Enduring Models of Couples Therapy: What principles have stood the test of time?

Artificial Intelligence is currently one of the hottest topics in news and culture. I find it fascinating to think about with respect to couples relationships and also the client-therapist relationship. I wanted to have some fun kicking off the Couples Conference so I decided to create an Ellyn avatar to point out the paradox of the authentic AI therapist.

Here it is for your enjoyment.

The theme of this year’s conference was Enduring Models of Couples Therapy: What principles have stood the test of time?

We asked the founders/developers of PACT, RLT, Developmental Model, Solution-Focused Therapy, and IFS to do keynotes summarizing their principles or interventions that have had lasting impact.

The Developmental Model of Couples Therapy: Ellyn Bader

Let’s start with the 5 principles that I emphasized:

1. Strong leadership by the therapist is essential. Without knowing where you are going you will easily get caught accidentally supporting regression and repeating the couple’s familiar negative patterns.
2. Couples relationships can evolve through a series of predictable stages. Identifying the stage enables you to target effective interventions.
3. Commitment to individual change matters. Without autonomous changes, partners stay stuck waiting for the other to change.
4. Effective differentiation is the foundation for vitality, intimacy, managing differences, and forming an enduring loving partnership.
5. Lasting change for clients in couples therapy comes from them taking emotional risks, sustaining effort, and building new emotional capacities.

The Developmental Model is not a pathology model. Your focus is not on symptoms but on stimulating developmental growth and increasing the emotional capacities of each partner. Using this model enables you to work from much more than intuition. You recognize where partners are stuck and you understand why. You learn to support partners taking risks and being accountable for their own growth. Doing this allows you to avoid interventions that are too far ahead of your clients and to identify developmental assists that will drive each partner forward towards the goals they want to achieve.

Internal Family Systems: Frank Anderson

Frank has worked for many years with both Dick Schwartz and Bessel Van der Kolk. He has expertise in trauma and dissociation.

He described the role of IFS in working with relational trauma. Trauma, whether it is past or present, blocks connection.

The goal of IFS is to release self-energy and access the inner resources of the client. 

In the face of trauma, people will either repeat, regress or learn.

The extreme or reactive parts (exiles) show up only when a wound is activated. Their role is to stop the pain, and they can come in the form of either hypo or hyper-activation. 

Of course, often with couples these extremes will also hurt the partner.

Much of the therapeutic work can be in the form of helping protective parts separate from the self and learn about themselves and their role. One example would be appreciating the positive intent behind blaming energy, so they can then hold space for compassion and empathy.

Solution-Focused Couples Therapy: Elliot Connie

Elliot described the 3 phases of solution-focused work with couples.

1. What is the desired outcome? “What are your best hopes for us talking today?”
2. Getting a more complete description of the desired outcome.
3. Closing the session.

He described several ways to discuss the outcome. First you can dig more deeply into the positive history of the couple. Explore what it was that made them fall in love. 

Then move on to “What would you notice if you woke up happy and transformed?’

Questions are essential and the therapist is introducing love and hope via their questions.

As you move to closing the session, tell the couple that you appreciate them answering all your questions. Don’t presume a second session. Instead ask, “Would another session be useful?”

Throughout the work, the therapist aims to get the client proficient in solution-focused language.

Relational Life Therapy: Terry Real

Terry described the 3 phases of RLT. 

1. Waking the client up to what is happening or what they are doing.
2. Inner Child work. In this phase RLT practitioners focus on re-parenting the wounded self.
3. Learned connection.

Terry focuses a lot on joining with clients through the truth. He will speak directly to the grandiose narcissist or the unrelenting victim.

In the 3rd stage of RLT, relational skills can be taught since so many clients had no good role models.

PACT: Stan Tatkin

Stan gave a very extensive presentation of the multiple aspects of PACT. Here is a summary of a few:

PACT is a poly-theoretical approach which has at its goal, secure functioning.

PACT is a difficult approach to master with a lot of moving parts, but when integrated, it becomes exquisitely simple, fun, and energy conserving for the therapist.

PACT focuses on experiential moments “show me” psychotherapy.

Secure functioning is available to most everyone. It is not the same as secure attachment.

Secure functioning will only occur if the couple therapist expects it. 

PACT therapists are above all investigators. They test and retest their hunches and hypotheses. They are constantly looking for the best version of the truth and then tailor interventions to what is in front of them.

Synthesizing

I wanted to know what has been most important in each approach over time. I came away from the conference thinking about the essence of these presentations.                     

Above all, I love the creativity invested in finding solutions that will really help our clients. 

I was also struck by these similarities across many or most of the models:

1. A focus on experiential moments in the room as the fulcrum of change.
2. Difficult or triggered moments become the place for necessary repair and learning.
3. Trauma in different forms interferes with connection and needs a way to be addressed by the therapist.
4. There is no cookie cutter approach. The art of couples work will inevitably lead to growth in the therapist.

I think it’s healthy to be exposed to a variety of styles and approaches for your work. If you think about what aspects of a particular approach resonate with you, you might find ways to use them. I don’t recommend jumping from one approach to another haphazardly. Rather, use what works best for you and incorporate it into your own professional style. Or you might choose to immerse yourself in one of them –  train, study, and grow. I’d be delighted to welcome you if you choose to pursue deeper training in The Developmental Model. Training usually opens twice a year and you can get on the waiting list here.