Category Archives: CBT

What Is Solution-Focused Therapy and How Does It Work?

Most types of psychotherapy involve exploring feelings, being validated, finding explanations, exploring wishes and dreams, setting goals, and gaining clarity. Every therapist has unique ways of working with clients, based on his or her personality, training, and views of how people change.

A solution-focused therapist is likely to do the following:

1.    Instead of going over past events and focusing on problems, the therapist helps you envision your future without today’s problems.

2.    During the course of therapy (often as few as 3 to 6 sessions), the therapist helps you discover solutions.

3.    The therapist encourages you to identify and do more of what is already working.

4.    The therapist guides you to identify what doesn’t work and to focus on doing less of it.

5.    The emphasis is on the future, not the past.

6.    SFBT therapists believe that the client is the best expert about what it takes to change his or her life.

7.    The therapist’s role is to help you identify solutions that will remove the barriers to having the life you want.

Solution-Focused Brief Therapy (SFBT) is a process that helps people change by constructing solutions rather than dwelling on problems. This type of therapy tends to be shorter-term than traditional psychotherapy. Steve de Shazer and Insoo Kim Berg of the Brief Family Therapy Center in Milwaukee are the originators of this form of therapy.

The SFBT therapist helps the client identify elements of the desired solution, which are usually already present in the client’s life. The client learns to build on these elements, which form the basis for ongoing change. Rather than searching for the causes of the problem, the focus is on defining the changes and making them a reality. The two key therapeutic issues are: (1) how the client wants his or her life to be different, and (2) what it will take to make it happen.

Creating a detailed picture of what it will be like when life is better creates a feeling of hope, and this makes the solution seem possible. The therapist helps the client focus on the future and how it will be better when things change. It is important to develop a set of specific, detailed goals. These goals drive the therapy process and keep it focused and efficient.

Why SFBT Is Usually Short-Term

SFBT therapists don’t set out to artificially limit the number of sessions. A good brief therapist will not focus on limiting sessions or time, but rather on helping clients set goals and develop strategies to reach those goals. Focusing on the client’s goals and the concrete steps needed to achieve them usually takes less time than traditional therapy, in which the client typically spends many sessions talking about the past and explores reasons and feelings. SFBT therapists aim to provide clients with the most effective treatment in the most efficient way possible so that clients can achieve their goals and get on with their lives. As a result of this focus, the counseling process often requires as few as six sessions.

Types of Problems That SFBT Addresses

Solution-Focused Brief Therapy is an effective way of helping people solve many kinds of problems, including depression, substance abuse, eating disorders, relationship problems, and many other kinds of issues. Since it focuses on the process of change rather than on dissecting the problem, more serious issues do not necessarily require different treatment. The SFBT therapist’s job is to help clients transform troubling issues into specific goals and an action plan for achieving them.

In The Miracle Method, authors Scott D. Miller and Insoo Kim Berg describe how to create solutions with these steps:

1.    State your desire for something in your life to be different.

2.    Envision that a miracle happens and your life is different.

3.    Make sure the miracle is important to you.

4.    Keep the miracle small.

5.    Define the change with language that is positive, specific, concrete, and behavioral.

6.    State how you will start your journey rather than how you will end it.

7.    Be clear about who, where, and when, but not why.

Signs That You Should Consider Seeing a Therapist

There are several ways to know when you would be doing yourself a favor by finding a licensed, professional therapist to work with.

1.    You’ve tried several things on your own, but you still have the problem.

2.    You want to find a solution sooner rather than later.

3.    You have thoughts of harming yourself or others.

4.    You have symptoms of depression, anxiety, or another disorder that significantly interfere with your daily functioning and the quality of your life. For example, you have lost time from work, your relationships have been harmed, or your health is suffering. These are signs that you need the help of a trained, licensed professional.

Life Balance

It is important to balance aspects of life by taking one step at a time. One of the most important things to remember is to set aside specific times to accomplish tasks. Getting more organized, setting specific times for doing tasks, and achieving a schedule will help individuals attain diminutive tasks throughout every day duties. Learning time management skills is definitely a way to help one accomplish goals.

Many people who claim to be victims of psychological or physiological effects of stress may have been able to deal more efficiently with the stressors by using different coping skills. Because we can not always change and manipulate stress nor our external realities, sometimes changing one’s outlook on life greatly affects the way an individual deals with and views stressors. For example, an individual who has a positive outlook, is physically fit, and in touch with many of the dimensions of her being may be able to make a connection by really listening to her body and focusing what her body may be trying to telling her. It is important that people know the avenues to use while dealing with and preventing stress. Massage therapy, accupuncture, yoga, and meditation may be a few ways to help individuals make the connection to life balance . I’ve learned that I really hold tension in my shoulders. So, when I am stressed out I try and work on releasing the tension in this area of my body. Deep relaxation may be another way to manage stress. I have actually written a few of my own meditations to practice.

The basic difference between constructive and destructive reactions to stress is that destructive reactions are maladaptive and constructive reactions are usually more effective.

Examples of destructive reactions are:

1.      Defensive Behavior

2.      Using Drugs and Alcohol

3.      Burnout

             Examples of constructive reactions are:

1.      Changing Self Defeating Thoughts and Messages

2.      Acquiring A Sense of Humor

3.      Utilizing Tips for Managing Stress

How to Forgive Another Person for Past Hurts

No one gets through life without being hurt by another person. We all have experienced the pain of a thoughtless remark, gossip, or lie. If you have experienced an unhappy marriage, the devastation of infidelity, or suffered physical or emotional abuse, you know what it feels like to be hurt. It is tempting to hold on to these feelings and build a wall of safety around yourself, but the best way to heal is to forgive the person who hurt you.

What Is Forgiveness?

When you forgive another person, you no longer allow their behavior to cause you anger, pain, bitterness, or resentment. When you choose not to forgive, you make the choice to hold on to your feelings of resentment, anger, and pain.

Why Should I Forgive?

Think of forgiveness as a gift that you give to yourself. It is not something you do for the person who hurt you. It is a gift to yourself because it enables you to stop feeling painful feelings and pushing others away. Forgiveness frees you from anger and allows you to restore your ability to have close and satisfying relationships with others.

Anger is a poisonous emotion that comes from being hurt. When you are consumed with anger and bitterness, it hurts you at least as much as it hurts the person who has harmed you. It is as if you are filled with poison. If these feelings are not resolved, they can begin to eat you up inside. You have two choices: to stay connected to the person who hurt you by keeping these poisonous feelings alive, or to let the feelings go and forgive the person who harmed you. When you withhold forgiveness, think about who is actually being hurt. It is more than likely that the person who is filled with anger and anxiety is you, not the other person.

What Forgiveness Is Not

Forgiving another does not mean you will never again feel the pain or remember the thing that hurt you. The hurtful experience will be in your memory forever. By forgiving, you are not pretending the hurtful behavior never happened. It did happen. The important thing is to learn from it while letting go of the painful feelings.

Forgiveness is not about right or wrong. It doesn’t mean that the person’s behavior was okay. You are not excusing their behavior or giving permission for the behavior to be repeated or continued.

When you forgive another, it does not mean you wish to continue your relationship with them. This is a separate decision. You can forgive a person and live your life apart from them.

Forgiveness can only take place because we have the ability to make choices. This ability is a gift that we can use it whenever we wish. We have the choice to forgive or not to forgive. No other person can force us to do either.

Steps to Forgiveness

The experience of forgiveness is a process. Since each situation is unique, it is impossible to predict how long it will take or which steps will be the most important to carry out. Here are some ideas for beginning the process:

1.    Acknowledge your feelings of anger and hurt. Sometimes it seems like it might be easier to deny the feelings or push them back down, because it hurts to feel them. In the long run, denying these feelings only causes you more pain and actually prolongs the hurt.

2.    Express your feelings constructively. No matter how badly you were treated or how angry you are, it is never acceptable to harm anyone else. You may need to find a neutral third party to talk to until you feel calmer toward the person who hurt you.

3.    Depending on the situation, the person who hurt you may still be a danger to you, physically or emotionally. It is important to protect yourself from being harmed again.

4.    At some point, you will see that you are harmed by holding on to feelings of hurt and anger. These feelings can take up space in your psyche and intrude on your sense of well-being. You may feel physically ill. This is when you will be ready to make the decision to stop hurting.

5.    Be willing to see the situation from the other person’s point of view. This will help you develop compassion, which will eventually replace the feelings of anger. One helpful technique is to write a letter to yourself as if you were the other person. Use his or her words to explain the hurtful things that were done to you. This takes you out of the victim role and helps you restore your power.

6.    It is not necessary to know why the hurtful behavior happened. Even if you do learn the reason, you probably won’t feel any better. Chances are, the person who harmed you isn’t sure why they did it either.

7.    Think about the part you played in the situation. Don’t blame yourself; rather, forgive yourself for the role you played.

8.    Recall a time when you caused harm to another person, and that person forgave you. Remember what the guilt felt like. Then, remember what you felt when the other person forgave you. You probably felt grateful and relieved. Remember how this felt and consider giving this same gift to the person who hurt you.

9.    Make a list of the actions you need to forgive. Describe the specific actions that caused you harm. State what happened, as objectively as possible.

10.    Make a list of the positive aspects of your relationship with the person who hurt you. There must have been something positive, or you wouldn’t have participated in it. This helps you regain some perspective and not paint the picture in completely negative terms.

11.    Write a letter to the person who harmed you. This letter is for your healing; you do not need to mail it. Describe the positive aspects of the relationship and express your forgiveness for the hurtful behaviors. Express all of your feelings, both positive and negative.

12.    If you have decided to end your relationship with the person you have forgiven, have a ceremony to symbolize it. You may wish to burn the letter and the list, or you may visualize some kind of ending.

13.    Sometimes the person you need to forgive is you. You can begin to forgive yourself by realizing that when you made the mistake, you did not set out deliberately to hurt another person. If you had known how to make better choices, you would have. You did the best you could at the time.

14.    Make the forgiveness tangible. You may choose to send the letter to the person you are forgiving or tell a trusted friend what you have done.

Once you have let go of the pain and released yourself form past hurts, you will most likely feel a greater sense of freedom and well-being. Now you are free to move on with your life without bitterness and resentment. You no longer need to look back on your past with anger.

You Can Have Excellent Listening Skills

Any professional counselor will tell you that one of the biggest problems they see among their clients is poor listening skills. People get into trouble in their relationships because they have not developed their ability to listen and communicate.

Barriers to Effective Communication

There are some good reasons why many people are less-than-effective communicators. These are the most common reasons:

    Lack of skill; not knowing how

    Not taking the time to think through what one wants to say

    Not taking the time to anticipate what another person might be thinking and feeling

    Fear of revealing too much of oneself

    Being afraid of another person’s anger

    Not wanting to hurt another person’s feelings

Four Key Listening Skills

Listening skills are the building blocks of effective communication. These skills enable you to demonstrate that you are interested in what the other person has to say, as well as hearing and understanding the other person. Four key listening skills are open-ended questions, summary statements, reflective statements, and neutral questions and phrases. They are easy to learn with a little practice.

Open-ended questions begin with what, why, how do, or tell me.

    These questions get the other person to open up and elaborate on the topic.

    Asking these kinds of questions gets the other person involved by giving him or her a chance to tell what they think or know.

    These questions are designed to encourage the other person to talk.

    They are useful when the other person is silent, or reluctant to elaborate.

    They are also useful in dealing with negative emotions (such as anger or fear), since they help encourage the other person to vent feelings.

Examples of open-ended questions:

“How do you feel about what she said?”

“Tell me all about this new project.”

“What do you think about the new offices?”

Summary statements sum up what you hear the other person is saying.

    A summary statement enhances the other person’s self-esteem by showing that you were listening carefully.

    It also helps you focus on facts, not emotions.

    It helps the other person clarify his or her own thinking by hearing your summary.

    Summary statements also help you deal with multiple disagreements so you can deal with them one by one.

    They help eliminate confusion by focusing on the relevant facts.

    Summary statements also help you separate the important issues from the trivial.

Examples of summary statements:

“So you’re saying you want to go to the library and the bookstore before you decide which books you need. Then you want to go over your choices with me.”

“You’re saying that you tried your best on this homework assignment, but it was beyond your control.”

Reflective statements rephrase what you heard the person say and reflect it back.

    A reflective statement is a way of demonstrating that you were listening carefully.

    It shows the other person that you take them seriously and want to understand what they are feeling.

    It helps you clarify whether you understand what the other person is saying and feeling.

Examples of reflective statements:

“You feel sad because your mother has to leave so soon after such a good visit.”

“You’re feeling upset because I was late again.”

“You sound frustrated that you won’t be able to finish the project on time.”

Neutral questions and phrases get the other person to open up and elaborate on the topic you are discussing.

    These questions are more focused than open-ended questions.

    They help the other person understand what you are interested in hearing more about.

    They further communication because they help you gain more information.

    When you ask these kinds of questions, you demonstrate to the other person that you are interested and that you are listening.

Examples of neutral questions and phrases:

“Give me some more reasons why we should buy the computer now rather than in January.”

“Tell me more about why you want to take this job.”

Try Your Hand at Using Listening Skills

Here are some common life situations where good listening skills would come in handy. Read each one and think about which of the four listening skills would help the most. Write an example of what you could say to the other person to validate his or her feelings and encourage further expression of emotion. Check your answers with those on the back page of this newsletter.

1.    Your spouse returns from an important business trip. He is very quiet. When you ask him how the trip went, he shrugs his shoulders and says, “Okay.”

Which listening skill would be effective in this situation?

What could you say?

2.    Your coworker says, “I really wish I didn’t have to go to that conference next week. I know I have to, but I wish I could get out of it somehow. I don’t like traveling, I hate being away from my family, and I resent having to spend time kissing up to those field people!”

Which listening skill would be effective in this situation?

What could you say?

3.    “I wish I could just stay home and garden today,” your spouse says.

Which listening skill would be effective in this situation?

What could you say?

4.    You are 20 minutes late to pick up your son for a soccer game. There was no way you could let him know you were going to be late. When you arrive, he opens the car door and glares at you. He growls, “I thought you’d be on time for once!”

Which listening skill would be effective in this situation?

What could you say?

5.    Your business partner wants to stay in your present office space, which you have outgrown. You want to look for a bigger place. She says, “It makes me so nervous to make such a big commitment! And what if we don’t like it in the new place? I think we should just stay where we are.”

Which listening skill would be effective in this situation?

What could you say?

Suggested Answers to Listening Skills Exercise

Lots of different listening skills would be effective in each of the five situations. Here are some suggested answers:

1.    Open-ended question: “Why don’t you tell me about it?”

2.    Reflective statement: “You sound frustrated and upset about having to go to the conference.”

3.    Reflective statement: “You really love gardening because it’s so relaxing.”

4.    Reflective statement: “You are really upset with me for being late, aren’t you?”

5.    Summary statement: “You’re afraid that we’ll be in over our heads and will think it’s a mistake.”

Divorce Recovery Strategies

As a licensed mental health professional, I work with many individuals, couples, and families who are affected by divorce. I have developed this list of survival strategies for people who are experiencing divorce. If you or someone you love is in this situation, I hope these ideas will help you.

1.    Take your time as you adjust to your changed life circumstances. Recognize that you are going through a major life transition that cannot be rushed.

2.    Set up temporary arrangements to help you get through the changes involved in your divorce process.

3.    You will often feel frustrated. Avoid the temptation of acting for the sake of acting just because it gives you a temporary feeling of being in control.

4.    When you feel uncomfortable, slow down and identify what you are feeling and why.

5.    Don’t force any more changes on yourself than are necessary.

6.    Explore both the benefits and costs of your new life.

7.    Think about the future. In your journal, explore the question, “What is waiting to happen in my life now?”

8.    Remember to ask yourself, “What am I supposed to learn from this?”

9.    Protect yourself against the inevitable forgetfulness and absent-mindedness which many divorcing people report. Make a list of important account numbers, telephone numbers, and the like, and keep them in a safe place.

10.    Watch out for too many changes in your life as you recover from the divorce and the changes in your life circumstances. Change causes stress, and you have enough right now.

11.    Let people help you.

    If it’s impossible to reciprocate, say so.

    People know that your life isn’t like it used to be.

    Don’t let your inability to reciprocate prevent you from accepting what people willingly offer.

12.    Let go of your need for perfection. You will not survive emotionally unless you lower your expectations.

13.    Develop your ability to be flexible and find creative ways to solve problems.

14.    Learn to set priorities. Do the most important things first.

15.    Trust your gut feelings. Pay attention to your instincts and act on them.

16.    Simplify everything in your life. You cannot afford to keep it complicated.

17.    Find an outlet for your anger. If a friend is not available, look for a minister, rabbi, or professional counselor. If money is an issue, look for a therapist who will see you for a low fee.

18.    Teach yourself to let go of guilt. You don’t have time for it and it’s not necessary.

19.    Focus on issues you have control over. If something is beyond your control, don’t waste your emotions on it.

20.    Create a ceremony to acknowledge your divorce.

21.    Learn to be assertive. You can’t say yes to every request, whether it is from your family members or people in the community who want your time and resources. If you give it all away, you will have nothing left for yourself.

22.    Find ways to take care of your body. Get regular checkups and make time to exercise. You need rest now more than ever. Watch your alcohol intake.

23.    Find someone who will listen to you. Sometimes you have to ask, for example, “I need a sounding board right now. Can I have 15 minutes of your time?”

24.    Rent a sad movie and let yourself cry (when the kids aren’t around). Crying allows you to release the sadness that you are sure to feel.

25.    Do at least one fun thing for yourself every week.

26.    In your private journal, make a list of all the things you’re afraid of.

27.    In your private journal, make a list of all the things you worry about.

If you have children:

28.    Manage your own emotions so you will be able to help your child manage his or her struggle.

    Learn as much as you can about how children respond to divorce and life in a single-parent home.

    Do not expect your child to respond the same way you do.

    Take your child’s developmental stage into consideration when responding to his or her behavior.

29.    Make it okay for your children to talk to you about their feelings.

30.    Keep appropriate boundaries.

    Don’t give in to the temptation to let your child take care of you.

    Let your children be children.

    Avoid burdening them with your feelings and the facts of the divorce.

    Find another adult to be your sounding board.

31.    Even though you may be unable to be present as much as in the past, your children still need adult supervision. Look for ways for other adults to look in on your kids when they are home alone, even when they are teenagers.

32.    Just because your child appears to be handling his or her emotions well, don’t assume that he or she is okay. Some kids respond to divorce by becoming overly responsible or by closing down their emotions. They may need to hear, “Tell me how you’re feeling.”

33.    While it is important to listen and accept your children’s feelings, it is equally important to set limits on behavior.

34.    Keep a private journal where you express your feelings. Be sure to keep it in a private place where your children won’t find it. A journal provides a place to express anger, sadness, loneliness, and fear—all of those feelings you feel every day as a single parent.

35.    Remind yourself that recovering from divorce will take time. Your recovery will happen on its own schedule, and it will happen. You will get through this intact.

36.    Get together with other single-parent families. Sharing times with people facing similar issues can make you feel normal.

Resolving Conflicts in Relationships

Every relationship has conflicts. In some relationships, conflict is a serious problem; in others, differences seem to be resolved without creating a major incident.

Think about the kinds of conflicts that happen in your daily life. These are typical:

1.    Disagreements over who should do what

2.    Disagreements over how things should be done

3.    Conflicts of personality and style

Nonproductive Ways of Dealing with Conflict

Now that we’ve identified some typical situations where conflict arises in your everyday lives, let’s look at some examples of ways that people deal with them. These are the common ones:

1.    Avoid the conflict.

2.    Deny the conflict; wait until it goes away.

3.    Change the subject.

4.    React emotionally: Become aggressive, abusive, hysterical, or frightening.

5.    Find someone to blame.

6.    Make excuses.

7.    Let someone else deal with it.

All of these responses to conflict have one thing in common: They are all nonproductive. All of them are destructive, some physically. This is why learning to manage conflict is so important.

Factors That Affect How People Manage Conflict

The skills involved in managing conflict are learned behaviors. None of us is born knowing how to deal with differences of opinion, arguments, or turf wars. Some of the factors that affect how we behave in the face of conflict are:

1.    Behavior learned in families. In some families, conflict and confrontation are a communication style. In others, conflict always remains hidden.

2.    Behavior learned from role models. People who have had a teacher or boss who modeled effective conflict resolution skills are more likely to develop these skills themselves.

3.    Status. People in higher-status positions usually feel freer to engage in conflict and are less likely to avoid confrontation.

4.    Unwritten rules. Some groups encourage conflict; others have unwritten rules that it is to be contained or avoided.

5.    Gender differences. Males are generally encouraged to be more confrontational than females.

Active Listening

Active listening is a valuable skill for resolving conflicts because it enables you to demonstrate that you understand what another person is saying and how he or she is feeling about it. Active listening means restating, in your own words, what the other person has said.

Active listening is a way of checking whether your understanding is correct. It also demonstrates that you are listening and that you are interested and concerned. These all help resolve a situation where there are conflicting points of view.

Active listening responses have two components: (1) naming the feeling that the other person is conveying, and (2) stating the reason for the feeling.

Here are some examples of active-listening statements:

“Sounds like you’re upset about what happened at work.”

“You’re annoyed by my lateness, aren’t you?”

“You sound really stumped about how to solve this problem.”

“It makes you angry when you find errors on Joe’s paperwork.”

“Sounds like you’re really worried about Wendy.”

“I get the feeling you’re awfully busy right now.”

Actively listening is not the same as agreement. It is a way of demonstrating that you intend to hear and understand another’s point of view.

Benefits of Active Listening

If a person uses active listening as part of his or her communication style, it has a positive effect on dealing with conflicts when they arise. This is because of the following benefits:

1.    It feels good when another person makes an effort to understand what you are thinking and feeling. It creates good feelings about the other person and makes you feel better about yourself.

2.    Restating what you’ve heard and checking for understanding promotes better communication and produces fewer misunderstandings.

3.    Responding with active listening has a calming effect in an emotional situation.

General Tips for Managing Conflict

1.    Stick with “I” statements; avoid “you” statements.

2.    Avoid name-calling and put-downs (“A reasonable person could see that…”).

3.    Soften your tone.

4.    Take a time-out (“Let’s take a break and cool down”).

5.    Acknowledge the other person’s point of view (agreement is not necessary).

6.    Avoid defensive or hostile body language (rolling eyes, crossing arms in front of body, tapping foot).

7.    Be specific and factual; avoid generalities.

Preventing Conflicts

Now that we’ve talked about how to resolve a conflict, let’s look at how to prevent conflicts from happening. Think of situations in your life where there don’t seem to be many conflicts. What might be happening there? Chances are, you are practicing one of the following conflict-prevention skills:

1.    Bring issues out in the open before they become problems.

2.    Be aware of triggers and respond to them when you notice them.

3.    Have a process for resolving conflicts. Discuss the process with those around you and get agreement on what people should do in cases of differing viewpoints.

How to Balance Work and Family Life

What Is Your Definition of Success?

If you want to create balance in your life, it is important to know how you define success. The following list is a place to start. Cross off those that don’t seem important to you and add your own. Next, identify which of the items on your list are the most essential to your success definition and which items present the greatest challenge to you.

1.    Being able to move on when a situation is no longer productive or positive

2.    Being satisfied with your work situation

3.    Enjoying the present, not putting off the good things until some time in the future

4.    Expressing your creativity

5.    Fulfilling your potential

6.    Holding yourself with esteem separately from your work

7.    Being authentic

8.    Identifying your values and basing your choices on them

9.    Managing your money well

10.    Not feeling envious of others

11.    Paying attention to your spiritual life

12.    Spending time in fun ways away from your workplace

13.    Spending time with people you cherish and enjoy

14.    Taking good care of yourself

15.    Understanding when to fight for something and when to give in

What would you add? Which items present the greatest challenge to you?

The 80/20 Rule

The 80/20 Rule, also known as the Pareto Principle, says that 20% of what we do produces 80% of the results. Some examples of this principle are:

    20% of the people sell 80% of the widgets.

    20% of the salespeople earn 80% of the commission.

    20% of the parts in your car cause 80% of the breakdowns.

    20% of the members of an organization do 80% of the work.

The 80/20 principle can help anyone create balance in their life. Here’s how:

1.    Identify the times when you are most happy and productive (i.e., the 20% that produces the 80%) and increase them as much as possible.

2.    Identify the times when you are least happy and productive (i.e., the 80% that produces the 20%), and reduce them as much as possible.

Your Seven Habits of Success

You have probably heard of Stephen Covey’s Seven Habits of Highly Effective People. As you create balance in your life, think about your own list of success habits. What seven things would lead to more happiness in your life if you did them every day? Here are some ideas to get you started:

1.    Do something you love doing for at least part of the day.

2.    Get some physical exercise.

3.    Get some mental exercise.

4.    Stimulate yourself artistically.

5.    Stimulate yourself spiritually.

6.    Do something for someone else.

7.    Do something just for fun.

8.    Acknowledge yourself for something you said or did.

What ideas would you add?

Dealing with Workaholism

What if a person needs more than just self-help in dealing with a lack of balance in work and family life? An organization called Workaholics Anonymous can help.

Workaholics Anonymous is a 12-step recovery program similar to Alcoholics Anonymous. It is a “fellowship of individuals who share their experience, strength, and hope with each other that they may solve their common problem and help others recover from workaholism. The only requirement for membership is a desire to stop working compulsively.”

How Do You Know if You Are a Workaholic?

Ask yourself these questions if you think you might be a workaholic:

1.    Are you more comfortable talking about work than anything else?

2.    Do you become impatient with people who do things besides work?

3.    Do you believe that more money will solve the other problems in your life?

4.    Do you get irritated when people ask you to stop working and do something else?

5.    Do you get more energized about your work than about anything else, including your personal relationships?

6.    Do you look for ways to turn your hobbies into money-making endeavors?

7.    Do you often worry about the future, even when work is going well?

8.    Do you take on extra work because you are concerned that it won’t otherwise get done?

9.    Do you take work home with you? Do you work on days off? Do you work while you are on vacation?

10.    Do you think about your work while driving, falling asleep, or when others are talking?

11.    Do you think that if you don’t work hard you will lose your job or be considered a failure?

12.    Do you work more than 40 hours in a typical week?

13.    Do you work or read while you are eating?

14.    Have your long hours hurt your family or other relationships?

Relationship Checkup

Most adults engage in long-term relationships, including marriage and other committed partnerships. Nearly everyone experiences difficulties in their marriage or committed relationship from time to time, but some people seem more prepared to anticipate these hard times and respond to them more skillfully than others.

The Relationship Checkup is a list of 11 points that will help you evaluate your relationship. These points are based on recent research completed separately by psychologists Judith Wallerstein and John Gottman (see Suggested Reading, last page). Check off the statements that apply to your relationship, and you will quickly gain a sense of the strengths and the opportunities for improvement.

1.    People in successful, long-lasting relationships invested themselves fully in the relationship. While they have positive relationships with their parents, siblings, and other relatives, they are not overly involved with them. Some signs that you have a healthy relationship with your family (not too close, not too distant) include:

    Your families visit when invited.

    Their visits are short but satisfying.

    You speak with family members by phone, but not too often.

    Family members give advice when they are asked.

The following are some signs that your family may be too involved in your life. This can create problems in your relationship over time.

    Your family members visit too often.

    They stay too long.

    They telephone frequently.

    They give unsolicited advice.

    They drop in unannounced.

2.    People in successful relationships have their own identity as a couple. There is a feeling of both togetherness and independence in the relationship. If you have developed an identity as a couple, the following things are most likely true:

    You feel loyal toward each other.

    You listen carefully to each other.

    You know each other’s histories.

    You pay attention to each other’s moods and body language.

    You share your thoughts and feelings.

    You allow each other a private space and don’t intrude on it.

    You respect each other as separate, autonomous people.

If you have not fully developed your sense of identity as a couple, you will recognize signs like these:

    You are sometimes disloyal toward each other.

    You don’t listen carefully to each other.

    You don’t know very much about each other’s pasts.

    You ignore each other’s moods and body language.

    You keep your thoughts and feelings to yourselves.

    You sometimes invade each other’s private space.

    Even though you may live in the same house, it sometimes seems like you are living parallel lives.

3.    Bringing children into a relationship changes it radically. Couples with children learn to successfully integrate them into their relationship. Positive signs include:

    You accept that there are times when you must place your own needs after the needs of your child.

    You do your best to stay in touch with each other emotionally and nurture your relationship.

    You set aside time every week for the two of you to spend time alone together.

The following signs indicate that you have not fully integrated children into your relationship:

    You resent the times when you must put your child’s needs ahead of your own.

    You are overly focused on your child.

    You have lost touch with each other emotionally.

    You hardly ever find time to be alone with your partner.

4.    Every relationship is challenged by crises and life transitions. Losing a job, a death in the family, a serious accident, or other significant event can test any relationship. If your relationship has successfully navigated life’s crises and transitions, the following statements are most likely true:

    You never blame each other for the stress that comes with the crisis.

    You face difficult times as a team.

    You look for ways to support each other emotionally.

    You help each other keep your perspective when there is a crisis.

    You seek outside support during times of crisis (talking to friends and family, seeing a counselor, etc.).

If the crises and life transitions have done harm to your relationship, you have probably experienced the following during the difficult times:

    One partner seems to emotionally abandon the other.

    One partner blames the other.

    One partner becomes extremely angry, worried, or anxious.

    You don’t seek support from people who could help you.

5.    Successful relationships are safe places where anger, conflict, and differences may safely be expressed. Each partner is allowed to have and express their own views. The following signs point to this being true:

    You have had serious conflicts, but you have not allowed them to damage your relationship.

    You respect the other person’s right to stand his or her ground.

    You may find anger uncomfortable, but you accept that it is a part of life.

In relationships where it is not safe to express conflict, the following things are true:

    Your conflicts have harmed your relationship.

    You disagree about many things but never talk about them.

    You both try to intimidate the other into agreeing with your point of view.

    Anger is so uncomfortable that you avoid it.

    There are no limits to what you will do when you become angry.

6.    Successful long-term relationships have a positive sexual component. The partners take care to protect their sexual relationship from the demands of work and family. The signs of such a relationship are:

    You sometimes have different levels of sexual need, but you make room for each other’s changing levels of desire.

    You are honest with each other about your changing sexual desires and feelings.

    You set aside time for your sexual relationship and protect your privacy.

If a sexual relationship is less than satisfying, the following statements are true:

    You find it hard to talk about sex.

    Sex is like a battlefield.

    You never have time for sex.

7.    Successful partners share laughter and fun times, and work to maintain their mutual interests. For example:

    You have fun together.

    You make each other laugh.

    You find each other interesting.

    You each have your own interests that you pursue on your own.

If your relationship is becoming stale, you will tend to describe it like this:

    You rarely have fun together anymore.

    You don’t laugh much when you are together.

    You are bored with each other.

    You avoid spending time together.

    You have few shared interests.

8.    Relationships that last are safe places where you can let down your guard and be vulnerable. You know you can count on the other to comfort and encourage you. If this is true, you might describe it as follows:

    It is okay to be vulnerable when you are with your partner.

    You understand each other.

    You encourage each other.

    You pay attention to each other’s moods and respond when the other seems needy.

If your relationship is not a very safe place, the following is probably true:

    It is not safe to be needy and vulnerable in your relationship.

    You exhaust each other’s emotional reserves.

    You don’t pay attention to each other’s moods.

    When you are worried about something, you avoid telling your partner.

    You feel worse about yourself when you are with your partner.

9.    People who have successful long-term relationships stay romantic and idealistic about each other, even though they are growing older. These are some of the signs of such a relationship:

    You have good memories of when you fell in love with your partner.

    You are glad to be growing older with your partner.

If you have lost some of the romance of your relationship, you are likely to agree with these statements:

    You can hardly remember the days when the two of you first fell in

love.

    Seeing your partner grow older makes you feel badly because it reminds you that you are growing older.

10.    You have far more positive moments in your relationship than negative ones. Some signs of positive moments include:

    You show affection for each other.

    You apologize for the hurtful things you may say or do.

    You show each other empathy.

    You are polite to each other.

Examples of negative moments include:

    Your discussions often leave you feeling frustrated.

    You often pick on each other.

    Many of your conversations turn into arguments.

    You behave disrespectfully toward each other.

    You are physically violent with each other.

11.    People in successful relationships are able to manage conflict productively. They are skilled at keeping times of discord from getting out of control. For example:

    You call a time-out when your emotions escalate.

    You know how to calm yourselves down.

    You take care to speak and listen nondefensively.

    You take care to validate the other person’s point of view, even when you disagree with it.

Couples in less successful relationships allow conflict to become damaging in the following

ways:

    You blame each other.

    You treat each other disrespectfully.

    You deny responsibility for your own actions.

    You become so angry that you leave or emotionally withdraw.

Number of items you checked in the nonshaded areas:

Number of items you checked in the shaded areas:

Ideally, you checked no items in the shaded areas. If you checked more than five, you have some opportunities to improve your relationship. As a beginning, you may wish to read books about these issues. You may also wish to make an appointment for a free consultation with one of our professional counselors and develop a relationship-building plan. You will find additional relationship-building tips on our web site.

Skills for Making Your Marriage Thrive

Any marriage counselor will tell you that one of the most common problems observed when couples come for help is poor communication skills. People get into trouble in their marriages because they have not developed their ability to listen and communicate.

Barriers to Communication

These are a few of the things that prevent people from communicating effectively:

    Not knowing how to communicate properly

    Not taking the time to think through what you want to say

    Not taking the time to anticipate what your partner might be thinking and feeling

    Fear of revealing too much of yourself

    Fear of your partner’s anger

    Not wanting to hurt your partner’s feelings

Empathy and Acceptance

People marry because they want to spend the rest of their lives with their partner. They have every hope of growing together and creating a relationship that makes them feel emotionally healthy. Two factors that are necessary for this to happen are empathy and acceptance on the part of both partners.

Empathy is the capacity to put oneself in another’s shoes and understand how they view their reality, how they feel about things.

Demonstrating empathy and acceptance is critical to maintaining a strong relationship. Let’s look next at some communication skills that enable you to create a climate of empathy, acceptance, and understanding. First we will explore a skill called Active Listening.

Active Listening

Active listening is a way of communicating that creates the important climate of empathy, acceptance, and understanding.

    It is a two-step response to a statement made by your partner.

    It includes reflecting back what emotion you detected in the statement, and the reason for the emotion.

This is what active listening sounds like:

“Sounds like you’re upset about what happened at work.”

“You’re very annoyed by my lateness, aren’t you?”

Why Active Listening Is a Valuable Skill

Active listening is a valuable skill because it demonstrates that you understand what your partner is saying and how he or she is feeling about it.

    Active listening means restating, in your own words, what the other person has said.

    It’s a check on whether your understanding is correct.

    It demonstrates that you are listening and that you are interested and concerned.

Actively listening does not mean agreeing with the other person. The point is to demonstrate to your partner that you intend to hear and understand his or her point of view. This is good for your relationship for several reasons:

    When someone demonstrates that they want to understand what you are thinking and feeling, it feels good.

    It creates good feelings about the other person.

    Restating and checking understanding promotes better communication and fewer misunderstandings.

More Active Listening Examples

Here are some more examples of active listening:

“You sound really stumped about how to solve this problem.”

“It makes you angry when you find errors on Joey’s homework.”

“Sounds like you’re really worried about Wendy.”

“I get the feeling you’re awfully busy right now.”

More Communication Skills

Although our space is limited in this short newsletter, there are a few more communication skills that I must mention. These include asking open-ended questions, making summary statements to check understanding, and encouraging your partner to open up and elaborate by using neutral questions and phrases.

Open-ended questions begin with what, why, how do, or tell me.

    These questions get the other person to open up and elaborate on the topic.

    Asking these kinds of questions gets the other person involved by giving him or her a chance to tell what he or she thinks or knows.

    These questions are designed to encourage your partner to talk.

    They are useful when the other person is silent or reluctant to elaborate.

    They are also useful in dealing with negative emotions (such as anger or fear), since they help encourage the other person to vent feelings.

Summary Statements

Summary statements sum up what you hear your partner saying.

    A summary statement enhances your partner’s self-esteem by showing that you were listening carefully.

    It also helps you focus on facts, not emotions.

    It helps your partner clarify his or her own thinking by hearing your summary.

    Summary statements also help you deal with multiple disagreements so you can deal with them one by one.

    They help eliminate confusion by focusing on the relevant facts.

    Summary statements also help you separate the important issues from the trivial.

Neutral Questions and Phrases

Neutral questions and phrases get your partner to open up and elaborate on the topic you are discussing.

    These questions are more focused than open-ended questions.

    They help your partner understand what you are interested in hearing more about.

    They further communication because they help you gain more information.

    When you ask these kinds of questions, you demonstrate to your partner that you are interested and that you are listening.

Business Skills for Marriages

You might be surprised to hear that the same skills that help people succeed in business can also be used to build a better marriage. Like any business, a marriage is a partnership of people. Many of the skills that make businesses run successfully—planning, organizing, and setting goals—also can be applied to running your marriage successfully. These are some of the skills that will strengthen any marriage:

1.    Create an overall vision of what you want your life to be like; consider all life areas.

2.    Develop a long-range strategy.

3.    Set short-term and long-term goals.

4.    Plan the steps that will help you accomplish your goals.

5.    Organize projects.

6.    Manage projects.

7.    Manage people.

8.    Evaluate progress and results at regular intervals.

9.    Revise goals as needed.

Facilitating Communication between Couples

By Elizabeth Mahaney, M.A., LMHC, MFT, NCC, DCC, Ph.D

Abstract

Communication is central to a healthy marriage.  Communication was ranked as the number one problem among couples in therapy (Hecker &Wetchler, 2003). There are several obstacles that can contribute to poor communication between couples. Research findings with regard to communication between couples tends to focus on distressed versus non-distressed couples.  Research findings also stress and focus on the importance of positive communication between couples. The main goal of cognitive behavior therapy is to increase the desired behavior or cognition and decrease the undesirable cognitions and behaviors. There are basically three main phases of goals to help the therapist facilitate communication between couples which include; early-phase, middle-phase, and late-phase. During the early-phase the therapist assesses each partner and gains information about how the couple interacts and communicates. Complimenting and highlighting the couple’s effective communication begins the process of shaping. The therapist could ask the couple to define the problem behavior, as well as determine if there are any unacceptable forms of communication between the partners. Next, during the middle-phase the therapist should focus on decreasing inappropriate communication and increasing suitable communication between the couple. Implementing cognitive behavior psycho-education allows the couple to gain knowledge and information about communication skills and techniques. The late-phase goal of therapy is when the therapist draws attention to the eradication of the conflicting communication styles and patterns and investigates problem-solving competence. Cognitive behavior therapy uses thought patterns to change moods and behaviors. With cognitive-behavior therapy, the therapist should be aware that nonverbal communication is just as important as verbal communication with regards to communication. Self-report scales as well as several different techniques, activities, and homework assignments may be utilized to assess communication problems in a couple’s relationship. Furthermore, in facilitating communication between couples the therapist should demonstrate the importance of using “I” messages. Multicultural issues intermingled with a lack of communication can add a heavy burden on couples. Effective communication is facilitated by a healthy relationship built on mutual respect. Couples from diverse backgrounds are usually faced with greater communication obstacles.

  

Manual: Facilitating Communication between Couples

With Cognitive Behavior Therapy

   

Introduction

Communication is central to a healthy marriage.  It is the main source of tranquility, love, and the continuity of a relationship. The absence of communication builds up to conflict, which could possibly end the relationship at hand.  Communication was ranked as the number one problems among couples in therapy (Hecker &Wetchler, 2003).  Communication is something we all know is necessary to keep any relationship strong and loving, and although we are aware of the importance of communication, we still seem to be clueless about what exactly good communication really is. This does not mean you are clueless as a person.  It means that more attention is required on your part, so that you can become more open and invite the many forms of communication that exist.  Hence, you will be able to understand yourself and your partner more adequately.

There is nothing that keeps a relationship healthy better than understanding.  Once you start becoming more familiar with your communicating styles, as well as your partners, you will be able to work better as a team in making the best of your relationship.  Effective communication cannot happen on its own or with the efforts of only one person. Both you and your partner have to be open and willing to work as a team on improving the way you communicate, so that you both can enhance your relationship skills and build a relationship where you both will have an understanding of who you are as individuals and what you both need and want. Just remember to stay real with yourself and avoid painting a foggy and falsified picture- so that you will never be caught off guard with nay-painful surprises or stressful misunderstandings (Ruigrok, 2005).             

Couples are often adept at dealing with people outside the relationship, but few people enter an intimate relationship with the basic understandings or the technical skills that make a relationship blossom.  They frequently lack the know how to make joint decisions, to decipher their partners communication.  Because of the strength of feelings and expectations, the deep dependency, and the crucial, often arbitrary symbolic meanings that they attach to each other’s actions, partners are prone to misinterpret each other’s actions (Hecker & Wetchler, 2003).

Communication problems are one of the most damaging problems that a relationship can face.  Many couples often feel that their partner should know what they are thinking, but do not communicate their thoughts and wants to them.  Open communication sounds good, but in reality it is very difficult. The reason for this is that we do not want to be open, especially in the beginning of a relationship. Consciously or unconsciously, many people think that if we are real, other people are not going to like us.

Presenting Problems in Communication between Couples

There are several obstacles that can contribute to poor communication between couples.  Examples include, but are not limited to:

Contempt: insults or put-downs

One or more partners fails to listen to each other

Criticism: attacking or blaming the other partner

Men and women have different expectations for intimacy independence

Cross-complaining: spouses do not acknowledge each other’s concerns and desires

Fault-finding/Blaming the other partner

Defensiveness: warding off a perceived attack from a partner

Problem escalation: one spouse’s statement of a problem is followed by a negative response from the partner

Lack of clarity when sending/receiving messages while communicating

Debating the truth

Poor logic in a spouse’s statements

Stalemates: each person takes an unyielding position regarding the solution to the problem

Frequent topic shifts

Interruptions

Over-generalized statements: broad conclusions based on limited # of incidents

Dichotomous thinking: all or nothing thinking

Inconsistencies between verbal and nonverbal communication channels

Sidetracking: shifting from one topic to another

Vague statements that do not specify particular behaviors and emotions

Passive aggressiveness to coerce a partner

Selective abstraction: focusing one’s attention on only some aspects of a situation

Personalization: a partner concludes that events are related to them, when this is not the case

Magnification & Minimization: exaggerating or minimizing the significance of an event

Stonewalling/withdrawing

*Source: (Baucom & Epstein, 1990)

Differing communication styles between men and women can also serve as an obstacle to healthy communication.  Examples of male and female communication styles include: (1) men talk to give information or report, while women talk to collect information or gain rapport, (2) men focus on facts, reason, and logic, while women focus on feelings, senses, and meaning, and (3) men thrive on competing and achieving, while women thrive on harmony and relating (Simon & Pederson, 2005).  Cognitive behavior therapy is a theoretical approach that can be utilized to counteract the presenting problems mentioned earlier, as well as teach couples the skills necessary to identify and modify dysfunctional cognitions or behaviors in the future (Baucom & Epstein, 1990). 

Review of Literature

            Research findings with regard to communication between couples tends to focus on distressed versus non-distressed couples.  For example, Baucom and Epstein (1990) note that, “distressed couples exhibit more negative nonverbal communication such as criticism and put-downs, and fewer forms of positive communication, such as acknowledgment, than non-distressed couples” (p. 39).  Research findings also stress and focus on the importance of positive communication between couples.  Epstein and Baucom (2002) point out that, “although the findings are not totally consistent, several studies have demonstrated that happy couples exhibit a higher rate of positive communication than distressed couples when the partners are having a conversation with each other” (p. 29).  These findings are significant because in cognitive-behavioral therapy, the therapist attempts to assess how distressed couples are while they interact with one another, so that the therapist can alter negative behaviors that may be maintaining the poor communication between the couple.  Researchers also study the way that couples send and receive each other’s messages when communicating, which is also referred to as encoding and decoding.  Baucom and Epstein (1990) state that, “research findings regarding the encoding and decoding of marital communication indicate that when attempting to understand a couple’s misunderstandings, it is important to investigate the degree to which it is a problem of unclear expressiveness by one party, or ineffective listening by the other party” (p.34).  Encoding and decoding between couples is important to cognitive-behavioral therapists because they assess the specificity and clarity of these actions while the couple is interacting with one another.  Then the therapist can help the couple alter the manner in which they send and receive each others messages.  As a result, partners will be more understanding of one another.        

Goals and objectives of Cognitive Behavior Therapy

The main goal of cognitive behavior therapy is to increase the desired behavior or cognition and decrease the undesirable cognitions and behaviors. Another goal of cognitive behavioral couples therapy intervention techniques involves the use of cognitive restructuring. Restructuring is a process of evaluating cognitions and determining the accuracy of the cognition and changing those that are inaccurate or unrealistic. Attributions, assumptions, expectations, and standards that are unrealistic are worked on together by the therapist and partners to produce complementary explanations that are more accurate.  Hence, partners can direct more positive feelings towards one another.

There are basically three main phases of goals to help the therapist facilitate communication between couples which include; early-phase, middle-phase, and late-phase.

First, the early-phase goal is for the therapist to establish the therapeutic relationship with the couple by showing respect. The therapist can accomplish this task by modeling appropriate communication skills and positively reinforcing open progressive communication and interaction between the couple both during the session and out of the session. The therapist assesses each partner and gains information about how the couple interacts and communicates. The therapist should also be aware of any unresolved issues that may be contributing to the miscommunication. Complimenting and highlighting the couple’s effective communication begins the process of shaping. Shaping is a technique used by therapists that is based on operant conditioning and implies dividing the behavior into subsections, then rewards and punishments are implemented to produce the desired behavior. The therapist could ask the couple to define the problem behavior, as well as determine if there is any unacceptable communication between the partners.  The therapist may also ask the couple what their views of proficient communication mean to each of them. Homework consisting of charting inappropriate communication could be given to the couple. The use of functional analysis can be used to examine past experiences of communication patterns. Furthermore, a therapeutic contract should be developed during this phase to specify goals and objectives.

Next, during the middle-phase the therapist should focus on decreasing inappropriate communication and increasing suitable communication between the couple. There are several ways that communication can be facilitated during this phase. Implementing cognitive behavior psycho-education allows the couple to gain knowledge and information about communication skills and techniques. Two more major techniques that can be implemented in this phase are problem solving skills and communication enrichment. Challenging irrational beliefs facilitates the exploration of the couple’s inability to communicate. In addition, it is beneficial to investigate pessimistic assumptions and attributions that sustain the lack of communication among partners. It is also imperative that the therapist and couple discuss contracts and charts to observe changes or any need for renegotiation. The couple and the therapist must negotiate how the partners will treat each other and how they will communicate needs, wants, thoughts, and feelings. The therapist should recognize explicit constructive and unconstructive reinforcements for productive communication and let the couple know that it is crucial to maintain consistent reinforcement. The token system may be initiated. The token system is a technique that the therapist and partners develop. An inventory of preferred behaviors is listed with points associated with each item. The partners may earn points or have points deducted depending on the behaviors being displayed. When the points have accrued the couple may trade points for a variety of rewards. Time outs have been a popular disciplinary tool for parents to use with their children but time outs can be a useful instrument to help partners control situations that may escalate into an argument. It is a good idea for the therapist and couple to develop a plan for when the couple feels as though the situation is getting out-of-hand, it may be beneficial to take a time out so ensure that words or behaviors are not inappropriately exchanged.

Finally, the late-phase goal of therapy may be implemented which is when the therapist draws attention to the eradication of the conflicting communication styles and patterns and investigates problem-solving competence. In this phase the therapist and couple discuss any residual issues that may need to be explored and worked out. They also note any changes that have been made in the relationship, as well as changes in communication. Further psycho-education and communication guidance may be employed. It is important for the therapist to check-in with each partner and assess contracts and limitations to their communication. Any miscommunication that still exists should be worked through while maintaining rewarding patterns of communication. A contract may be put into place regarding how long the couple remains in therapy.  This may depend on the couple’s relationship satisfaction, or how well the couple communicates consistently with one another.  For example, the couple will terminate therapy if they appropriately and consistently communicate with one another for thirty consecutive days.  It is beneficial to renegotiate how the partners will treat each other and how they will communicate needs, wants, thoughts, and feelings. References and other support groups should be made available for the couple to explore. The couple and the therapist should make a list of warning signs of falling back into the same patterns of miscommunication and formulate a plan to deal with these issues. In addition, a list of appropriate and reinforcing behaviors and patterns of communication should be created to help the couple sustain improvements in their relationship. 

Theoretical approach and Rationale

The rationale for using cognitive behavior therapy is that when couples experience difficulties in their relationship, especially communication, the problems are likely to include behavioral, cognitive, and affective components.  The assessment of these factors is crucial in preparation for therapeutic interventions with couple’s communication patterns (Baucom & Epstein, 1990).  Hence, cognitive behavior therapy can be utilized if cognitions, behaviors, or emotions are distorted and maintaining a couple’s communication problem.

Cognitive behavior therapy is an approach that originated as a result of the psychodynamic approach (with an added cognitive element). This approach includes behavioral techniques for families, couples, adolescents, children, and sexual dysfunctions. Cognitive behavior therapy uses thought patterns to change moods and behaviors. It is relatively short term. There are several positive aspects of this approach including: being empirically based, goal oriented, practical, active, and collaborative.  Despite these benefits, CBT can not be used for individuals in whom thinking or communicating is severely disturbed. If partners do not complete “homework” and keep accurate records, the therapeutic process can be greatly hindered. In addition, CBT focuses on a client’s present situation and does not attempt to dig up the past which can result in a lack of self compassion.  With cognitive-behavior therapy, the therapist should be aware that nonverbal communication is just as important as verbal communication with regards to communication. 

The key theorists for cognitive behavior therapy include:

Albert Bandura

Aaron Beck

Albert Ellis

Joseph Wolpe

Richard Stuart

B.F. Skinner

Norman Epstein

Neil Jacobson

Gerald Jones

Gerald Patterson

Donald Meichenbaum

Arnold Lazarus

*Source: (Hecker & Wetchler, 2003)

Program Activities and Materials

The program activities and materials are based on Marriage enrichment and relationship enhancement philosophies and concepts.

1.Increasing and Identifying Rewarding Communication:

•One should reward their partner even if he or she is not showing rewarding communication and behavior in return. It may take a little while for one another to teach each other positive communication because the present communication and behavior has been used. It is important to follow the rule of reciprocity; if you communicate, usually, your spouse will reward you by communicating accordingly. Unfortunately, unrewarding actions are also reciprocated.

•It is important to know what each partner likes and dislikes about the other’s communication style and behavior. The partners are not mind readers and need each other to help teach one another and learn what they find rewarding. Many couples spend a lot of time dwelling on the negative and not enough time articulating what is positive and rewarding.

•Each partner should be very specific about the rewarding communication or behavior that they get pleasure from. For example, if a spouse told her partner that she enjoyed how nice he was to her last week, this taught her partner nothing. If a spouse were to say I really enjoyed how you called me Tuesday night to let me know that you would be home a little late, I really appreciate when you are thoughtful, this would give her partner insight and the ability to repeat the rewarding communication and behavior.

Homework assignment:

A.   List seven rewarding ways that your spouse communicated during the past week.

B.    Throughout the up coming week write down seven specific times your partner communicated and behaved in a rewarding manner. Do not show your spouse until the next therapy session.

C.    List seven specific rewarding things, which do not take up too much time, that you would like your spouse to do during the next week.

1.Taking Responsibility and Rewarding Communication-

·      Both partners in a relationship must take responsibility for change to occur. A general rule is actions that are rewarded will increase and actions that are punished will decrease.

·      Both partners must teach each other specific actions that they like and follow these rules;

A.   Articulate the specific action that pleased you,

B.    Genuinely reward your spouse immediately,

C.    Stay in the here and now.

Activity:

Ask yourself if you have ever heard or said any of these statements;

·      “You never talk about anything with me anymore” (thinking in a way that it is all or nothing).

·      “You told me how you felt today but you usually never tell me about anything” (using the zap method of treatment).

·      “Why can’t you be more open, caring, emotional” (using why as an accusation)?

·      Do you tend to withdraw, mope, or sulk?

Now think about how you would respond to these statements and what the outcome would be.

·      The all or nothing statement will promote feelings that your spouse can do nothing to make a difference so there is no need to try resulting in withdrawal or defensive interactions and behavior.

·      The zap method ends with punishment or accusation regarding the past so the spouse will more than likely remember the negative accusation and not the reward.

·      The “why” statement is the most common statements made by couples in distress and usually the outcome is an argument and then withdrawal. How is your spouse supposed to respond to this question? Withdrawal may decrease the chances of an argument but will annoy the other partner and furthermore, withdrawal does not teach each other what you do enjoy.

1.Build on the Positive-

·      The more the specific behavior is rewarded the better the chance of the behavior to increase. It is up to each partner to let the other know what he or she likes. The purpose of teaching each other what is enjoyable is to improve the relationship and facilitate better communication skills between each other.

Homework:

·      List seven specific times and examples of when you reward your spouse during the upcoming week.

4. Thoughts that are Automatic-

Automatic thoughts are ideas or notions that may or may not be accurate and are usually associated with negative viewpoints. It is beneficial to be aware and challenge automatic thoughts. The following is a list with examples of some automatic thoughts that are common among distraught couples.

ü     Labeling- giving your spouse a name such as “aggressive” and believing that he or she will always be that way and is not capable of changing.

ü     Shoulds- an irrational way of thinking about your relationship and standards that ought to be upheld. For example, “I should not have to ask my spouse to tell me what is on his or her mind”, “I should never be bored or discontented in my relationship”, “why should I have to change”?, “change should just happen and occur quickly”, If my spouse can not get the hint of what I want, than why should I stay in this marriage”?

ü     Fortune-telling- predicting that your spouse will never change which results in telling yourself that you will never be happy.

ü     Perfectionism- comparing your relationship to an impracticable idealistic view of how a relationship should be. For example, “it is not like we just met, we have been together for a while so he should know exactly what I want”.

ü     Mind-reading- perceiving that your spouse is insinuating something with out sufficient evidence. For example, a spouse may think that her husband does not care about her because he did not open the door for her.

ü     Discounting the positive- when a spouse ignores the rewarding behavior or styles of communication by believing that the actions are insignificant because that is what a husband or wife should do. Another illustration of discounting the positive when one believes that his or her success is trivial.

ü     Catastrophic thinking- believing that the argument or issue that occurred means that your marriage is awful and doomed.

ü     Emotional reasoning- you feel a certain way and relate the way you feel with how your marriage is going. For example, “I feel depressed which means that my marriage must be failing”.

ü     Negative filter- when a partner only focuses on the negative and does not see the positive aspects of the relationship.

ü     Externalizing- believing that you have no control over what happens.

ü     Over-generalizing- taking a broad view of the situation and using statements such as “if I fail at me marriage, I will fail at everything”.

Homework:

Write a list each day of the automatic thoughts or comments and notice any patterns.

5. Ground Rules Regarding Having Differences of opinions and Arguing-   

·      Use “time out” if you and you spouse are prone to explosive actions and comments. (It is important to allow for your partner to ask for a time out and receive it without the other partner following Him or her in to the other room).

·      The issue should be solved by both of you and each person should be invited to discuss their opinion and offer ideas to the solution. Possible solutions should be prioritized from most acceptable to not suitable.

·      It is imperative that both partners compromise and come to a mutual agreement. Keep in mind that modifications may be needed if the first arrangement is not sufficient.

·      Stay on the present issue and do not bring up differences from the past or material that is irrelevant.

·      Accept responsibility for the role each person plays in the dilemma.

·      Remember not to label, use the why accusation (why do you always…?), withdrawal, mope, use sarcasm, use a loud tone of voice, or use threats or ultimatums.

·      Consider that rewarding each other for cooperating and compromising may increase more positive correspondence in the future.

6. Empathetically Listening to Your Partner-

Rephrasing is a good way for couples to show that they are truly listening to one another. When having a discussion briefly state the point of the conversation using only about three statements and then ask your partner to rephrase your statements. After your partner rephrases specify what was correct and clear up any misunderstandings. If there were any misunderstandings, explain your point once more and ask your partner to rephrase again. Next, ask for any disagreeing view points. If there are disagreements subsequently rephrase the differential statements. The rephrasing technique can be used to be certain that each partner is being heard clearly and may help decrease the severity of the altercation.

A number of other different techniques and activities may be employed in cognitive-behavioral therapy to help patients uncover and examine their thoughts, as well as change their behaviors.  They Include:

•Cognitive rehearsal- The patient imagines a difficult situation and the therapist guides him through the step-by-step process of facing and successfully dealing with it.  The patient then works on practicing, or rehearsing, these steps mentally.  Ideally, when situation arises in real life, the patient will draw on the rehearsed behavior to address it.

•Journal- Patients are asked to keep a detailed diary recounting their thoughts, feelings and actions when specific situations arise.  The journal helps to make the patient aware of his or her maladaptive thoughts and to show their consequences on behavior.  In late stages of therapy, it may serve to demonstrate and reinforce positive behaviors.

•Modeling- The therapist and patient engage in role-playing exercises in which the therapist acts out appropriate behaviors or responses to situations.

•Conditioning- The therapist uses reinforcement to encourage a particular behavior.  For example, a child with ADHD gets a gold star every time he stays focused on tasks and accomplishes certain daily chores.  The gold star reinforces and increases the desired behavior by identifying it with something positive.  Reinforcement can also be used to extinguish unwanted behaviors by imposing negative consequences.

•Systematic Desensitization- Patients imagine a situation they fear, while the therapist employs techniques to help the patient relax, helping the person cope with their fear reaction and eventually eliminate the anxiety altogether.  The imagery of the anxiety producing situations gets progressively more intense until, eventually, the therapist and patient approach the anxiety causing situation in real life.  Exposure may be increases to the point of “flooding”, providing maximum exposure to the real situation.  By repeatedly pairing a desired response (relaxation) with a fear producing situation, the patient gradually becomes desensitized to the old response of fear and learns to react with feelings of relaxation.

•Validity testing- Patients are asked to test the validity of the automatic thoughts and schemas they encounter.  The therapist may ask the patient to defend or produce evidence that schema is true.  If the patient is unable to meet the challenge, the faulty nature of the schema is exposed. 

•Self-report scales- May be utilized to assess communication problems in the couple’s relationship.  Some examples include: the Marital Communication Inventory, the Primary Communication Inventory, the self-report form of the Verbal Problems Checklist, and the Problem-Solving Communication and Affective Communication scales from the Marital Satisfaction Inventory (Baucom & Epstein, 1990).  These inventories are effective tools for gathering information about the couple’s patterns of communication, and they help with determining what areas the couple needs to work on during the treatment process.

•“I” Messages- In facilitating communication between couples the therapist should demonstrate the importance of using “I” messages. “I” type messages place focus on the speaker’s feelings with regard to their partner’s behavior. By using “I” statements the listeners can gain a better understanding of the effects their actions have on their partner.  The therapist should understand what type of communicator each client is. Expressive communicators tend to share emotions and feelings. These individuals usually need responsive feedback. Problem-solving communicators may seldom talk about their feelings. These types of communicators may place facts in place of their feelings when giving a statement (Baucom & Epstein, 1990).

Diversity Issues

Diversity issues can sometimes create severe conflict within a relationship.  Couples who are combated with diversity and communication issues are dealt a dueling dilemma when trying to coexist in harmony.  Gender differences are the first issue couples must deal with. Men and women can be on opposite ends of the communication spectrum. Communication between members of the opposite sex can be difficult when neither party understands the issues being brought forth by each other. When gender roles (with regard to responsibility) are strongly defined within a relationship, a couple’s communication may suffer. When gender issues are combated with communication issues, the role of the therapist becomes more difficult. The therapist must be sensitive to both sides and respect the argument given by both parties involved.

            Multicultural issues intermingled with a lack of communication can add a heavy burden on couples. Effective communication is facilitated by a healthy relationship built on mutual respect. It is imperative that couples understand each others culture, beliefs, and values. Multicultural frameworks are important in therapy. With the U.S. being a collection of diverse individuals, effective couples therapy is of grave importance (Hecker & Wetchler, 42). Couples from diverse backgrounds are usually faced with greater communication obstacles. Learning and understanding the cultural norms of a partner is important. Not being culturally aware can cause a breakdown in communication. Some groups, such as Native Americans feel that problems should be dealt with on a personal level. If in a relationship with an individual of strong Western ideology, communication can become compromised. Hanna & Brown (1995) present questions for assessing racial and cultural factors in therapy:

§       How does your racial/cultural/religious heritage make your family different from other families you know?

§       Compared to other families in your cultural group, how is your family different?

§       What are the values your family identifies as being important parts of your heritage?

§       At this particular time in you family’s development, are there issues related to your cultural heritage that are being questioned by anyone?

§       What might an outsider not understand about your racial/cultural/religious background? (Hecker & Wetchler, 429)

Not only could the answers to these questions aid in facilitating communication between a diverse couple but it could also aid the therapist in gaining an understanding of that culture. Exploration into the importance of culture can assist in understanding and overcoming communication obstacles (Hecker & Wetchler).

Program Evaluation

l     Assess diagnostic workup of patients at the start of therapy placing emphasis on problems, needs, and issues brought to the table.

l      Review treatment plans including the goals and the couples needs for therapy.  Assess their level of communication, anxiety and stress from the start of therapy.

l     After reviewing information and history from the beginning of therapy, therapists can evaluate the progress made by clients by means of discussing with clients the progress they have made, observation of new and beneficial communication skills, charting/journaling, evaluation of goals met and satisfaction of relationship between the couple.

l     Assess if the desired behavior or cognition has been increased and the undesirable cognitions and behaviors have been decreased or eliminated.

l     Measure whether restructuring has taken place-determining the accuracy of a cognition and changing those that are inaccurate or unrealistic

References

Baucom, D. H., & Epstein, N. B. (1990). Cognitive–Behavioral Marital Therapy.  New York:

            Brunner/Mazel.

Becvar, D. S., & Becvar, R. J. (2003).  Family Therapy: A System Integration fifth

            edition.

Brown, J., & Brown, C.  (2002).  Marital therapy:  concepts and skills for effective practice.

California: Brooks/Cole.

Bauserman, R. (2002). The Journal of Family Psychology 2002, Vol. 16, NO. 1, 91-102.           

Corey, G.  (2001).  Theories and Practice of Counseling and Psychotherapy (6th ed).

            Wadsworth.

Corey, G., Corey, M., & Callahan, P.  (2003). Issues & Ethics in the Helping Professions

            (6th ed).  Brooks/Cole- Thompson Learning.

Corliss, R. and Steptoe, S. (2004, January 19). The Marriage Savers. Time, 88-96.

Dattilio, M. F. (2001).  Cognitive-Behavior Family Therapy:  contemporary myths and

            misconceptions.  Contemporary Family Therapy, (23), 1.

Doss, B. D., Thum, Y. M., Atkins, D. C., Sevier, M., & Christensen, A. (2005). Improving

relationships: mechanisms of change in couple therapy. American Psychological Association, 73(4), 624-633.

Epstein, N. B., & Baucom, D. H.  (2002).  Enhanced Cognitive-Behavioral Therapy for Couples.

            Washington, DC: American Psychological Association. 

Gehart, D. R., & Tuttle, A. R.  (2003).  Theory based treatment planning for marriage

            and family therapists: integrating theory and practice. Brooks/Cole.

Hecker, L. L., Wetchler, J. L., (2003).  An introduction to marriage and family therapy.  New

            York:  The Haworth Clinical Practice Press.

Hunt, R.A., Hof, L. and DeMaria, R. (1998). Marriage Enrichment; Preparing, Mentoring, and

           Outreach. PA: Brunner/Mazel.

Simon, V., & Pederson, H.  (2005, March).  Communication with men at work: bridging the gap

            with male coworkers and employees.  Retrieved February 18, 2006, from

            http://www.itstime.com/mar2005.htm