At the SCV-CAMFT South Region Luncheon at the Los Gatos Lodge on April 19, Steve Darrow, LCSW and Mary Cook, LMFT, CADCII, LPCC, LAADC, presented on Conjoint Couples Counseling. They have been offering Conjoint Couples Counseling for “high risk” couples for over 15 years as an adjunct to their regular private practices.
Conjoint Couples Counseling occurs when there are two therapists working with one couple. In this model, all four meet together at some sessions, and each partner meets with one of the therapists separately as needed.
There are a number of therapeutic advantages to this approach:
1. Both members of the couple have an advocate.
2. Individual issues can be dealt with within the safety of the existing therapeutic relationship.
3. Individual counseling sessions maximize the couples counseling time together.
4. One therapist can be “process observing” for additional insight.
5. Couples benefit from the richness of having access to the experiences of two different counselors.
Concerns about this method include cost, claims that clarity regarding transference can be confused, destructive competitiveness between the therapists, or that co-therapists may become too close, shut out others and destroy healthy interchange.
At this presentation Steve and Mary introduced the conjoint model of working specifically with high risk couples and presented the model they work with themselves.
Initially Steve and Mary meet with the couple for an intake appointment to explore the presenting problem. It is then determined which therapist should work individually with which partner of the relationship. For a period of several months, Steve and Mary engage in individual therapy with their respective individual clients to establish a solid alliance, clarify individual goals and prepare for the couples therapy. The conjoint model they use explicitly refers to the following structure:
1. Each person in the couple meets with either Mary or Steve every two weeks.
2. The couple meets with both Steve and Mary every two weeks.
3. The division into therapeutic dyads is not necessarily gender specific, but is based on a clinical assessment of client compatibility needs both in style and issue focus.
Throughout the program, Steve and Mary discussed the challenges to establishing a good working relationship with a co-therapist and outlined the nine phases of co-therapy team development by Dugo and Beck (1991).
These phases are:
- Creating a contract
- Forming an identity
- Building a team
- Developing closeness
- Defining strengths and limitations
- Exploring possibilities
- Supporting self-confrontation
- Implementing and integrating changes
- Closing
Crucial factors in developing a successful co-therapy team include respect, openness, trust, support, and complementary personalities and therapy styles. The success of the relationship depends on the openness and willingness of the therapists to communicate about differences that arise.
Steve and Mary presented a past case, outlining how they applied the model and the challenges with their own countertransference. Steve pointed out that working with high conflict couples can be quite difficult but that he and Mary infuse humor into their work which has benefited their couples.
They were encouraging other therapists to partner up and attempt to use it as well, and both reported to enjoy working together in this intense style as couples work becomes accelerated.
Steve Darrow can be contacted at 408-985-1217 and Mary Cook can be contacted at 408-449-0333.
