gather more information that could be helpful when coming up with an adequate treatment plan. Finally, we will identify different interventions that the couple can practice to help resolve their issues.
Narrative Couple Therapy: Overview
Therapists who use narrative theory for couples therapy work to help people find new experiences in their lives by experiencing, telling, and circulating stories of as-yet-unstoried aspects of their lives and relationships. They say that couples don’t view their stories as stories, but instead as their “reality.” Narrative theory suggests that the client’s view of their “reality” is based on different social constructions in our society. These therapists are cautious of terminology used to label couples as functional or dysfunctional because it can support dominant norms of how a “healthy” couple should be. Narrative theory supports that the therapist discusses with each new couple what they view as problematic and what is preferred in their relationship. The therapy looks for problematic discourses between the couple and offers them the opportunity to describe and evaluate the effects of those discourses on their relationship.
The therapist will invite the couple to explore, describe, and experience new directions in life that are already unfolding, as well as ask about their relationship in ways unrelated to the problem. This helps the couple avoid viewing their relationship solely as a “problem” whenever they come to therapy. The therapist, through the lens of this theory, is viewed as decentered but influential. They will inform the client, with permission, of insider knowledge from other couples and ask them to evaluate the usefulness of the information in relation to their problems (Lebow & Snyder, 2022).
Solution Focused Couple Therapy: Overview
SFBT (Solution Focused Brief Therapy) therapists look at how the couple converses with each other and collaborate with the couple to construct new conversations about their relationship concerns. SFBT believes that the couple already has the competence, resilience, and inner resources to find solutions to their problems. The job of the SFBT therapist is to collaborate relationally and conversationally with couples so that they can build solutions toward their desired future.
Solution Focused Therapy also adopts a minimalist philosophy summarized by three rules:
- If it “ain’t broke, don’t fix it.”
- Once you know what works, do more of it.
- If it doesn’t work, don’t do it again. Do something different.
Using these three rules and the constructivist communication approach from MRI therapies, SFBT therapists use communication as a tool to focus on solutions to future problems. Instead of overinterpreting, conceptualizing, or formulating intervention strategies, SFBT therapists use a method called “listen-select-build” while working with clients. This process is used to co-construct issues that the partners want to work on and potential solutions in a collaborative manner.
SFBT therapists “listen” by being genuinely curious to hear from the couple, following carefully alongside their narrative, and using the partners’ exact words or frame of reference to solicit more input. They “select” by following up on certain narratives and moving forward with the therapeutic conversation. These therapists purposefully select certain narratives and use various techniques to ask more questions, listen more, and guide the couple to identify blocks of solutions to their issues, which forms the “build” step (Lebow & Snyder, 2022).
Similarities Between Both Theories
One similarity between Narrative therapy and Solution-Focused therapy is that both theories ask the couple what is problematic in their relationship and what is preferred in their relationship. Solution Focused therapists will help the couple reach a solution by listening to the couple carefully and asking them strategic questions. They will then select the responses they get to develop an idea of the couple’s preferred future and how to best achieve that future. Narrative therapists will listen to what is problematic and what is preferred in the relationship because they do not have partners in a couple to have essential, relatively fixed identities and understand that the problems and preferred future can be different for every couple that they encounter (Lebow & Snyder, 2022).
Another similarity between Narrative and Solution Focused therapy is that both theories look for different narratives in the couple’s relationship. SFBT will listen to the couple’s different narratives for what the couple would like to work on and then build goals off of those narratives. Narrative therapy will also listen to the different narratives of the clients both individually and in the perspective of their relationship as well and help the couples use those narratives to build their life story and how they would want to work to build a new story (Lebow & Snyder, 2022).
A third similarity between the theories is that they both work collaboratively with the couple in order to reach the couple’s desired goal. SFBT therapists will be open-minded and flexible in using new ideas and are also excellent listeners, especially when listening for couples’ previous solutions to the problem. They are also very tenacious and patient. These are all great qualities to help work collaboratively with the couple in order to achieve the goal they want. They also view “resistance” in a session with a couple as a moment to realize that they are not quite in tune with the couples’ goals and will need to reevaluate in order to get on the right track as the couple. Meanwhile Narrative therapists recognize that the assumptions and biases that they might have can affect how they approach assessment and treatment with a couple. They will try their best to build a context where everyone present feels free to talk about their issues and will encourage couples to ask questions about the questions that the therapist will ask. This way the clients will feel comfortable evaluating the therapist’s bias and how to relate to it (Lebow &
Snyder, 2022).
Differences Between Both Theories
One difference between the two theories is how they view the therapeutic process when working with a new couple. Narrative couples therapy views that the time span and number of sessions is determined by each couple. They point out that some couples come into therapy where their issues might only require a few meetings while others will spend years in therapy developing rich and detailed stories of their lives together with meetings paced at wide intervals and how most couples are somewhere in between. Meanwhile with SFBT, they view this process as the same with whoever may attend the sessions. Typically, SFBT takes about 5 sessions to observe progress and a course of therapy may last 1 to 10 sessions, to which afterwards couples can return on an as needed or intermittent basis (Lebow & Snyder, 2022).
A second difference between the two theories is that solution focused will not spend a lot of time going over the details of the problem that the couple is facing while narrative theory will spend more time discussing the problem as well as ask the couple how their culture might affect how they view the problem. The role of the therapist for SFBT is to pay limited, if any attention to the problem-saturated narratives that the couple have been dealing with and opt instead to ask more questions, listen to the couple and select responses from them to highlight and facilitate the couple’s preferred future. Meanwhile the role of the Narrative therapist is to focus on the different narratives and stories that the couples experience both on their own and together as well. These therapists want to hear about how the problems the couple names affects their lives and relationships. The therapist will then ask more questions about the problem including, how ideas in their cultures might support it, the effects the problem has on their lives and on their relationship and to consider the stand that they want to take in relation to it (Lebow & Snyder, 2022).
A third difference between the two theories has to do with goal setting. SFBT therapists don’t spend time exploring the problems the couple is experiencing in detail and instead try to direct the couple towards constructing a goal of what the couple would like to change. They will try to achieve this by asking the couple specific questions that make the goal behaviorally specific, and to help each partner understand the requests. Narrative therapy on the other hand views goal setting as closing possible avenues that the couples’ story can take. Since these therapists’ general purpose is having the couple live moment to moment to make their worlds more satisfying, they use “projects” or “directions in life.” They think about the possibilities that unfold during a story and avoid goal setting because they are planned in advance and are pursued single-mindedly (Lebow & Snyder, 2022).
Analysis of Theories
A strength of narrative couples therapy is that the approach has general applicability. Even though that couples problems, time spent in therapy, how intense the sessions are and outcomes can vary from couple to couple, and vary from context to context, this theory can prove to be effective to couples seeking premarital counseling, to couples with mental illness issues, to couples who are struggling to reclaim their relationship from violence and abuse. A strength of SFBT is that it is evidence based. The amount of research that is supporting the use of Solution-Focused therapy has been rapidly increasing over the past decade. After qualitatively reviewing the controlled outcome of studies of SFBT, it was discovered that there is strong support for SFBT for internalizing disorders, with comparable treatment effect when compared with other well-established psychotherapies. Additional systematic reviews and meta-analysis have supported SFBT efficacy for Latino populations, Chinese populations, work with children and families and clients with comorbid medical conditions. A weakness of SFBT is that they have a lack of studies in specifically evaluating couple therapy or a focus on specific outcomes related to the presenting problems of couples. While evaluating the meta-analysis of the studies, it was noted that only a handful of studies addressed interpersonal and family relationship outcomes (Lebow & Snyder, 2022).
Theory Selection and Case Conceptualization
The presenting problem with Maria and Marissa is that Marissa has been getting more anxious about the possibility of losing Maria and having to raise their kids on her own, while Maria is losing patience with Marissa in reassuring her that she is not going to get hurt or is going to leave them. The precipitating factor of their visit is that Marissa has been having nightmares about Maria getting hurt and it has been affecting her ability to sleep on a regular basis and these thoughts of her almost getting killed in combat haven’t been going away. The perpetuating factor of their issue is that Marissa has not taken the time to work through her trauma from being in the military like Maria has and it has started to affect their relationship and their family. A predisposing factor is that Marissa seems to be suffering through some psychological trauma from her time spent serving in the military. Some protective factors is that Marissa knows that her behavior is a problem and is willing to get the help she needs.
Another factor is that Maria is in full support of Marissa getting the help she needs and still clearly loves and cares for her. The theory chosen to help Maria and Marissa is the Narrative Therapy theory and this was for a couple reasons. The first reason is that the therapists that utilize this theory are aware that what someone views as a “healthy” relationship is heavily influenced by that person’s culture. It is very likely that the therapist working with this couple will not have the same background as them (being from Mexican American descent, having served in the military, being a part of a same sex couple as well as being parents to adopted kids) and will consider these factors when helping the couple think about their preferred future in their story. The second reason that this theory was chosen is that the therapist using this theory is constantly asking for feedback from the couple with what is working for them and what isn’t working for them. The therapist will encourage the couple to ask questions about the therapist’s questions to avoid making any misinterpretations or assumptions about what the couple may want from treatment.
This not only helps the therapist better understand the couple’s needs and wants, but will also help the couple feel more comfortable knowing that the therapist is working with them and not simply as an expert (Lebow & Snyder, 2022).
Assessment Questions
One question that the therapist should ask the client during a session would be “What effect does the problem have on other relationships? Either with your kids or with others?” In order to fully understand the couple’s story, it would be appropriate to ask about how their current problem is affecting not only their relationship, but the relationships of their kids and others as well. It’s important for the therapist to know how much value they put into their other relationships and how that can affect how they view their story A second question a therapist would ask would be “How does the problem alter your relationship with yourself?” For Marissa this would be good to ask to see how she currently views herself in her story and to eliminate any assumptions made about how she feels about the problem. Another question the therapist would ask would be “What is it like to experience the problem?” This question is beneficial to ask so the couple can identify how they feel about the problem and potentially discover new feelings from themselves or of their partner about the problem. This information is beneficial when establishing the couples’ preferred future and continuing their story.
Another question to ask during the assessment would be “Are we talking about what you want to talk about?” The therapist may know the presenting problem, but there might be other problems that the couple haven’t brought up for one reason or another. It’s crucial to keep in mind that the therapist maintains a safe space for the clients to feel comfortable enough to openly discuss any other potential issues to consider when coming up with a treatment plan. An additional question for the therapist to ask would be “Is this conversation useful?” The therapist would ask this question because it is important to be constantly evaluating what works for the couple and what doesn’t work for the couple. There would be no point to go in a certain direction with assessment in a conversation with the client only for it to not really be useful to them or think it won’t help them with their current problem (Lebow & Snyder, 2022).
Interventions
One intervention that the therapist would recommend the couple participating in is asking the client to name the problem to separate the problem from the client themselves. Externalizing the problem is beneficial to the client because it has a powerful deconstructive effect that will bias the client to interact with it differently than they would if they saw the person with the problem as intrinsically problematic. It will also help the couple work together against the problem as opposed to viewing it as working against each other (Lebow & Snyder, 2022).
A second intervention that the therapist would recommend the couple participate in is to have the clients identify what type of relationship that they would prefer to have with the problem and to specify how this would look and what the client would be doing differently. Doing this will also help the client externalize the problem. In addition to this, it will allow the clients to tell the therapist what they want their preferred future to look like and will paint a clearer picture on how the clients view their story and what they want from it (Gehart & Tuttle, 2003).
A third intervention the therapist should recommend the clients participate in is to have the clients identify the effects of sociopolitical issues or beliefs that may have strengthened the problem-saturated narrative. The couple has said that they have been dealing with this problem for quite some time and it would be important to identify any reasons that the couple may have avoided receiving help up to this point and if their values or beliefs have contributed to this at all.
These values and beliefs are also important to know when they can be shaping how the couple may view the problem and how the therapist can help the couple look at the problem from other perspectives (Gehart & Tuttle, 2003).
Conclusion
In this reflective therapeutic analysis we have discussed a general overview of Narrative Couples Therapy and Solution-Focused Couples Therapy. We identified similarities and differences between the theories as well as gone over potential strengths and weaknesses of both.
After providing a case conceptualization of Maria and Marissa’s problem that they have been dealing with, a theory was chosen that would benefit the couple the best. Using the Narrative theory, we provided appropriate assessment questions to ask the couple as well as list why it would benefit the therapist to ask these questions. Finally, after using all the information gathered, we discussed three different interventions that the couple can utilize in order to work on their problem together.
References
Gehart D. R. & Tuttle A. R. (2003). Theory-based treatment planning for marriage and family therapists : integrating theory and practice. Brooks/Cole/Thomson.
Lebow, J. L., & Snyder, D. K. (2022). Clinical Handbook of Couple Therapy. Guilford Publications.
Kaleigh Elwell