Clinical Application of the Couple Adaptation to Traumatic Stress (CATS) Model: A Pragmatic Framework for Working With Traumatized Couples

ABSTRACT

The authors attempt to apply knowledge of traumatization to clinical practice with couple dyads. Elaborating on the Couple Adaptation to Traumatic Stress (CATS) Model (Nelson Goff & Smith, 2005), the authors have worked to bridge the gap between a general understanding of trauma's impact on the couple relationship and couples' treatment. This article facilitates the application of the CATS Model to clinical work with couples impacted by trauma. Incorporating Herman's (1997) traumatic process with the original CATS Model, the authors created a more specific, clinically useful framework for clinicians. The goal of the current article is to provide clinicians with a pragmatic illustration articulating a clinical framework for understanding and treating posttraumaumitc symptoms and processes within the couple relationship. The main implication is that clinicians will be able to conduct effectively guided systemic therapy with distressed couples necessary to generate progress in the treatment of symptomatology and couple functioning of trauma survivors and their partners.     

Basic Considerations in the Application of Therapy and Education to Parent Groups

This article presents a couples group therapy treatment approach that uses analytic object relations concepts such as transference/countertransference, projective identification, containment, and the holding environment. Object relations theory is seen as the most useful theory with which to view couple interaction because it is based on a two-person psychology and focuses on the impact of relational systems on the development of the person. This includes the idea that the person grows within the attachment to another person. Group therapy is seen as a more effective treatment approach because the group is a resilient holding environment that provides an avenue in which projective identifications can be understood and contained, power can be redefined, isolation of the couple can be decreased, and the couple's responses can become more versatile. The model described is illustrated with clinical vignettes from an open-ended couples group.     

Description and First Steps Toward the Empirical Validation of the Plan Formulation Method for Couples

The aim of this paper is to empirically assess the reliability of the plan formulation method for couples, a procedure for formulating the case, planning, and monitoring the couple therapies according to control-mastery theory. We hypothesized that when couples are looking for couple therapy, they have an unconscious couple’s plan for the therapy, which includes the couple’s goals; the pathogenic beliefs that the partners want to disprove; the traumas from which these beliefs originated and that the partners want to master; the vicious relational circles that make the couple suffer and that the couple wants to break; the virtuous relational circles that are expressions of the couple’s resources and that the couple wants to fuel; and the relational insights that may help the couple get better. Our study involved 15 couples treated by four experienced therapists. Four raters independently formulated each couple’s plan based on the first three sessions following a standard procedure, and we calculated the intraclass correlation for pooled judges’ ratings. For a subsample of three couples—who before and after treatment had completed the dyadic adjustment scale (DAS) and the outcome questionnaire-45.2 (OQ-45.2)—the compatibility of the therapists’ interventions with the couples’ and partners’ plans was assessed. The relationship between the ratings of compatibility, DAS and OQ-45.2, was assessed. The results showed excellent interjudge reliability for each couple’s plan formulation (average ICC?=?0.82), attesting to the validity of the procedure; and preliminary data on the therapeutic process suggested that therapists’ interventions compatible with couple’s plans could help partners achieve good outcomes.

     

Couples Therapy with Childhood Sexual Abuse Survivors (CSA) and their Partners: Establishing a Context for Witnessing

This article proposes a clinical practice for therapy with couples in which one partner suffered sexual abuse in childhood. Such couples often encounter unique difficulties with physical contact, intimacy, sexuality, communication, and trust, and their relationship dynamic may be marked by reenactments of past traumatic relational patterns. This clinical practice is founded on the assumption that establishing the witnessing lacking during the traumatic event in childhood can break the traumatic reenactments in adulthood, and spur recovery. The suggested practice may facilitate twofold witnessing: the couple's therapist witnesses the reenactments of the trauma in the couple's relationship; and the survivor's partner witnesses the trauma's effect on the survivor's personal life and relationship. Twofold witnessing can help break the cycle of traumatic reenactment and help the survivor integrate the events of her life into a more coherent, continuous narrative. The partner's presence also facilitates acknowledgement of what happened to the survivor, and helps the survivor elaborate on her stories of resistance, survival, and strength. Finally, each of the partners is able to appear more wholly and fully, and together to tell the preferred stories of their life as a couple, replete with the multiple relational patterns they wish to live, which may contradict the characteristics of the original trauma.     

Reshaping Couple Configurations that Get in the Way of Relationship Repair and Healing

In the context of relationship trauma, partners' reactive patterns of engagement can disrupt and derail attempts at relationship correction and healing. A circumplex typology of couple patterns of engagement in relational trauma context is defined in terms of partners' underlying views of self in relation to other (VSIRO). VSIRO is conceptualized along a continuum anchored at opposite poles by inflated (self-aggrandizing) versus collapsed (self-abnegating) VSIRO, with a balanced (egalitarian) VSIRO, characterized by accountability and forbearance, as the target position. The circumplex model delineates four problematic couple configurations—a dejected couple, a taker–enabler couple, an ultimate fighting couple, and a debtor–collector couple. Where problematic engagement occurs, therapists need to reshape couple engagement toward the balanced, egalitarian position prior to relational trauma work. Clinical vignettes depict these couples and springboard an analysis of unique needs and interventions associated with each couple configuration. Reshaping couple patterns of engagement using a circumplex model of couple configurations is an essential prerequisite to effective and ethical relational trauma work.     

The Tao of Creating Sacred Relationships

SUMMARY

This article articulates the major premises of Sheldon Z. Kramer's book, Transforming the Inner and Outer Family: Humanistic and Spiritual Approaches to the Mind-Body Systems Therapy(The Haworth Press, Inc., 1995). This overview briefly introduces and explains the power of meditation in psychotherapy, meditation and the use of the body, creating congruent communication, working with incongruence in couples and bridging the inner and outer couple.     

Increasing Couple Intimacy Using Virginia Satir's Temperature Reading

SUMMARY

This article describes the process of using Virginia Satir's Temperature Reading, a communication tool, to increase intimacy with couples. It presents a rationale and theory for using a daiiy couple Temperature Reading to develop communication skills for learning how to share intimately in relationships. Temperature Reading provides a safe environment where each member of the couple can learn to share personal information and can practice listening to the other in a supportive and cooperative manner. Therapists and couples alike can utilize this process as described here.     

Deconstructing the “Covered Bridge” - Couples Therapy with Sexual Abuse Survivors and Their Partners

SUMMARY

In accepting the editor's invitation to submit an article for this volume, I have taken the subject matter, Building Bridges, quite literally: that is, to talk about bridges as a rather compelling metaphor for couple relationships. I have chosen to focus on the covered bridge, in particular, as it informs me most graphically of the structure and therapeutic challenge presented by couples in which one partner is a child sexual abuse survivor. In my clinical work with such couples, I invariably find myself in the role of surveyor/engi-neer/builder, deconstructing the “covered bridge” and engaged in building a stronger, more open and enduring structure. The steps toward rebuilding and transforming the “covered bridge” structure for these couples are outlined and illustrated.     

Time and Rhythm in Couples

In this article, a theory is offered on the role of time in couple functioning and distress. The theory argues that no single set of temporal patterns is associated with couple distress or satisfaction. Rather, it advocates attention to the individual differences between couples in their understanding of the meaning of the temporal patterns in their relationship. The couple's narrative about the evolution and maintenance of these temporal patterns can be understood as revealing much about partners' experiences of the relationship in terms of the concepts of closeness and power. Interventions on the temporal dimension may be useful when the couple presents with an explicit problem in temporal patterns; when a particular temporal pattern prevents the couple from addressing other issues; and when the therapist wishes to reframe a problem in a manner that lowers conflict intensity. Along with the theory, a preliminary taxonomy of time problems in couples is presented as a guide to assessment. This is followed by clinical vignettes to illustrate how the theory can be used in couple therapy.     

Strengthening Couples from a Single-Parent Household Using Relational Cultural Therapy

ABSTRACT

Individuals initially learn about intimate relationships from observing others, such as their parents or caregivers’ relationship, which may positively or negatively affect their own romantic relationship. This article focuses on the application of Relational-Cultural Therapy (RCT) concepts to establish resilience among couples with at least one partner from a single-parent household. Some individuals from single-parent households may not have witnessed romantic relationships to confidently engage in adult romantic relationships. Additionally, clinicians may not consider family background as a source of contention for a couple’s presenting concerns. Thus, this article provides creative interventions and implications to assist counselors in working with couples.     

Therapeutic handling of marital infidelity

Abstract

In working with couples and families, the occasional clinical use of mental imagery techniques can frequently promote therapeutic breakthroughs. When sessions focused on a couple's (family's) current communication problems reach a point where progress seems slow and laborious, a therapist can encourage the couple (parents and perhaps even older children) to try one or more imagery sessions to understand their interactional patterns within the context of their own developmental periods. This article describes how imagery can lead couples to new and more constructive perspectives on the meaning of their interactions.     

Where the Whole Thing Fell Apart

Abstract

This article examines the intersection of societal prejudice and psychological trauma. In an instrumental case study created through a layered narrative analysis, the author highlights the potentially traumatic effects of racism and discrimination, while also exploring the phenomenon of resilience in a complex ecological system. The findings suggest that the enduring and continual strain of racial prejudice may cause significant psychological distress, particularly when those experiences reinforce early negative experiences within a family; and that assessments of resilience need to consider the contribution of ecological context to psychological outcomes as well as to an individual's ability to mobilize personal resources when such a context finally shifts.     

The Prize:

The Prize: Disability, Parenthood, and Adoption details the concerns and experiences of the author and her husband, an inter-racial couple with disabilities, during the process that culminated in the adoption of their daughter. The author discusses the reactions of others-relatives, social workers, doctors, lawyers, friends, and her husband-to her desire to have a child, and reveals her own considerations and fears. She also documents the couple's experiences, good and bad, with fertility doctors, support groups, adoption agencies, and private adoption lawyers. The article should be of special interest to those involved or interested in the adoption process, particularly as it applies to disabled and/or interracial couples.     

A psychodynamic perspective on early childhood trauma in an adult: A case study

Abstract

This paper uses a long-term case to illustrate, from a psychodynamic perspective, a number of issues arising in working with an adult survivor of early childhood trauma. The paper takes an overview of the case study, identifying issues which are inextricably interwoven in the client's experience of trauma, and which impact on the working alliance. The therapeutic relationship forged with the client is discussed in terms of its intrinsic successes and failures together with the implications of early traumatic experiences for the termination of counselling.     

Existential psychotherapy with fast-track,suburban couples

In this article, the authors describe the existential situation of the fast-track suburban couple and a treatment approach based upon the philosophical concepts of Gabriel Marcel and Viktor Frankl. In this treatment approach, the therapist uses availability, primary reflection and secondary reflection treatment experiences to host the client couple's discovery and actualization of the meaning potential in their intimate life.     

Spontaneous Moments and the Domain of Non-Verbal Communication

Abstract

This paper investigates the impact of non-verbal interactions and spontaneous encounters on the therapeutic process and on a client's structural and behavioral patterns. The following case vignette concerns a client who presents with a pattern of non-verbal relational schemas based on his early traumatic experiences. The non-verbal and verbal role reenactments that unfold between client and therapist will be examined from an intersubjective, dialogical and self psychological perspective. Finally, the paper will explore how important therapeutic shifts may occur by attending to and working through these non-verbal aspects of the treatment, leading to new relational structures.     

From Application to Approach: A Systematic Review of 50 Years of Psychoanalytic Couple Therapy

ABSTRACT

This systematic review of contributions to peer-reviewed journals in the area of couple interventions aims to provide a comprehensive and intensive overview of this evolving field, within psychoanalysis. Using a pan theoretical systematic review methodology, 113 peer-reviewed journal articles were reviewed, dated between 1963 and 2014, addressing the topic of couple therapy and psychoanalysis. This article addresses a number of specific questions including, where authors have published their work, what methodologies they have used, with which couples psychoanalysts have been working, how writers from within different theoretical orientations talk about their work with couples, and how the field has changed over time. It also explores emerging themes of the relationship between couple and individual therapy, sex, and co-therapy. This review of writing over the past 50 years suggests that although Classical contributions have waned over time, couple psychoanalysts from within Object Relations, Self Psychology, Intersubjectivity, and Relational orientations have evolved in their discourse about couple distress, from an application of psychoanalytic concepts to full-bodied, well-articulated, clear, and concise approaches to diagnosis and treatment. The first 50 years of writing in the field of couple psychoanalysis has brought us distinct treatment models, which have opened the door for greater communication and sharing within and between orientations.     

Client Perceptions of Couples Therapy: Helpful and Unhelpful Aspects

This article describes a qualitative study that investigated client perceptions of helpful and unhelpful aspects of couples therapy. A thematic analysis of interviews revealed among other themes, that couple participants associated helpful therapy experiences with (a) being given choices regarding ideas and ways of working that fit for them, (b) working with a therapist they trusted, and (c) developing new ideas about the couple relationship. Implications of this study for future research, practice, and training are described.