Vignette: During the first session, you are introduced to a heterosexual couple, Susan and Tom. Tom is 36 years old and works as a real estate agent, while Susan is 34 years old and works at a marketing firm. They have three kids, ages 10, 7, and 3. After gathering information regarding payment, the couple’s history, and assessment, they start to delve into what brings them into treatment.
Tom explains that Susan recently got promoted at her job, which has led to her spending more time at work and less time at home. In the past, Susan has done most of the domestic work and taken care of the kids, but since her promotion, Tom has had to do more of the housework, and he’s gotten tired of it. He says that she isn’t considerate of the work he has to do and accuses Susan of wanting to spend more time with her male coworker. He says that he has tried to talk to her about spending more time with him and the kids at home, but they always end up arguing. Tom turns to Susan and says, “The kids and I barely see you anymore! You didn’t need this promotion anyway; we were making a fine amount of money before.”
Susan, looking exasperated, replies that he’s just upset because now he actually has to do some work around the house beyond taking out the garbage and mowing the lawn. Susan says that he’s never been good about helping with housework, but now that she has to work more, he’s complaining about doing a few extra tasks before she gets home. She turns to Tom and says, “You’re just upset because now I’m making more money than you! My coworkers have nothing to do with this!”
Theory Chosen: The theory I have chosen is Emotionally Focused Therapy. This approach will benefit the couple by helping them deescalate negative interaction patterns and the reactive emotions associated with them, replacing these patterns with more positive emotional reactions and lasting bonds.
Presenting Problem: Tom is upset that Susan isn’t spending much time with the family and that his workload around the house has increased. He also feels insecure about no longer being the primary breadwinner. Susan is tired of doing housework and isn’t taking Tom’s request to spend more time with the family seriously.
Assessment:
- Predisposed factors: Tom feels insecure about not being the primary breadwinner; Susan hasn’t spent as much time with her family.
- Precipitants: Tom feels rejected because Susan spends more time at her job than with him and the family.
- Perpetuating factors: Susan dismisses Tom every time he brings up spending more time with family, thinking he’s overreacting, which makes her more distant.
- Protective factors: Tom still cares about wanting more time with Susan and family together. Susan cares about providing for the family.
Initial Phase Client Goals
- Goal: For both partners to gain a meta-perspective on their interactions.
- Intervention: Cycle DeescalationGuiding Tom and Susan through one of their arguments, the therapist will help the couple identify the negative interaction cycle where these issues are expressed. The therapist will then help them access the underlying, attachment-oriented emotions each partner experiences. With this new perspective, the therapist will help reframe the argument, focusing on the cycle, underlying emotions, and attachment vulnerabilities. For example, the therapist could ask Tom why he thinks Susan prefers spending time with her coworker over her family and ask Susan why she dismisses Tom’s desire for more family time.This intervention will help them realize that the way they’ve been communicating has worsened the situation. They need help understanding each other’s needs behind the words they say.
Working Phase Client Goals
- Goal: For withdrawn partners to reengage in the relationship and openly express the terms of reengagement.
- Intervention: Changing Interactional PositionsThe therapist will help the couple identify disowned attachment needs and aspects of themselves, encouraging each partner to accept the other’s experiences. After this, the therapist will instruct the couple on restructuring their interactions to facilitate expressing their needs. For example, Tom identifying his need for time with Susan, and Susan validating his feelings and actively listening.This intervention will help each partner better understand their partner’s needs and wants and communicate more effectively.
Termination Client Goals
- Goal: Consolidate new responses and cycles of interaction.
- Intervention: Consolidation and IntegrationThe therapist will help the couple develop solutions to old problems, consolidating new patterns of attachment behavior. For instance, the couple, with the therapist’s guidance, can work together to address Tom’s dissatisfaction with household chores.Using skills built from previous interventions, the therapist can guide the couple in integrating new ways of resolving conflicts.