CASE STUDY: A THERAPEUTIC FAILURE DESCRIPTION OF THE CASE - Handbook of couples therapy

A White, middle-class, childless, dual-income couple, Amanda and Roger presented for therapy to resolve issues regarding infidelity and poor communication. They had been dating for two and half years and had been married for one year. Amanda brought a history of childhood and adolescent sexual abuse, as well as current problems with alcohol abuse. She initiated a short-term affair that was the crisis that brought the two to counseling. Roger used both alcohol and marijuana when stressed, and self-identified as wanting to avoid conflicts. Roger desperately wanted to stay in the relationship, but reported feeling helpless and ineffectual. Both expressed a wish for more closeness and affection, although Amanda had no sexual desire for Roger and also talked about ending the relationship. Amanda had been in individual therapy previously working on her sexual abuse concerns. In the first session, the therapist, a relatively inexperienced clinician, conducted a half-hour interview to get the history behind the couple’s presenting concerns. They reported difficulty for the past six months, with Amanda attending classes part-time in a nearby city and Roger working 12hour days to make ends meet. Roger admitted resentment over Amanda’s new interests and friends at school; Amanda complained about Roger’s What the Research Tells Us 447 448 SPECIAL ISSUES FACED BY COUPLES lack of responsiveness to her in the evening. Roger felt unappreciated for all his hard work. Amanda would try to engage Roger, usually in angry ways, which would be followed by Roger’s shutting down and withdrawing. Amanda would then withdraw as well, and eventually chose to turn to an extra-marital relationship for support. Amanda had stopped the affair before the couple entered therapy and expressed anger and impatience that Roger did not appear to be over it yet. The therapist made no specific interventions in the initial session. In four following sessions, the therapist taught and coached the couple on communications skills and had them practice using the skills in session to discuss something positive in their relationship and then to discuss more difficult issues. The therapist helped the couple to identify negative patterns of interaction and reframed or challenged dichotomous thinking and dysfunctional relationship beliefs. For homework, the therapist asked the couple to come up with a time they could do something fun together at least one time during the week and made a concrete and specific plan tailored to their preferences and schedules. The couple was also asked to have check-in conversations with each other each evening, with each partner alternating the initiation of that conversation. Amanda and Roger complied with all assignments, but remained hostile and frustrated in sessions. The therapist constructed a genogram with the couple in their fourth session to explore family-of-origin patterns that might be related to their own relationship. The couple failed to attend the next two sessions and appeared to have quit with their core issues unresolved.
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