Down the Relationship Rabbit Hole, Assessment and Strategy for Therapy

Down the Relationship Rabbit Hole

Assessment and Strategy for Therapy

Published by Ronald Mah at Smashwords

Copyright 2013 Ronald Mah

Ronald Mah's website- www.ronaldmah.com

Smashwords Edition, License Notes

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Abstract:

Assessment is critical for successful therapy. Individuals often come with issues that affect their ability to have successful relationships, not the least of which are committed romantic intimate relationships. Couples and families come to therapy to repair fractured relationships causing great pain and dysfunction. Straightforward questions help assess the quality and dynamics of relationships and direct therapy. Trust, vulnerability, self-expression, empathy, and investment are presented as foundational to intimate relationships, as power tools to assess relationship quality, and to also direct therapy to build relationships. The seven-step devolution of relationship model also is used to assess quality and status of problematic relationships and to direct therapeutic strategies and interventions to heal and rebuild positive relationships. Assessment, intervention, and evaluation become unified therapeutic processes using the set of beginning questions and the two valuable models presented in this book by a licensed marriage and family therapist highly experienced in working with difficult relationships.

link to Table of Contents

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Linked Table of Contents

Abstract

INTRODUCTION: DICK AND JANE

ALMOST NOTHING

Chapter 1: BEGINNING QUESTIONS

Chapter 2: FOUNDATIONS FOR COUPLES and OTHER RELATIONSHIPS

Chapter 3: FACILITATING TRUST

Chapter 4: FACILITATING VULNERABILITY

Chapter 5: FACILITATING SELF-EXPRESSION

Chapter 6: FACILITATING EMPATHY

Chapter 7: FACILITATING INVESTMENT

Chapter 8: USING THE FIVE FOUNDATIONS

CASE EXAMPLES

Chapter 9: DEVOLUTION OF THE RELATIONSHIP

COMMENTING- Stage 1

COMPLAINING- Stage 2

CRITICIZING- Stage 3

CONTEMPT- Stage 4

DEFENSIVENESS- Stage 5

DISCONNECTING EMOTIONALLY- Stage 6

DIVORCE- Stage 7

Chapter10: USING CONCEPTS IN THERAPY

Chapter 11: EMOTIONAL RECONNECTION

Chapter 12: TAKING INDIVIDUAL RESPONSIBILITY

Chapter 13: ACKNOWLEDGING RESPECTIVE INJURIES

Chapter 14: UNDERSTANDING THE SYMBOLIC COMPONENTS OF COMMUNICATION

Chapter 15: LEARNING HEALTHIER COMMUNICATION

Chapter 16: THERAPY FROM ASSESSMENT

CONCLUSION: OUT OF THE RABBIT HOLE

Bibliography

Books by Ronald Mah

Biographic Information

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**Author's Note: Other than public figures or people identified in the media, all other persons in this book are either composites of individuals the author has worked with and/or have been given different names and had their personal identifying information altered to protect and respect their confidentiality.

INTRODUCTION: DICK AND JANE

This is Dick. This is Jane. See Dick run. See Jane run after Dick. See Dick run and hide. Hide Dick hide. Hide in your bottle. Hide at work. Hide in sports. See Jane run her mouth. See Jane run the house. See Jane run the social calendar. See Jane run down. See Jane run to Sally. Hear what Sally tells Jane about Dick. Stop Sally stop. Dick talks to Sally. Stop Dick stop. Jane talks to Sally. See Sally get triangulated. Run Sally run. Jane blames Dick. Dick blames Jane. Dick blames work. Dick blames Jane's mother. There is not much fun with Dick and Jane. So, they come to therapy! See the therapist fall down the rabbit hole! In the homogenized times in the 1940s, 50s, and 60s, the adventures of Dick and Jane (Gray and Arbruthnot, 1941) and their associates Sally and Spot populated the basal readers of young American readers. Highly simplistic if not also lacking in any diversity resembling the spectrum of actual Americans, the characters and behaviors are comparable to well-intended but also simplistic renditions of what an individual, couple, or family is all about. If problems arose at all, they were benign and readily managed. The stories gave an implicit message of what people, relationships, and life was supposed to look like. Psychological and psychotherapeutic theories often imply how individuals should function. This is how psychological health looks. This is neurotic. This is good communication. This is bad communication. This is a healthy family. This is a dysfunctional family. Therapist, now that you have the picture, make him, her, or them healthy, communicate well, and behave functionally. If there were so-called wholesome Dick and Jane persons, they ordinarily would not be the clients who seek therapy. That is, unless beneath the wholesome suburban veneer there is alcoholism, abuse, trauma, domestic violence, emotional distress, despair, and conflict, anxiety and depression, infidelity, and any of a host of minor to severe stresses and dysfunctional behaviors. The feigned innocence of the original Dick and Jane did not include the possibility that one or both may have been molested, or come from an alcoholic family system or divorced parents. Homosexuality? Heterosexuality or sex at all was not addressed although there were explicit heteronormative values and gender models presented. Mixing metaphors- the therapist has fallen like Alice in Lewis Carroll's classic Alice's Adventures in Wonderland (1885) down the rabbit hole and sits at the Mad Hatter's tea party. Dick and Jane exist in their version of a topsy-turvy world of singing flowers, caterpillars smoking hookahs, Mad Hatters, false disappearing smiles of the Cheshire Cat, and more nonsensical characters and dynamics. Who and what Dick may be or who or what Jane is, and/or what has been going on in their relationship (or rabbit hole), much less within their family among the children requires insightful astute initial assessment by the therapist Alice! Whether it is one person, two people in a couple, or a few members in a family, the therapist may continually be confronted with fantastic and odd occurrences incompatible with functionality outside the rabbit hole. The therapist starts with almost nothing (other than it is one person, a couple, or a family) and yet must not only make accurate assessment and diagnoses at a therapeutic tea party amidst the shenanigans of Mad Hatter, the March Hare, the Dormouse, and even a megalomaniac Red Queen of Hearts. Rather being drawn into, seduced, or co-opted by the client, couple's, or family's dysfunction, the therapist must assess and implement such into effective therapy. See the therapist. See the therapist want to run!

ALMOST NOTHING

When a client or clients present for therapy, the therapist has the barest information to begin therapy. Often there are issues about intimate or other important relationships. An individual has had problems finding and staying in relationships, or perhaps habitually finds him or herself in high toxic dysfunctional relationships. Perhaps, the relationship is with a so-called BFF (best friend forever), another family member- a sibling maybe, a teammate, a co-worker, a supervisor, supervisee, or a colleague or teammate in some social or athletic group. The therapy focus of treatment may specifically be about the relationship between the partners in a committed or married couple, or the relationships among the members of a family: a nuclear biological family, a blended family, the extended family, and/or a multi-generational family. Therapy may be for an individual, male or female, a couple, a family, but are there other important composition not yet disclosed? Is sexuality an issue; is everyone or someone heterosexual, gay or lesbian? A gay rabbit hole? A straight rabbit hole? Age may be relevant as may be class, occupation, or cultural background. A working class tea party? High tea? Three cups of tea? Assessment is necessary to find the direction of therapy. or more of the initial sessions may be largely dedicated to informal conversational or formal and structured assessment with specific diagnostic tools such as a mental status exam (MSE). A mental status exam applicable to an individual may include looking at, examining, or assessing a multitude of issues. For example, a mental status exam considers (Martin, 1990):

Level of Consciousness

Appearance and General Behavior

Level of Consciousness

Speech and Motor Activity

Affect and Mood

Thought and Perception

Attitude and Insight

Examiner's Reaction to the Patient

Attention

Language

Memory

Constructional Ability and Praxis

Assessment exists primarily to gather information for counselors to better understand clients' concerns and as the underpinning for making intervention decisions. Many authors have proposed wider purposes for assessment including identifying the focus and goals of counseling, identifying the source of clients' concerns, identifying clients' self-understanding, providing new perspectives, teaching new ideas, creating evaluative structures, unearthing conflicts, serving as a stimulus for discussion, and expanding treatment options (Forrest, 1994, page 172). While the MSE examines current status, it does not necessarily consider how the individual arrived at his or her current status. The family-of-origin, prior experiences, cultural distinctions including gender roles, class expectations, and developmental progression are among many other considerations to understand an individual's personality, values, and behavior. Similar or identical experiences in one person can manifest in divergent ways due to other influences idiosyncratic in another individual. Comparable categories for examination of a couple or a family would include individual issues along with interactional dynamics. In a couple however, 1 + 1 often equals much more than 2 or the simple sum of two sets of individual characteristics. Arguably each individual holds a multiplicity of factors. Set against or with another individual's comparable multiplicity, they result in some exponential rather than additive result. A family moreover with additional members is often significantly more complicated as well.

Various approaches to therapy may not fit the client's (individual, couple, or family) needs. The therapist who approaches a client with set strategies and tools or interventions in mind has not assessed the unique qualities of the client nor examined how the client is or is not comparable to others he or she has worked with or studied. The therapist with a favored theory and favored interventions becomes like a person in love with smacking things and particularly with a hammer! Everything looks like a nail and gets smacked. A particular therapeutic approach and accompanying therapeutic interventions can be very appropriate and effective when it matches with one individual, couple, or family's needs, yet may be problematic and unsuccessful with another client with different needs. Therapist should take care not to simplify therapy with favored assumptions for example, of homogeneous couples and couple's dynamics. Sperry (1989) notes that, The most comfortable and easy way to practice marital therapy is to view many if not all couples and their problems as basically similar and then apply a standard therapy or mix of therapies to these couples… particularly with the 'traditional couple.' The traditional couple is a relatively young couple, married more than two but usually less than seven years, with a fairly focused set of concerns. For a number of reasons such a strategy is misguided and deprives many couples of effective treatment… couples tend to be… more culturally diverse, more dysfunctional, and more multisymptomatic, including health and medical factors. Of necessity, marital therapists have had to expand their repertories of both assessment and treatment modalities to adequately tailor their therapy to spouse and couple (page 547)

A hammer is great for driving nails, but challenging for driving screws, difficult for cracking walnuts, and ineffective for sawing wood. Even all nails are not the same nor are all hammers the same. Therapeutic strategies and interventions for a couple with poor communication may prove inadequate for a couple with domestic violence. Work with an individual or an individual in a couple that has encountered trauma may prove significantly different from work with an individual who has or a couple where one member has had an affair. In addition, one couple's communication problems may not be the same as another's communication problems. The trauma in one client may not resonate as destructively as the trauma in another client. Uncovering important influences and factors may be curiouser and curiouser, but always informative to the direction of therapy. The therapist, similar to any person will be drawn to types of therapy that resonate with his or her personality, style, intellectual, affective, psychological, spiritual, and other characteristics or prejudices. If the therapist does not carefully examine this dynamic, the client who may match with him or her stylistically may be well