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Marital therapy process

Mark Dombeck, Ph.D. Updated: Mar 4th 2016

Assessment

Martial therapists often start a therapy relationship by asking clients to participate in an information gathering assessment phase during which they attempt to understand the nature of the problem they have been asked to address. The assessment process may be formal or informal depending on the therapist.

magnifying glass on question markAn informal assessment consists of one or more sessions devoted to an interview process where the therapist asks the couple to describe their problems. Sometimes these early information-gathering sessions involve both partners being present; at other times the partners are individually interviewed.

When a more formal assessment process is called for, in addition to the interview, one or more formal questionnaires, exercises or interviews designed to gather more objective information may be used. Family-systems trained therapists often ask each partner to complete a 'genogram' which is a sort of psychologically informed family tree. Systems therapists are sensitive to the intergenerational dynamic relationships and vulnerabilities that each partner in a relationship have been shaped by (for instance, whether one partner was raised in an alcoholic environment and had to take on parent-like responsibilities before they were ready, or was a child of a holocaust survivor, etc.). They use the genogram to better understand how family background conditions influence marital behavior. Behaviorally based therapists, more interested in the nature of the current relationship, may ask each partner to fill out a 'dyadic adjustment scale' wherein each partner is asked to describe how they understand their relationship. The behaviorally informed therapist will then compare each partner's responses on this questionnaire to learn how similarly each partner views the relationship.

Generally the assessment phase will be one to three sessions in duration and will terminate in a session where the therapist presents his or her understanding of the problem to the couple along with a proposed treatment plan and goals.

Intervention

Having made a best attempt to understand a couple's problems, a therapist will next work with the couple to address those problems. The therapist's task involves teaching the couple how to interrupt their slide towards disengagement (via contempt, frustration and defensiveness; Gottman's "four horsemen") so that their more loving efforts have a better chance at success. Though the therapist may appear to be improvising at any given moment, there are only a limited number of interventions the therapist will use.

 

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