Work with Ambivalence in Couples Therapy
After completing your readings this week, write a treatment plan for the ambivalent couple in the given case vignette. Be sure to integrate the suggestions from the readings/video in your treatment plan. You may use your own treatment plan or one from the readings. Remember to give credit to the author(s) of the original treatment.Initial Phase of Treatment 1. Increase couple’s awareness of negative interaction cycle and the primary emotions for each. a. Identify the negative interaction cycle with both secondary and primary emotions for each partner. b. Reframe their conflict in the broader systemic context of the negative cycle to help create a greater sense of unity and understanding. Working Phase of Treatment 2. Increase emotional engagement and expression of withdrawn partner to reduce avoidance. a. Use empathy, validation, and conjecture to help withdrawn partner express attachment needs and primary emotions. b. Facilitate enactments to allow couple to directly communicate about attachment needs and to facilitate acceptance by partner. 3. Reduce criticism by pursuing partner and replace with increased nonblaming expression of underlying attachment needs. a. Heighten pursuer’s primary emotions to help facilitate softening of critical position. Header_0 b. Facilitate enactments to promote acceptance and prompt new healing interaction cycles. 4. Increase the ability of both partners to respond to each other and create a sense of relational safety. a. Track interaction cycle to help couple develop new interaction patterns. b. Use enactments to help couple develop new ways of responding to each other. Closing Phase 5. Increase couple’s ability to effectively respond to new stressors in the relationship. a. Track positive interaction cycles to identify what worked and how they affected each person’s sense of emotional safety. 6. Solidify secure bond by increasing the consistency of the positive interactions. a. Facilitate enactments that highlight how safety is created for each partner. b. Heighten new emotional responses. Case study – Barbara and Ron
Barbara and Ron attended therapy following multiple disputes that became recurrent in their couple. Barbara stated that she was irritated by Ron’s inability to be respectful of their home environment. It seems that he did not care about keeping the house clean. While both partners were working, Barbara took charge of the household by performing main housekeeping tasks. She took as a great offense Ron’s inability to be respectful of her time and his inability to keep the rooms and bathrooms clean. Ron stated that he was surprised about Barbara’s reactions and found that she was exaggerating. He stated that he could no longer tolerate Barbara’s nagging about his behavior and was ready to move out if they don’t find some of resolution.SAMPLE TREATMENT PLAN PRIMARY PROBLEM: ANGER MANAGEMENT Definitions: Expressions of anger that include threats, breaking objects, violating others’ individual space, and refusal to speak to certain family members. Expressions of anger that are perceived by others as demeaning, threatening, or disrespectful. Disagreement among family members about the threat created by the angry member. Goals: Terminate expressions of anger that are demeaning, threatening, disrespectful, or violent. Get in touch with feelings of emotional pain and express them verbally in appropriate ways rather than through angry outbursts. OBJECTIVES INTERVENTIONS 1. Each family member identifies the destructive effects that his/her uncontrolled anger has had on all family members, including self. .devreser sth 2. Identify any secondary gain that gir llhas been derived through A .deexpressing anger in an taropintimidating style. rocnI ,snoS 3. Family members sign a contract & yestipulating that they will attempt liW nto manage their anger with the hoJ .support and guidance of family 410therapy. 2 © thgirypoC 1. Have each family member describe how his/her respective uncontrolled expression of anger is counterproductive to himself/herself and to other family members; assist them in identifying the negative effects of uncontrolled anger (e.g., fear, withdrawal, guilt, revenge, etc.) on others. 1. Assist family members in identifying what secondary gain (acquiescence to demands, fear based service, etc.) is derived from uncontrolled anger. 1. Urge family members to sign a contract agreeing to accept responsibility for containing their own anger and managing it effectively. Dattilio, Frank M., et al. The Family Therapy Treatment Planner, with DSM-5 Updates, 2nd Edition, John Wiley & Sons, Incorporated, 2014. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ncent-ebooks/detail.action?docID=1891004. Created from ncent-ebooks on 2022-02-23 18:32:31. 4. Implement assertiveness as a INTRODUCTION 9 1. Clearly define examples of replacement for angry aggression to declare independence. nonassertive, assertive, and aggressive expressions of anger and then have each family member give personal examples of each to demonstrate their understanding of the concept (see Your Perfect Right by Alberti and Emmons). 2. Use role-playing and modeling to teach assertiveness as an alternative to angry aggressiveness used to declare independence. 5. Identify the various cues for anger as it escalates. 6. Verbalize an understanding of the steps in using time-out as an anger control technique. .devreser sthgir llA .detaroprocnI ,snoS & y 7. Report on the use of time-out at eliW home to control anger. nhoJ .4102 © thgirypoC 1. Teach family members how to identify the cognitive, affective, behavioral, and physiological cues of anger and how to differentiate low, moderate, and high ranges; recommend the book Angry All the Time by Potter-Efron. 1. Teach family members the five steps in using time-out to control anger: (1) self-monitoring for escalating feelings of anger and hurt; (2) signaling to another family member that verbal exchange is not a good idea; (3) acknowledgment of the need for the other family members to back off; (4) separation to cool down and use cognitive self-talk to regain composure; and (5) returning to calm verbal exchange. 1. Assign family members to implement the time-out technique at home; review results, reinforcing success and redirecting for failures. Dattilio, Frank M., et al. The Family Therapy Treatment Planner, with DSM-5 Updates, 2nd Edition, John Wiley & Sons, Incorporated, 2014. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ncent-ebooks/detail.action?docID=1891004. Created from ncent-ebooks on 2022-02-23 18:32:31. 10 THE FAMILY THERAPY TREATMENT PLANNER 8. Implement the use of the “turtle” 1. Suggest the use of the “turtle” technique of retreat to control technique, in which family anger escalation. members imagine themselves individually retreating into their shells until they cool down. DIAGNOSIS ICD-9-CM ICD-10-CM DSM-5 Disorder, Condition, or Problem 312.34 F63.81 Intermittent Explosive Disorder
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