Getting together Scotland's
COUPLE THERAPY
Selected international thinking and research to inform
Scotland's relationship services and other helping professions
to do better for couples and families who have relationship problems
Overview, Thinking It Through …
(but you may prefer to scroll down to) select linked Resources
Here Nick is an enthusiast not an expert. His thinking and views here are not to be taken as gospel.
They are his views alone, not those of any organisation. They are based on the linked resources.
The webpage is not written in stone. Improvement will continue.
Please help by feeding back your views - use the contact box at the end.
Nick presented at the EFTA congress in Istanbul in October 2013 in a seminar on "Couple Therapy being new for Family Therapists: View his presentation there with his notes under the title: How come Couple Therapy is "novel" to Euro-Family Therapy when American "MFT" is 50 years old?! Sue Johnson of EFT fame was discussant!
Scotland's relationship services and other helping professions
to do better for couples and families who have relationship problems
Overview, Thinking It Through …
(but you may prefer to scroll down to) select linked Resources
Here Nick is an enthusiast not an expert. His thinking and views here are not to be taken as gospel.
They are his views alone, not those of any organisation. They are based on the linked resources.
The webpage is not written in stone. Improvement will continue.
Please help by feeding back your views - use the contact box at the end.
Nick presented at the EFTA congress in Istanbul in October 2013 in a seminar on "Couple Therapy being new for Family Therapists: View his presentation there with his notes under the title: How come Couple Therapy is "novel" to Euro-Family Therapy when American "MFT" is 50 years old?! Sue Johnson of EFT fame was discussant!
OVERVIEW
Nick Child, ex-CAMHS Psychiatrist and now (Couple and) Family Therapist, whose website and words you are reading, created this material originally for family therapists in the UK. But here he adapts it for a wider audience including Couple Counsellors (CC) and other helping professions, if not lay people, couples and families too. In particular it is to bring home to Scotland the Couple Therapy (CT) developments and lessons of the last 50 years in North America's more concerted field of Marriage / Couple and Family Therapy (MFT) in order to enrich, bridge and similarly bring together the relatively separate fields here of Couple Counselling and Family Therapy. In contrast with our rather low CT profile in Britain, here is the International Commission on Couple and Family Relations - click to their conference in London in June 2013 titled: "Surviving the Crisis: Putting the Couple Relationships at the Heart of an Early Intervention Agenda for Families."
Nick's interest in couples and Couple Therapy (CT) - and the awareness of a gap in Family Therapy (FT) as well as in Couple Counselling (CC) - grew from his FT work in the voluntary sector based in and sharing the work of a CC agency. This is also part of his wider campaigning within FT for a higher profile for non-statutory sector work - FT in the UK having grown largely in the NHS and other statutory services. That campaign has led to exploring less familiar roads in the UK - including CT - and to a comparison with the highly developed non-statutory culture in North America. See more about this in his Learning from America Again conference presentation here.
Nick Child, ex-CAMHS Psychiatrist and now (Couple and) Family Therapist, whose website and words you are reading, created this material originally for family therapists in the UK. But here he adapts it for a wider audience including Couple Counsellors (CC) and other helping professions, if not lay people, couples and families too. In particular it is to bring home to Scotland the Couple Therapy (CT) developments and lessons of the last 50 years in North America's more concerted field of Marriage / Couple and Family Therapy (MFT) in order to enrich, bridge and similarly bring together the relatively separate fields here of Couple Counselling and Family Therapy. In contrast with our rather low CT profile in Britain, here is the International Commission on Couple and Family Relations - click to their conference in London in June 2013 titled: "Surviving the Crisis: Putting the Couple Relationships at the Heart of an Early Intervention Agenda for Families."
Nick's interest in couples and Couple Therapy (CT) - and the awareness of a gap in Family Therapy (FT) as well as in Couple Counselling (CC) - grew from his FT work in the voluntary sector based in and sharing the work of a CC agency. This is also part of his wider campaigning within FT for a higher profile for non-statutory sector work - FT in the UK having grown largely in the NHS and other statutory services. That campaign has led to exploring less familiar roads in the UK - including CT - and to a comparison with the highly developed non-statutory culture in North America. See more about this in his Learning from America Again conference presentation here.
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This Scotland's CT webpage was launched alongside a sell-out conference in April 2013 that confirmed a growing interest in CT and a partnership between key Scottish relationship help organisations. At the conference Gail Palmer from Ottawa and ICEEFT introduced one of the leading North American approaches to Couple and Family Therapy, Emotionally Focused Therapy. For loads more on EFT go to ICEEFT. This was organised by AFT Scotland in partnership with Relationships Scotland, Scottish Marriage Care, and the Family Therapy Training Network amongst others.
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Gail Palmer Bringing It Home in Edinburgh in April 2013
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The title "Bringing it home" refers to the British origins - not just of Sue Johnson herself but also - of EFT's foundation in attachment theory ... John Bowlby, psychoanalytic / psychodynamic / object relations approaches, and the Tavistock in London. The Tavistock is where Bowlby worked. The UK's main centre for psychoanalytical CT is based at the Tavistock too (see here). The TCCR is the main centre for Couple Psychotherapy in Britain and the main influence on CC in the UK, linked to its sister institute, the Scottish Institute of Human Relations (now turned into: Human Development Scotland) and the SIHR's psychodynamic courses in CT too (see here). At the same time as he was creating his more famous attachment theory, Bowlby also created and wrote about the first Family Therapy ... click for his (1949) paper The Study and Reduction of Group Tensions in the Family in Human Relations, 2, 123-28. There have been many applications of Attachment Theory in psychoanalytical psychotherapy for adults and children. in British family therapy there is e.g. Rudi Dallos and Arlene Vetere's (2009) Systemic Therapy and Attachment Narratives. Janet Reibstein's (1997) paper 'Rethinking marital love' and in her (full review of her) book describe successful partnerships plainly and evidently in attachment terms. With research that linked with Channel 4 TV, she shows how people want to be in close safe relationships despite all the evidence of marriage breakups and the individualistic culture. Successful partnerships work together to promote protection, mutual focus, balance, gratitude and pleasure - all features of good attachments. Following Pinsof (1982) a couple or couple therapist would focus on educational / cognitive, behavioural and emotional changes on the way to achieve this.
Otherwise, it has taken North America and a few decades to bring attachment, FT and CT together more effectively. See below for more on how EFT bridges systemic and psychodynamic approaches. Meanwhile, here is the booklist created for the EFT Conference. It has four sections: key EFT books, and key introductory books on other US Couple Therapy, on UK Family Therapy, and on UK Couple Counselling / Psychotherapy. EFT Training with Gail Palmer is now established in Scotland; for more info go to The Spark.
But this webpage is to present a much broader picture than any particular model for Scotland to learn from. The bigger aim is to encourage Scotland to emulate North America by developing a more concerted field of couple and family relationship help here too, and to better bridge psychodynamic and systemic approaches. This requires us to set aside institutional hurdles that readily provide an excuse not to, and find the mutual sensible overlapping things we can do together instead. Compared to all other psychotherapies, FT and CC share a practice of seeing more than one client in the room to work on their relationship. Nick did create a weird diagrammatic fairy story PowerPoint called "A String Tale" of how things went differently on either side of the Atlantic. But it doesn't really help to make things clearer!!
Next, still trying to give you more than just words, here's how Nick provocatively portrayed to FTists the systemic take-over of CT in the USA - something that never happened in Britain. Many British FTists would say they do know about working with couples. But there is no doubt of the continuing distance if not the divide between psychodynamic non-statutory CC and systemic statutory FT in Britain. And the absence in either CC or FT of the CT found in the married up field of MFT in America. We do need to remember that some of what got left out in the merger there had to be brought back in later as Couple Therapists discovered they needed it (e.g. as in EFT). And the result has been a more concerted field there with genuinely married up systemic and psychodynamic models.
Otherwise, it has taken North America and a few decades to bring attachment, FT and CT together more effectively. See below for more on how EFT bridges systemic and psychodynamic approaches. Meanwhile, here is the booklist created for the EFT Conference. It has four sections: key EFT books, and key introductory books on other US Couple Therapy, on UK Family Therapy, and on UK Couple Counselling / Psychotherapy. EFT Training with Gail Palmer is now established in Scotland; for more info go to The Spark.
But this webpage is to present a much broader picture than any particular model for Scotland to learn from. The bigger aim is to encourage Scotland to emulate North America by developing a more concerted field of couple and family relationship help here too, and to better bridge psychodynamic and systemic approaches. This requires us to set aside institutional hurdles that readily provide an excuse not to, and find the mutual sensible overlapping things we can do together instead. Compared to all other psychotherapies, FT and CC share a practice of seeing more than one client in the room to work on their relationship. Nick did create a weird diagrammatic fairy story PowerPoint called "A String Tale" of how things went differently on either side of the Atlantic. But it doesn't really help to make things clearer!!
Next, still trying to give you more than just words, here's how Nick provocatively portrayed to FTists the systemic take-over of CT in the USA - something that never happened in Britain. Many British FTists would say they do know about working with couples. But there is no doubt of the continuing distance if not the divide between psychodynamic non-statutory CC and systemic statutory FT in Britain. And the absence in either CC or FT of the CT found in the married up field of MFT in America. We do need to remember that some of what got left out in the merger there had to be brought back in later as Couple Therapists discovered they needed it (e.g. as in EFT). And the result has been a more concerted field there with genuinely married up systemic and psychodynamic models.
The missing letter is "C" for "Couple".
Here's a more difficult question >>>>> 
Fifty years ago. But why the macho pictures? Well here’s what they said about Haley and his paper >>>>
Meanwhile in the UK field of systemic FT there has been almost NO British home-grown systemic CT! But at least the publications show we want to learn more about it. (NB there is a new psychoanalytical move to bridge the two - see here.) >>>>
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How long ago and who? Which of these dates and .. well it wasn't those boxers!! The answer is
<<<<<<<< 
So it sounds like a knock out alright! The underside to this is that CT had to smuggle psychodynamic ideas back in eg EFT’s use of Attachment theory. Note Alan Gurman’s textbook: a 4th edition in 2008, big, lots of approaches - a result of 50 years of marriage of couple and family therapy.
<<<<<< 
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THINKING IT THROUGH
SISTERS vs COUSINS
Unfortunately the simple story and diagrams need to be unpacked into a more complex picture. Couple Therapy anywhere is inevitably going to be a more systemic than psychoanalytical approach for what the Americans call “couple distress”. Working with the most difficult kinds of couple distress often does however require a combination of active conflict management and systemic approaches alongside some kind of psychodynamic understanding of what each adult brings to their relationship. Here is Nick's attempt to bridge the separate modes.
Nick here uses the term Couple Therapy to mean North American CT though there are some established smaller but important uses of the term in the UK too. Systemic here means it all works very much like FT does – North American CT is a close sister to FT where in Britain FT and CC are at best distant cousins. Couple distress is when couples have problems and present themselves as couples with relationship problems, attachment hurts and conflicts. CT in the US is united within MFT (as in the American Association of Marriage and Family Therapy). The use of the word “marriage” links to that stunning take over by Jay Haley, 1963 of “Marriage Guidance” into FT. See also Alan Gurman's (2008) history. “MFT” continues to be the inclusive formal title, not updating to “couple” because of America's religious and political sensitivities. Note that Canada plays a major role in CT so American does not mean just USA.
So Couple Therapy is also the name used in America for the main sub-specialty within MFT. The majority of all psychotherapists there offer therapy to couples. Few of them will have had any special training in CT if they are not an MFTist. But even an MFTist may not have had more than a basic CT training either. Because couples are a major clientele be it for distressed relationships or for mental health diagnoses, CT looks like the biggest modality in MFT. Nick makes a big thing (above) of the long established comparatively huge field of CT in America. He compares it with the (until recently) blank ignorance among FTists in the UK about couples as presenting any kind of special problem for therapists, let alone knowledge of the CT field or its important place, nor the awareness that they mostly do not see the couple distress clientele to know the difference. This is rapidly changing now in UK FT.
IN BRITAIN
British mainly NHS based FTists see couples too of course, but nearly always it is with a “third party” presentation – eg (as parents of) a problematic child, or a child with a problem, or a practical, or a MH problem like depression in one partner. NHS based FTists almost never get presented primarily with couple distress. Mostly in the UK, couple distress is considered to be the business of Couple Counsellors (CCors) in organisations like Relate, Marriage Care and their Scottish counterparts. And CCors quietly (and correctly) consider that UK FTists don’t see couple distress. So they do not rate UK FTists for that job even though FTists may seem to more powerfully profess to know all or even more about it. FTists have tended to talk as if what CC needs is to take on board their systemic ideas and methods and certainly to behave more like a profession ... this idea may be valid enough but it comes from the safety of FT's NHS stronghold ... and this is a shaky castle now. Without their NHS castle, FTists may find they're fish out of water when it comes to keeping their profession looking good!
CCors across the UK have taken on some systemic ideas and methods. But they remain rather more eclectic and psychodynamic eg more often it seems using ideas of countertransference than using FT's idea of systemic thinking. (See here for the many meanings of "systemic" including what FT generally means by it). There is evidence that even a more psychodynamically influenced American CT is too systemic and interventive for UK CC - Sue EFT Johnson and the Tavi CRC parted company when both sides realised who they were dealing with.
What about the question of professionalism? CCors mostly hold a low non-professional profile within the voluntary sector. There is comparatively rather a low profile - little published or researched description or information on which to base a view of what their models and shorter (than FT) trainings are. It does seem to be more of a mixture of psychodynamic and/or object relations and/or attachment theory, along with some influence by systemic theory (bearing in mind that “systemic” has many meanings anyway). The leading centre that CCors turn to is the clearly psychoanalytical Tavistock Couple Relationships Centre (and its little sister in Scotland, the Scottish Institute of Human Relations). Many in the UK would give the TCRC as the British centre of CT and of their training. The TCRC does apply its work to a wide range of concerns.
So anyway, the point is underlined - CT in North America is more systemic but had to re-import psychodynamic things; CC/CT in the UK is definitely more psychoanalytical; and UK systemic FT hasn’t really thought about it much but doesn't imagine couples as anything much different.
A RELATIONAL CORE IN COMMON
Of course attachment distress often if not always underlies many other relationship-linked “third-party” presentations. CT in the UK or the US is also useful for these triangulated presentations (eg children or depression, eating disorders), which draw from the “life and death” quality of the couple distress underneath them, sometimes reaching the point of risk of harm or violence. For directly presented couple distress, the risk of domestic violence is so important that it needs to be assessed and considered at the outset. In both UK and US there are some who emphasise this aspect while there are others who don’t though the basis for conjoint couple counselling or therapy must ensure that it is safe to talk openly in each other's presence.
We've seen that the key “knock out” point in America was when Marriage Guidance / Counselling and Therapy was knocked firmly out of psychoanalytic hands to join the systemic FT camp 50 years ago. They have a hugely developed CT field to show for it. Of course, Jay Haley was wrong to completely knock out psychoanalytical influences from FT or CT. Those influences can be seen in eg Imago or EFT’s use of Attachment theory. British CC has always held on to that original connection, but the field of CT / CC is nowhere near as concerted in the UK as in North America. What systemic CT beginnings there are in the UK now are mainly derived from American CT models, and they are applied mainly in the NHS MH sector (eg as NICE recommended treatment for depression). That is, systemic CT in the UK is still not engaging or thinking much about couple distress as such.
Within the systemic FT field in Britain, some (but not others) state that CT has been taught here. The defunct KCC courses did stuff on couples eg “strange loops” (an American idea though). And maybe Attachment Narrative Therapy (see here) could be stretched to cover couples too. Elsa Jones and Eia Asen’s famous research on CT for depression (see here) proves the rule: the cases were long-standing depressions who showed the underlying couple issues by a high rate of separation as the treatment worked (treatment for depression that is). Elsa and Eia were clear that they applied standard UK FT methods, not CT models of work. They were not faced with straightforward couple distress – the couple distress was in its “sleeping dog” form (see below and here).
CLINICALLY DIFFERENT REQUIREMENT
Typically, any British FTist who actually has to see a few couples primarily presenting with Couple distress quickly and readily will admit that their FT skills are not enough for the job. It seems likely that British couples do suffer or present the same kind of attachment hurts and distress as they do in America. As in America, we in Britain need to close the distant different CC and FT approaches here. Whatever the case Nick argues that CC and FT in the UK should include a working knowledge of America's models of CT, even if (and so that) a British CCor or FTist can compare and make an informed decision on whether they wish or need to use aspects of American CT here too. Statutory FT presented with diagnoses and non-statutory CC presented with couple distress should both make sure they can offer clients the best approaches available.
The recent splurge of CT publishing in the UK FT literature (mentioned above) shows that we in the UK are trying now to learn from American CT. The UK systemic CT literature is almost entirely of North American origin because there is very little published about systemic Couple Therapy or Counselling in Britain. TCRC is one psychoanalytical exception. And remember that Jones and Asen's CT was actually applied FT for depression, not CT for couple distress.
Nick’s argument is that learning about American systemic CT needs to be made more mainstream for the majority of FTists. The problem is that few UK FTists yet work with couple distress which CT is designed for, so many are not aware nor do they have an opportunity to practice or practise CT. So why learn CT at all then?! Nick says: "There are several issues that couples in distress need their therapists to be ready for ... for example: contracting and confidentiality with two individuals in conflict, risk assessment, control of session, managing high emotions, intimacy and sex, affairs, alcohol and other addictions. There is often a couple at the centre of a family. Even if not, CT will significantly raise the quality of all FT because it requires more knowledge about intimate attachments. It equips FTists to serve more client groups better and earn a living in all sectors. And of course these improvements will benefit the quality of British CC for their clients too."
TACKLING GRIDLOCK - EFT and GOTTMAN
There is a range of general approaches to how couples can improve their relationships. But the core problem for CT or CC is when more serious conflict and distress arises. John Gottman calls this gridlock - a good name for it; like traffic, it implies that unblocking one junction depends on unblocking others. Each school of CT has a characteristic method for tackling (the underlying causes of) gridlock. Sue Johnson (EFT) works to bring out the underlying attachment vulnerabilities - which is something that might happen in a more unfolding way in other approaches (e.g. psychodynamic) but clients need therapists who have a grasp of how to make something this important but difficult happen reliably. John Gottman's method accepts that couples may have perpetual serious differences but they can find ways to live with them without gridlock by exploring the dreams that underpin it. Bill Doherty focuses on the contracting stage to be clear what each party wants so that gridlock doesn't take root in the therapy. Harville Hendrix (Imago Therapy), from the outset, turns the couple's attachment and dreams into a sustained miracle question - ie create a vivid present picture of how things will be when the problem is gone. And so on. Dr Peter Pearson on the Couples Institute is one of many who describe this core problem pattern as inbuilt emotional brain-based reactions that once helped flight or fight now very much derail a couple's logic and communication.
A most interesting example of the blending of psychodynamic and systemic has been Emotionally Focused (Couple / Family) Therapy. Of course psychoanalysts might not agree that Bowlby, though a psychoanalyst, was properly psychoanalytical. EFT is much more actively systemic. Meanwhile Attachment approaches have been growing steadily in all kinds of ways all over the world including in British FT and CC. So it isn't a surprise that EFT – which is certainly of wider use than just for couple distress – is the leading North American model being brought back home to the UK. And Nick is pleased to report that for the 2013 EFT conference in Scotland the partner organisations are steadily becoming more concerted around this event.
John Gottman's work is interesting because it is based on loads of research. He started by getting couples into his "laboratory". Within minutes he can identify the signs that reliably predict which couples are on the way to separating - harsh start up to arguments, the "four horsemen of the apocalypse" (criticism, contempt, defensiveness, stonewalling), physiological (flooding, body language), failed repair attempts, and bad memories. Basing an approach to therapy on this is not so simple. You have to turn this into more positive advice. His approach is - unsurprisingly - a comprehensive, detailed description and technology of well functioning friendship (with the important extra section on solvable and perpetual problems or gridlock). His popular "Seven Principles" book (see below) is a thorough workbook that covers his research and therapy - he works with groups of couples in a more Relationship Education approach as well as with individual couples. Gottman Therapy itself, as an effective therapy, has not yet been evidenced. Nick has always wondered more naively about how strange it is that as intimate love grows to marriage, friendship seems to weaken if not disappear. So Gottman's detailed description and methodology of friendship is of much wider use than just for couples.
THE RESOURCES
Now to get on with the resources. These are a key selection of what Nick built his thinking on. They are organised starting with relatively minimal sized things and ending with literature for those who want to know much more. The key references are tagged "BEST". The links mostly open another Google document webpage; to download to your own computer click the small printer icon.
RESOURCES - MINIMUM:
Since FTists may need to be reminded what couple distress looks like, have a look at this scene from a film. Anyone who sees couples in distress sees many couples who are this challenging; anyone who does will tell you that ordinary UK FT skills are very often just not enough.
This multi-author guide is illustrated and fun and not too simplistic. WikiHow: Make Your Relationship Work
BEST: Couple Therapy Scene from the film “The Ref” – How not to do couple therapy
(Unfortunately Disney have removed the full youtube excerpts, but here's a partial one https://youtu.be/WRexU1FqPkA)
SISTERS vs COUSINS
Unfortunately the simple story and diagrams need to be unpacked into a more complex picture. Couple Therapy anywhere is inevitably going to be a more systemic than psychoanalytical approach for what the Americans call “couple distress”. Working with the most difficult kinds of couple distress often does however require a combination of active conflict management and systemic approaches alongside some kind of psychodynamic understanding of what each adult brings to their relationship. Here is Nick's attempt to bridge the separate modes.
Nick here uses the term Couple Therapy to mean North American CT though there are some established smaller but important uses of the term in the UK too. Systemic here means it all works very much like FT does – North American CT is a close sister to FT where in Britain FT and CC are at best distant cousins. Couple distress is when couples have problems and present themselves as couples with relationship problems, attachment hurts and conflicts. CT in the US is united within MFT (as in the American Association of Marriage and Family Therapy). The use of the word “marriage” links to that stunning take over by Jay Haley, 1963 of “Marriage Guidance” into FT. See also Alan Gurman's (2008) history. “MFT” continues to be the inclusive formal title, not updating to “couple” because of America's religious and political sensitivities. Note that Canada plays a major role in CT so American does not mean just USA.
So Couple Therapy is also the name used in America for the main sub-specialty within MFT. The majority of all psychotherapists there offer therapy to couples. Few of them will have had any special training in CT if they are not an MFTist. But even an MFTist may not have had more than a basic CT training either. Because couples are a major clientele be it for distressed relationships or for mental health diagnoses, CT looks like the biggest modality in MFT. Nick makes a big thing (above) of the long established comparatively huge field of CT in America. He compares it with the (until recently) blank ignorance among FTists in the UK about couples as presenting any kind of special problem for therapists, let alone knowledge of the CT field or its important place, nor the awareness that they mostly do not see the couple distress clientele to know the difference. This is rapidly changing now in UK FT.
IN BRITAIN
British mainly NHS based FTists see couples too of course, but nearly always it is with a “third party” presentation – eg (as parents of) a problematic child, or a child with a problem, or a practical, or a MH problem like depression in one partner. NHS based FTists almost never get presented primarily with couple distress. Mostly in the UK, couple distress is considered to be the business of Couple Counsellors (CCors) in organisations like Relate, Marriage Care and their Scottish counterparts. And CCors quietly (and correctly) consider that UK FTists don’t see couple distress. So they do not rate UK FTists for that job even though FTists may seem to more powerfully profess to know all or even more about it. FTists have tended to talk as if what CC needs is to take on board their systemic ideas and methods and certainly to behave more like a profession ... this idea may be valid enough but it comes from the safety of FT's NHS stronghold ... and this is a shaky castle now. Without their NHS castle, FTists may find they're fish out of water when it comes to keeping their profession looking good!
CCors across the UK have taken on some systemic ideas and methods. But they remain rather more eclectic and psychodynamic eg more often it seems using ideas of countertransference than using FT's idea of systemic thinking. (See here for the many meanings of "systemic" including what FT generally means by it). There is evidence that even a more psychodynamically influenced American CT is too systemic and interventive for UK CC - Sue EFT Johnson and the Tavi CRC parted company when both sides realised who they were dealing with.
What about the question of professionalism? CCors mostly hold a low non-professional profile within the voluntary sector. There is comparatively rather a low profile - little published or researched description or information on which to base a view of what their models and shorter (than FT) trainings are. It does seem to be more of a mixture of psychodynamic and/or object relations and/or attachment theory, along with some influence by systemic theory (bearing in mind that “systemic” has many meanings anyway). The leading centre that CCors turn to is the clearly psychoanalytical Tavistock Couple Relationships Centre (and its little sister in Scotland, the Scottish Institute of Human Relations). Many in the UK would give the TCRC as the British centre of CT and of their training. The TCRC does apply its work to a wide range of concerns.
So anyway, the point is underlined - CT in North America is more systemic but had to re-import psychodynamic things; CC/CT in the UK is definitely more psychoanalytical; and UK systemic FT hasn’t really thought about it much but doesn't imagine couples as anything much different.
A RELATIONAL CORE IN COMMON
Of course attachment distress often if not always underlies many other relationship-linked “third-party” presentations. CT in the UK or the US is also useful for these triangulated presentations (eg children or depression, eating disorders), which draw from the “life and death” quality of the couple distress underneath them, sometimes reaching the point of risk of harm or violence. For directly presented couple distress, the risk of domestic violence is so important that it needs to be assessed and considered at the outset. In both UK and US there are some who emphasise this aspect while there are others who don’t though the basis for conjoint couple counselling or therapy must ensure that it is safe to talk openly in each other's presence.
We've seen that the key “knock out” point in America was when Marriage Guidance / Counselling and Therapy was knocked firmly out of psychoanalytic hands to join the systemic FT camp 50 years ago. They have a hugely developed CT field to show for it. Of course, Jay Haley was wrong to completely knock out psychoanalytical influences from FT or CT. Those influences can be seen in eg Imago or EFT’s use of Attachment theory. British CC has always held on to that original connection, but the field of CT / CC is nowhere near as concerted in the UK as in North America. What systemic CT beginnings there are in the UK now are mainly derived from American CT models, and they are applied mainly in the NHS MH sector (eg as NICE recommended treatment for depression). That is, systemic CT in the UK is still not engaging or thinking much about couple distress as such.
Within the systemic FT field in Britain, some (but not others) state that CT has been taught here. The defunct KCC courses did stuff on couples eg “strange loops” (an American idea though). And maybe Attachment Narrative Therapy (see here) could be stretched to cover couples too. Elsa Jones and Eia Asen’s famous research on CT for depression (see here) proves the rule: the cases were long-standing depressions who showed the underlying couple issues by a high rate of separation as the treatment worked (treatment for depression that is). Elsa and Eia were clear that they applied standard UK FT methods, not CT models of work. They were not faced with straightforward couple distress – the couple distress was in its “sleeping dog” form (see below and here).
CLINICALLY DIFFERENT REQUIREMENT
Typically, any British FTist who actually has to see a few couples primarily presenting with Couple distress quickly and readily will admit that their FT skills are not enough for the job. It seems likely that British couples do suffer or present the same kind of attachment hurts and distress as they do in America. As in America, we in Britain need to close the distant different CC and FT approaches here. Whatever the case Nick argues that CC and FT in the UK should include a working knowledge of America's models of CT, even if (and so that) a British CCor or FTist can compare and make an informed decision on whether they wish or need to use aspects of American CT here too. Statutory FT presented with diagnoses and non-statutory CC presented with couple distress should both make sure they can offer clients the best approaches available.
The recent splurge of CT publishing in the UK FT literature (mentioned above) shows that we in the UK are trying now to learn from American CT. The UK systemic CT literature is almost entirely of North American origin because there is very little published about systemic Couple Therapy or Counselling in Britain. TCRC is one psychoanalytical exception. And remember that Jones and Asen's CT was actually applied FT for depression, not CT for couple distress.
Nick’s argument is that learning about American systemic CT needs to be made more mainstream for the majority of FTists. The problem is that few UK FTists yet work with couple distress which CT is designed for, so many are not aware nor do they have an opportunity to practice or practise CT. So why learn CT at all then?! Nick says: "There are several issues that couples in distress need their therapists to be ready for ... for example: contracting and confidentiality with two individuals in conflict, risk assessment, control of session, managing high emotions, intimacy and sex, affairs, alcohol and other addictions. There is often a couple at the centre of a family. Even if not, CT will significantly raise the quality of all FT because it requires more knowledge about intimate attachments. It equips FTists to serve more client groups better and earn a living in all sectors. And of course these improvements will benefit the quality of British CC for their clients too."
TACKLING GRIDLOCK - EFT and GOTTMAN
There is a range of general approaches to how couples can improve their relationships. But the core problem for CT or CC is when more serious conflict and distress arises. John Gottman calls this gridlock - a good name for it; like traffic, it implies that unblocking one junction depends on unblocking others. Each school of CT has a characteristic method for tackling (the underlying causes of) gridlock. Sue Johnson (EFT) works to bring out the underlying attachment vulnerabilities - which is something that might happen in a more unfolding way in other approaches (e.g. psychodynamic) but clients need therapists who have a grasp of how to make something this important but difficult happen reliably. John Gottman's method accepts that couples may have perpetual serious differences but they can find ways to live with them without gridlock by exploring the dreams that underpin it. Bill Doherty focuses on the contracting stage to be clear what each party wants so that gridlock doesn't take root in the therapy. Harville Hendrix (Imago Therapy), from the outset, turns the couple's attachment and dreams into a sustained miracle question - ie create a vivid present picture of how things will be when the problem is gone. And so on. Dr Peter Pearson on the Couples Institute is one of many who describe this core problem pattern as inbuilt emotional brain-based reactions that once helped flight or fight now very much derail a couple's logic and communication.
A most interesting example of the blending of psychodynamic and systemic has been Emotionally Focused (Couple / Family) Therapy. Of course psychoanalysts might not agree that Bowlby, though a psychoanalyst, was properly psychoanalytical. EFT is much more actively systemic. Meanwhile Attachment approaches have been growing steadily in all kinds of ways all over the world including in British FT and CC. So it isn't a surprise that EFT – which is certainly of wider use than just for couple distress – is the leading North American model being brought back home to the UK. And Nick is pleased to report that for the 2013 EFT conference in Scotland the partner organisations are steadily becoming more concerted around this event.
John Gottman's work is interesting because it is based on loads of research. He started by getting couples into his "laboratory". Within minutes he can identify the signs that reliably predict which couples are on the way to separating - harsh start up to arguments, the "four horsemen of the apocalypse" (criticism, contempt, defensiveness, stonewalling), physiological (flooding, body language), failed repair attempts, and bad memories. Basing an approach to therapy on this is not so simple. You have to turn this into more positive advice. His approach is - unsurprisingly - a comprehensive, detailed description and technology of well functioning friendship (with the important extra section on solvable and perpetual problems or gridlock). His popular "Seven Principles" book (see below) is a thorough workbook that covers his research and therapy - he works with groups of couples in a more Relationship Education approach as well as with individual couples. Gottman Therapy itself, as an effective therapy, has not yet been evidenced. Nick has always wondered more naively about how strange it is that as intimate love grows to marriage, friendship seems to weaken if not disappear. So Gottman's detailed description and methodology of friendship is of much wider use than just for couples.
THE RESOURCES
Now to get on with the resources. These are a key selection of what Nick built his thinking on. They are organised starting with relatively minimal sized things and ending with literature for those who want to know much more. The key references are tagged "BEST". The links mostly open another Google document webpage; to download to your own computer click the small printer icon.
RESOURCES - MINIMUM:
Since FTists may need to be reminded what couple distress looks like, have a look at this scene from a film. Anyone who sees couples in distress sees many couples who are this challenging; anyone who does will tell you that ordinary UK FT skills are very often just not enough.
This multi-author guide is illustrated and fun and not too simplistic. WikiHow: Make Your Relationship Work
BEST: Couple Therapy Scene from the film “The Ref” – How not to do couple therapy
(Unfortunately Disney have removed the full youtube excerpts, but here's a partial one https://youtu.be/WRexU1FqPkA)
Next, Nick suggests that this second Youtube video below encapsulates all the theory you need for understanding all kinds of couples in relationship distress. A couple of minutes demonstrate the whole of Attachment theory in its usual mother and baby context. The thing is that you can see exactly the same patterns happening in attachments between people of all ages too in couples and in families.
BEST: This is the Ed Tronick: Still Face Experiment –
So if those two videos show the problem that faces the Couple Therapist, and the theory that helps explain the problem, where do you begin to learn what to do about it? Nick suggests Bill Doherty to start with ... first the quick summaries. Lower down you can access more of his esources that will take you longer to read.
BEST: Click for the slides for Bad Couple Therapy and How To Avoid It, Bill Doherty
This was a Psychotherapy Networker webinar in 2011.
BEST: Or click for Bill Doherty’s paper on the same subject: Bad Couple Therapy
These give a broad picture of clinical situations that couples and therapists face, and how beginners and experienced therapists get it wrong. If anyone thinks that Couple Therapy does not need anything different than other therapies, Bill Doherty helps put you right.
Nick did a lot of transatlantic sleuthing but then discovered the following opening overview of CT in North America from Gurman's comprehensive textbook. This vividly tells the story of CT including Jay Haley’s “knock out” depicted above. There is absolutely no equivalent in the UK that would be accepted by Couple Counselling, by the various shades of British Couple Therapy, and by Family Therapy as covering the field and its history here.
BEST: Click to read the opening chapter from:
Alan S Gurman (ed) (2008) Clinical Handbook of Couple Therapy. 4th edition. Guilford Press: NY London
Here's a clear outline they call Accelerating Your Progress from the Couples Institute in California for couples and therapists for the common core of all CT models .. getting BOTH individuals ready to make changes rather than just hope the other one will make things better.
John Gottman and colleagues based their approach on famous direct observation and research of couples. Applying his findings of the signs that reliably predict couples lasting or not, he has developed "The Seven Principles for Making Marriage Work" (see below). But here are:
BEST: A brief taster of Gottman's 7 Principles - the Contents page, and from the very end, the Magic Five Hours that (after harder much harder work if they have been in trouble) successful couples use to do the trick + forgiveness. :
BEST: Brian Cade’s summary notes on John Gottman: “Myths and Mistakes of Marital Therapy”
RESOURCES - MORE:
BEST: Dr Peter Pearson's clear account of how inbuilt emotional brain-based reactions that once helped flight or fight now very much derail a couple's logic and communication. That website is a really good place to freely browse loads of issues and discussions - eg try the therapists' blog section, and the couples' blog section.
Here's the audio recording of the same Bill Doherty's webinar that produced the slides above (choose an audio player to "Open with" at the top e.g. Music Player).
BEST: Bad Couple Therapy and How To Avoid It, Bill Doherty.
Bill Doherty has given even more importance to the early contracting phase of CT – he calls it “discernment counseling” – to clarify just what kind of motivation and expectation brings each partner to CT. If a couple each thinks of CT as a place they just unload their troubles without having to make any active changes themselves, you can be in for a long stuck piece of work. If one is coming as a stage to make it ok to leave, then you need to know that at the start. Click to read more about this in his Minnesota Couples on the Brink Project.
Nick’s early notes (2011) on Couples and CT in the UK and USA show detective work in progress with an incomplete picture of CT in the UK and North America. This was before the stark evidence became clear about the long established US CT. Not recommended but do click to read Nick's detective work in progress notes.
Better than that, next is Nick’s shorter unpublished 2012 attempt to provide a clear conceptual framework to use to explain the variations across the board and the Atlantic about Couple distress and Couple Counselling / Therapy for other kinds of problems presented (eg children, depression). An interesting title?!
BEST: Click to read Nick Child. Awake and Sleeping Dogs: A Framework to Compare Patterns of Relationship Help in the UK and the US.
Next, for summarised samples of American CT. Nick’s other notes below relate to several North American CTists. They were made as part of a Psychotherapy Networker webinar based joint CPD series for Lothian Couple Counsellors and Family Therapists together to learn something new to us both during 2011 in Edinburgh.
Terry Real “New Rules of 21st Century Marriage” and Harville Hendrix “Imago Therapy”
Click to read Nick’s notes on Terry Real and Harville Hendrix.
BEST: Sue Johnson “Emotionally Focused Therapy”
Click to read Nick’s notes on Sue Johnson and EFT.
And click to hear Sue Johnson in an audio of one of her webinars (choose an audio player to "Open with" at the top e.g. Music Player)
If you prefer a less commodified approach to the same kind of EFT concerns but without an explicit attachment model:
BEST: Click to read Michele Scheinkman & Mona Dekoven Fishbane (2004) The Vulnerability Cycle: Working With Impasses in Couple Therapy. Family Process, 43, 279-299
Click to read Nick's colleague, Karen Holford’s, notes on Michele Weiner Davis “Recovering from Affair”.
This is Michele Weiner Davis's website: http://www.divorcebusting.com/
John Gottman and various colleagues are important for a rather different angle on couples and Couple Therapy. Here are the slides from John Gottman's webinar called "The Attuned Couple". The slides are very much what he talked through in the webinar. And here’s his website too: www.gottman.com/
Here’s another accessible and experienced website with blogs on a wide range of issues that CT presents:http://www.couplesinstitute.com
RESOURCES - MOST:
Popular (get them from Amazon) cheap but effective books on their models of CT work are:
Sue Johnson (2008) Hold Me Tight. Piatkus
John Gottman and Nan Silver (1999) The Seven Principles for Making Marriage Work. Orion Books
Harville Hendrix (1993/2005) Getting the Love You Want. Pocket Books
Here again is the booklist created for the EFT Conference. It has four sections: key EFT books, then key introductory books on other US Couple Therapy, on UK Family Therapy, and on UK Couple Counselling / Psychotherapy.
Here is Jay Haley’s 1963 “knock out” paper "Marriage Therapy" in the Archives of General Psychiatry. See above, and in Alan Gurman's chapter ... how come such an unlikely sounding journal was so widely read as to make this such a massive influence in USA?
BEST: Gerald R Weeks, Mark Odell, Susanne Methven (2005) If Only I had Known … Avoiding Common Mistakes in Couples Therapy. Norton. Buy this book on Amazon. If you work through this book properly, you will be a good CTist whatever your model is!
BEST: Here’s a PDF chapter from the Weeks book on “Confidentiality” which shows a more sophisticated clarity for a complex aspect of CT than we would have in the UK, and than is needed with families or other kinds of couple presentation. It also exemplifies the trend to find commonalities between the many models of CT. Nick created this pdf especially to tempt you to buy the book itself:
The best big textbook on CT for those that want to study it all is Gurman’s with the sparkling introductory chapter (linked above), systematically covering many of the main models, and also addressing specific issues and applications:
BEST: Alan S Gurman (ed) (2008) Clinical Handbook of Couple Therapy. 4th edition. Guilford Press: NY London
The webinars Nick learned from are courtesy of Psychotherapy Networker. They have loads of free and pay-for ways to learn more from the USA via their website:
http://www.psychotherapynetworker.org
Why not sign up (top right of their page) for all their notifications too? They agreed to my use of their material as part of promotion in the UK. Whether you pay or use the free opportunities, this is easily the best and cheapest way to learn (and keep replaying even) the top teachers in all fields in America.
Lastly, if you like Sue Johnson and EFT stuff, here's her keynote talk about emotional attunement from Tango to Attachment to EFT. Not sure if it will open for people who haven’t registered with Psychotherapy Networker, but have a go!
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Thanks for your interest Please remember that . . . Nick's thinking and views here are his alone. But they are based on the linked resources. The webpage is not written in stone. Improvement will continue. Please help by feeding back your views - use the contact box at the end. Suggest what what needs corrected or added. If you haven't had enough of him, there's plenty more on this forallthat.com website!! |
