Michelle W. Joy, LMFT with The Couples Institute in Menlo Park, presented Effective Interventions
 for Hostile, Angry Couples at our South Bay Luncheon on June 26, 2015. Michelle has been with The Couples Institute for 15 years, and has completed advanced training with founders Ellyn Bader, Ph.D. and Peter Pearson, Ph.D.

Michelle explained that blaming, fighting, angry couples are the most difficult to treat because we, as therapists, have to do so much in the moment. We need to be strong leaders with this type of couple.

The developmental model of couple’s therapy is based on the notion that couple relationships pass through developmental stages that mirror early human development. The hostile-angry couple is arrested in the first developmental stage, the Symbiotic stage.

With hostile-dependent couples, the focus is on the first two stages: Symbiosis (stage 1) and Differentiation (stage 2).

Hostile, angry couples have difficulty moving from symbiosis to differentiation. While in symbiosis, their boundaries are merged, differences are minimized, and similarities are emphasized. The emphasis in this stage is on bonding. As couples move into differentiation, they begin to notice each other’s flaws. When the individual in each emerges, disillusionment and disappointments occur. Often the couple is tempted to return to symbiosis.

Hostility is a pervasive aspect in the hostile-dependent relationship and couples expect their partner will meet all their needs. Each is sensitive to confrontation and exhibits a minimal level of self-responsibility. They often lack skills to repair relationship ruptures and tend to search for symbiotic solutions. These couples will demand intimacy and then push their partner away.

Some of the reasons these couples are so challenging to work with include:

1. Sensitivity to confrontation

2. Pervasive search for symbiotic solutions

3. Lacking skills to repair relationship ruptures

4. Triggering trauma in each other

How do we work with these couples? Michele said the therapist must:

1. Establish leadership

2. Define their role as someone active and intrusive in the couple’s system

3. Explain that it takes both of them to fix their negative cycle

4. Gather information from their family of origin, present challenges and future vision

5. Set effective individual goals to create the relationship they want to have

6. Facilitate positive interactions

In early sessions, Michelle talks to the couple about the brain chemistry. By explaining the function of the amygdala and the fight, flight and freeze responses, the therapist normalizes these human responses that do not work well in intimate relationships.

It is also important for the therapist to gather data from the couple about their past, present, and future. Finding out about trauma or negative experiences and how emotions were handled in their respective families of origin is crucial. Asking the couple about what kind of future they want to create and what will be required from each is also helpful with a hostile, angry couple.

The next step is to help the couple set future goals. These couples resist setting self-focused goals. By helping them identify the most common coping strategies and explaining how they are a problem, directs the couple to a solution. The couples will then discuss what attitudes or habits each will need to release and what each partner will do to make it easier for the other.

Michelle taught the Initiator- Inquirer exercise. This exercise is an effective communication exercise to support differentiation by helping couples develop skills and teaching them how to talk about their problems differently.

Initiator-Inquirer Exercise (I-I)

Initiators start the conversation, expressing their own thoughts, feelings, wants and desires clearly and without blame. Initiators start being accountable for moving toward their partner.

Inquirers listen and inquire, manage their own reactions, and Inquirers learn to delay gratification and manage their own reactivity thereby developing an increased ability to tolerate anxiety.

The Initiator learns “differentiation of self”, the ongoing ability to identify and express important aspects of their self, their thoughts, feelings, wants and desires. The Inquirer learns “differentiation from partner”, the ability to be curious about their partner’s self- disclosure while managing their own reactions.

The therapist will get a clear picture of the couple’s dynamics and developmental level. When couples can manage reflexes, they are able to have a good discussion for the first time in years.

When explaining the I-I exercise, it is important to emphasize it is not problem solving. It is slowing down, learning how to talk about problems and how to manage their reactivity.CTOBER 2

The Initiator will bring up one topic; be open to self-discovery; and create a psychologically safe space for their partner. The Inquirer will listen and ask questions like a journalist, getting to know their partner. The therapist monitors and watches the Initiator for any triggers, blaming, criticizing or guilt inducing, and staying with one issue. With the Inquirer the therapist monitors and watches for arguing, trying to change the partner, defensiveness, recapping accurately or becoming too triggered to stay in their role.

I have recently enjoyed reading “In Quest of the Mythical Mate” A Developmental Approach to Diagnosis and Treatment in Couples Therapy by Ellyn Bader, Ph.D. & Peter T. Pearson, Ph.D. which fully explains the developmental stages with examples of different types of couples in therapy sessions.

Michelle referred us to the Couples Institute website at www. couplesinstitute.com for packages of

I-I exercise cards to use with clients, as well as packages of “Stepping Stones to Intimacy,” which succinctly describe the five developmental stages.

Here are more resources from The Couples Institute: • For more Articles and Resources or online training program: www. couplesinstitutetraining.com/ developmentalmodel

• How to get the most from couples therapy: www.couplesinstitute. com/getthemost/

• On-site training programs and workshops (Menlo Park): www. MichelleJoyMFT.com

Kera Burdick, MFTI #81082 and PCCI #1349, Supervised by Kirsten Kell, LMFT #41953, works in Private Prac- tice in San Mateo, and loves working with individuals, couples, children and teens.