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Conflict Resolution, Counseling, Divorce, Family Fun, Life Transitions, Listening Skills, Marriage and family therapy, Psychotherapy, step family

Managing Today’s Stepfamily

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If you are a member of a stepfamily, you know how difficult it can be to integrate all of the new members and adjust to the new boundaries and rules. The following ideas may help you make a successful transition during this challenging process.

Have patience. Establishing new families takes time. Just because you love your new partner, it is unrealistic to think that you will automatically love his or her children. It is equally unrealistic to expect that your new partner’s children will instantly love you. It can be difficult to accept that even though you wish to have a relationship with your stepchildren, they may not be ready for a relationship with you.

Expect to adjust. With proper help and guidance, children can recover from family disruption. All children experience a difficult adjustment period following a divorce or remarriage. It takes time, patience, and perhaps some professional assistance, but most children are able to regain their emotional bearings. It is critical that the adults manage their own emotional recovery in order to help the children adjust without trauma.

If you are part of a part-time stepfamily, you may need a longer adjustment period. All relationships take time to grow and develop. When stepchildren see you less often, you have less time to get to know each other. This is why it may take a part-time stepfamily longer to move through the adjustment process.

Don’t expect your new family to be like your first family. If you expect that your stepfamily will be just like the family of your first marriage, you are setting yourself up for frustration. Your new family will have its own unique identity and will evolve in its own special way.

Expect confusion. Forming a stepfamily is a confusing time for everyone. Think about how confusing it is for a child to become part of two new families. All of the family members—parents and children—must learn to understand the new structure and learn to navigate the boundaries.

Allow time for grieving. Stepfamilies begin with an experience of loss, and everyone needs to grieve. The adults’ losses are not the same as those of the children, and both must be respected. Adults grieve the following losses:

•    The loss of a partner

•    The loss of a marriage relationship

•    Lost dreams of the way they thought it would be

•    They must adjust to changes that result from the divorce or death (moving to a new house, starting a new job, adjusting to changes in lifestyle, etc.)

Children grieve, too. Their losses are usually different from those of their parents:

•    They may now be living with one parent instead of two.

•    They may have less time with one or both parents during times of dating and remarriage.

•    There may be less stability in their homes.

•    They must adjust to changes that result from the divorce or death. (They may have a new place to live and go to a new school; they may have lost friends in this process.)

•    They have lost the fantasy of how they wanted their family to be.

Children have an especially difficult time resolving their grief when their parents are hostile with one another, when one or both of their parents remarry, and if they have trouble accepting their new stepparents.

Acknowledge the absent parent. When one of the original parents is absent, the children need a special kind of understanding. An absent parent (who has died or who lives elsewhere and doesn’t visit) is part of a child’s past. The child must be allowed to have memories of this parent. The children who have access to both of their parents are those who adjust the best to divorce. They should be allowed to regularly speak with, visit, and write to their noncustodial parent.

Help the kids fit in. Children of stepfamilies belong to two households. It is understandable that they have questions about where they fit in. They are usually able to adjust to having two sets of rules as long as they are not asked to choose which is better.

Be clear about the rules. Ideally, both sets of parents should discuss the family rules and what will happen if rules are broken. When the adults agree on the rules, they should explain them to the children. Most successful stepfamilies have learned that the rules should be decided together in the beginning, and that the biological parent should do the explaining and disciplining. The stepparent may have more involvement after the relationships with the stepchildren have been established. All of this works best when the parents can agree to be flexible and cooperative with one another. This may be difficult immediately following a divorce or remarriage, but it is important to work toward this objective.

Educate yourselves and seek emotional support. Read books about managing stepfamilies, attend classes, and participate in stepfamily support groups. Seek the help of an experienced mental health professional to help you through the rough spots. Marriage and Family Therapists have specific skills and training for working with families and stepfamilies.

Give the kids their own space. Make physical space available for the children who don’t live with you. Children need a sense of belonging. Creating a room or section of a room for visiting children will help them feel like part of your family.

Expect them to think it’s temporary. Accept the fact that your children may expect you and their other parent to reconcile. They may fantasize that your new relationship with your partner is only temporary. This is especially true in the beginning. Find a time to sit down with the children and explain that when two people are unable to live together anymore, it doesn’t mean they love their children any less. This is especially important for the parent who has moved away, since the children will inevitably feel a sense of rejection.

Expect resentment. No matter how good a parent you are, you will never be the biological parent of your stepchildren. It is natural for a stepchild to feel some resentment for you, especially when you are setting limits for their behavior.

Show the children love. Sometimes children need love the most at a time when it is the most difficult to give it to them. While bad behavior should never be rewarded, always praise children when they are behaving well.

4 horsemen, Assertiveness, CBT, Communication, Conflict Resolution, Counseling, Couples Counseling, Gottman Approach, Gottman Marriage Counseling, Marriage and family therapy, Marriage counseling, Marriage Therapy, Psychotherapy, relationship, self awareness

Facilitating Communication between Couples

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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

  

Assertiveness, Counseling, journaling, relationship, self awareness

I Have Everything I’ve Ever Dreamed Of. Why Am I Not Happy?

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Signs of Discontent

You don’t need a degree in psychology to know when you’re off-track, but sometimes it creeps up on you. It can seem like you wake up one day and realize that things are not right. These are a few of the signs:

•    You don’t want to get out of bed.

•    You have a hard time motivating yourself to do routine tasks.

•    You have doubts about yourself.

•    You feel mildly depressed for days at a time.

•    You sometimes overeat and/or use alcohol and drugs to feel better or escape.

•    You often feel chronically tired, deenergized, and listless.

•    You worry about how you will keep things together.

•    You feel bored or restless.

•    You wish you were somewhere else.

•    You often have headaches, stomach upset, and other body aches and pains.

•    You sleep too little or too much.

•    You have frequent bad dreams or nightmares.

•    You oversleep.

•    You complain and nag.

Feeling dissatisfied with your life is not a pleasant experience, but it can lead you in a positive direction. These feelings may be important because they are telling you that your actions are out of synch with your values, goals, or talents.

Rediscover What Is Important to You

Imagine that your life is handed back to you and you are able to do anything you want. What is important to you? What values will direct you? Consider each word on the following list individually. It is not necessary to force-rank them or compare them against each other. Assign a rating to each word:

1 = Critically important to me

2 = Important to me

3 = I can live without it

Acceptance by others

Accomplishment

Activity

Admiration

Appreciation

Authority

Beauty

Being liked

Being well-paid

Calm

Casualness

Certainty

Challenge

Choice

Comfort

Community service

Competition

Creativity

Enjoyment

Ethics

Excellence

Excitement

Fame

Financial security

Fitness

Flexibility

Fortune

Freedom

Fulfilling my potential

Fun

Growth

Harmony

Health

Helping others

Honesty

Independence

Informality

Leisure

Making a difference

Mastery

Morality

Nature

Novelty

Originality

Peace

Personal development

Pets

Pleasure

Popularity

Power

Prestige

Privacy

Prosperity

Quality

Recognition

Relaxation

Respect

Risk

Solitude

Spirituality

Stability

Status

Stimulation

Surprise

Time for friends

Time for my family

Uniqueness

Variety

Wealth

Wisdom

Now make a list that summarizes your most important values. If you think of something that isn’t listed, feel free to add it.

The final part of this process (and this is a very streamlined version of what is possible) is to compare how you are currently spending your time with your list of most important values. How well do they match each other? What clues can you find that will help you find more satisfaction in your life?

Things that don’t match:

What I can do about it:

Assertiveness, Communication, Conflict Resolution, Counseling, Couples Counseling, Marriage and family therapy, Marriage counseling, Marriage Therapy, relationship

Fine Tune Your Relationship

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Why do some relationships last forever and others fall apart? Here are some ways you can make your partner feel appreciated again and prevent your relationship from becoming a casualty.

    1.    Treat your partner as you would your boss, best friend, or best customer.

    2.    Think about what your partner wants and give it to him or her.

    3.    Think of ways you can do the unexpected and be thoughtful. Remember how you acted when you wanted to win your partner over.

    4.    Pay attention to your appearance. Dress nicely; get into shape.

    5.    Express your thoughts carefully. Being married doesn’t give anyone permission to let it all hang out.

    6.    Spend regular time together alone.

    7.    Look for ways to compliment your partner.

    8.    Hug when you say hello and goodbye. It feels good and it makes people feel loved.

    9.    Learn and practice communication skills. Relating successfully to another person requires a set of skills that can be learned.

    10.    Be polite. Just because you are married doesn’t mean you can forget your manners.

    11.    When you want something, say please.

    12.    When your partner does something for you, say thank you.

    13.    When your partner comes home after a day at work, greet her at the door and say hello. Ask how her day went.

    14.    When your partner leaves for work in the morning, say goodbye and “I love you” or “Have a good day.”

    15.    When your partner faces a challenge at work during the day, ask how it went when you get home.

    16.    During your evening meal together, avoid the temptation to watch television or read the paper or mail. Look at your partner and have a conversation.

    17.    If you want to make plans that affect how your partner will be spending time, check with him first and make sure it’s convenient.

    18.    When you ask your partner a question, make eye contact and listen to the answer.

    19.    When you disagree with something your partner says, pay attention to your response. Do you express your opinion without putting her down? You can express your opinion assertively rather than aggressively. For example, you can say, “I have another opinion. I think we should wait until spring to have the walls painted,” rather than, “That’s silly! We should wait until spring.”

    20.    Pay attention to how much of your side of the conversation is asking questions versus making statements. If you tend to be the dominant one, ask more questions.

    21.    Ask open-ended questions to encourage your partner to open up and talk. Open-ended questions begin like this:

    a.    Tell me about…

    b.    What do you think of…

    c.    What was it like when…

    22.    Have you become passive with your partner because that’s the easiest way to avoid conflict? Over time, this is not a good idea. You will inevitably begin to build up feelings of resentment because you are stifling your feelings, thoughts, and opinions. If you think you are choosing passive behavior too often, think about discussing it with your partner and asking him to help you be more assertive.

    23.    Researchers have found that people whose marriages last the longest have learned to separate from their families of origin (their own parents and siblings) and have appropriate, healthy boundaries. They value and honor their own privacy and separateness as a couple. This means they have regular, appropriate contact with their extended family, but that it is not excessive or stifling. How do you compare?

    24.    Check your communication with your partner and beware of using “You” messages. These are statements that begin with you. For example:

You need to come home by 6:00 tonight.

You shouldn’t do that.

You should call me from the office and tell me when you’ll be home.

Here is what you ought to do.

“You” messages are damaging because they make the other person feel bad or disrespected. It feels like you are talking down to him or her.

    25.    If you want to demonstrate to your partner that you respect and esteem him or her, try speaking with “I” messages instead. When you start your statement with “I,” you are taking responsibility for the statement. It is less blameful and less negative than the “you” message.

You can use this formula: Your feelings + Describe the behavior + Effect on you. This is how an “I” message sounds: When I heard that you’d planned a weekend up north, I was confused about why you hadn’t asked me first, so I could be sure to get the time off. It takes some practice and you have to stop and think about what you are going to say, but your marriage deserves to be handled with care.

    26.    Make a list of your partner’s positive qualities. Share them with him and tell her why you think each is true.

    27.    Ask your partner to do the same for you.

    28.    Respect each other’s private space. Over time, many couples let this slide.

    29.    As the years pass, many couples begin to feel like they are living in the same house, but have parallel lives. Their paths cross in fewer places. What is the trend in your relationship and what do you want to do about it?

Counseling, Couples Counseling, infertility

Infertility

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Infertility is a medical problem that results in the inability to conceive a child or carry a pregnancy to full term. A couple is usually diagnosed as infertile after one year of frequent, unprotected, sexual intercourse.

It is estimated that 10 to 15% of couples are infertile. About 35% of infertility cases can be traced to physical problems of the woman and 35% have causes in the man. In the remaining 30% of cases, infertility is either unexplained or is caused by problems in both partners.

Why Infertility Can Be Devastating

The inability to have children can be one of the greatest challenges that a person or couple will ever face. It affects people emotionally, physically, and financially. It can place tremendous stress on a couple’s relationship and on their relationships with family and friends.

On a physical level, the experience of being examined and tested monthly, weekly, or even daily is embarrassing, exhausting, and very expensive. Medications often have side effects, and daily injections may be required. Surgery is often necessary, and sometimes several procedures are needed.

As the process continues over months and years, the couple’s privacy is invaded time and again, physically and emotionally. One or both of the partners learn to put aside their feelings as they lie on the examining table, have fluids taken, or give sperm for the tenth, twentieth, or fiftieth time.

At the same time, family, friends and coworkers are waiting to see if this month will bring good news. The couple becomes used to hearing, “Anything new?” with an expectant smile. They also hear comments like, “Maybe you should take a month off and just relax,” or “A vacation would do you good” or “This sounds like a good problem. At least you can have fun trying.” To make it even worse, throughout this experience, the couple regularly hears of others who have become pregnant. In fact, it sometimes seems as if the whole world is pregnant.

These experiences often make the infertile person feel like a failure. The feelings come up each time there is a treatment failure or when yet another friend or acquaintance announces a pregnancy.

After each expensive procedure or round of treatment, when no pregnancy results, the disappointment turns to devastation. Many infertile people become depressed and anxious. The strain in the marriage and among family members sometimes becomes unbearable. The self-esteem of one or both partners plummets. They often feel lonely, sad, and angry. The long series of disappointments that many experience can cause a numbing effect, and depression can result. If one partner has the medical problem that is causing the infertility, he or she often feels guilty and may even offer the other a divorce. At the same time, the infertile person may fear that the other partner will leave the relationship. All of these changes can make people feel emotionally distant and needing to avoid intimacy.

Some people cut themselves off from friends and family. They look for ways to avoid attending social gatherings and family events, fearing that they will be subjected to discussions about pregnancy, children, or infertility. Socializing with friends and family who have children or who are pregnant is a special challenge. Sometimes these feelings are intensified, especially for women, when they are taking large doses of drugs that can affect their emotions.

Emotional Self-Care during Infertility

Almost no one expects to be infertile. Most people think they will grow up, get married, and have children, just like everyone else around them. So when a couple learns that they are infertile, they are often surprised at how devastated they feel. After all, they reason, they don’t have cancer or a deadly disease (in most cases); it’s just infertility. So why do they feel so badly? Most couples gradually come to realize that it is a distressing experience. Many eventually seek the help of a team of professionals, realizing that it is a good idea to create a support network and take advantage of the help that is available.

When one or both partners start to feel the impact of infertility, it can be a good idea to seek the services of a mental health professional, especially one who has experience working with the issues of infertility. Since these issues are so complex, it is important to find a counselor who has experience and training in dealing with the impact on individuals, couples, and families. Many couples also find relief in support groups where they can meet regularly with other infertile couples, share experiences, and support each other. Such groups are offered through organizations like RESOLVE, a national infertility support organization. RESOLVE also provides referrals to medical practitioners who specialize in infertility. Visit www.resolve.org for information.

Infertility is primarily a medical problem, but during treatment it is important to address the emotional implications of infertility. Joining a support group or seeing a qualified counselor is especially important at any of the following points:

·    When you begin a new phase of your treatment

·    After a course of treatment has failed

·    When you are faced with difficult decisions about treatment

·    When you are thinking about options such as surrogacy, egg or sperm donation

·    When you are considering stopping medical treatment

·    When you are thinking about adopting

·    When one or both of you have troubling feelings that won’t go away

·    When you experience strained relationships with your partner, friends, or family

·    When you avoid being with others because of the infertility

Although a mental health professional cannot influence the outcome of the medical treatment, he or she can help the couple get through the process by helping them communicate better with each other and gain support from family and friends.

Communication, Counseling, Couples Counseling, Marriage and family therapy, Marriage counseling, Marriage Therapy

Learn to Have Healthy Relationships & Manage Stress

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Learn to Have Healthy Relationships.

This subject could fill an entire book. In the limited space of this newsletter, let’s look at the key components of this stress-reducing strategy.

1. Identify the sources of stress in your relationships. Write about them in a journal. Make a list of people who cause you stress and explore what the issues are.

2. Resolve the underlying issues. For each of the situations identified in step 1, assess what needs to happen to resolve it. Make a list and design a plan to improve the situation.

3. Learn skills to improve relationships. Relationship skills are learned. We are not born knowing how to get along well with others, and most of us learned only limited skills from our parents. Identify the skills you need to develop, and make a plan for yourself. You can learn these skills by reading books, taking classes, or working with a therapist.

4. Avoid toxic people and situations. Some people have a toxic effect on you. If you can, limit the amount of time you spend with them. Look for opportunities to decline their invitations. When these people are family members, remind yourself that you don’t have to feel guilty about avoiding anyone who makes you feel bad about yourself. In work situations, look for ways to rearrange your schedule or your workspace to avoid interacting with such people.

5. Seek out positive people and situations. This step is the reverse of the previous step. Look for opportunities to spend more time with people and in situations that make you feel good. Think about people who make you feel good about yourself and look for ways to increase time with them.

6. Watch what you eat. Some substances amplify the stress response. These include:

· Caffeine stimulates the release of stress hormones. This increases heart rate, blood pressure, and oxygen to the heart. Ongoing exposure to caffeine can harm the tissue of the heart.

· Refined sugar and processed flour are depleted of needed vitamins. In times of stress, certain vitamins help the body maintain the nervous and endocrine systems.

· Too much salt can lead to excessive fluid retention. This can lead to nervous tension and higher blood pressure. Stress often adds to the problem by causing increased blood pressure.

· Smoking not only causes disease and shortens life, it leads to increased heart rate, blood pressure, and respiration.

· Alcohol robs the body of nutrition that it might otherwise use for cell growth and repair. It also harms the liver and adds empty calories to the body.

During times of high stress, eat more complex carbohydrates (fruits, vegetables, whole breads, cereals, and beans).

7. Get moving. The human body was designed to be physically active. However, in most jobs today, people are sitting down most of the time. They hardly move at all except when it is time for coffee break or lunch. When faced with stressors, we respond with our minds, not our bodies. It is no wonder that many of us have a difficult time responding to stressful events.

Exercise is one of the simplest and most effective ways to respond to stress. Activity provides a natural release for the body during its fight-or-flight state of arousal. After exercising, the body returns to its normal state of equilibrium, and one feels relaxed and refreshed.

8. Look for ways to let go of tension and anxiety. Meditation, hypnosis, and progressive relaxation are valuable ways to regenerate and refresh yourself. You can purchase meditation and relaxation audiotapes or record your own. This is especially important because your health and long life depend on minimizing stress and achieving a sense of balance and well-being.