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A third type of challenging clinical case is a situation that is probably the mo
A third type of challenging clinical case is a situation that is probably the most common request for counseling, which is couples counseling. It never ceases to amaze me that this is the number one reason–
and the research continues to demonstrate–
that people seek out counseling. Even if they come in with depression or anxiety, frequently, it’s associated with conflicts in their primary intimate relationships. Reportedly, this is the most difficult work that a therapist can do. And yet I think it’s the most rewarding.
It never ceases to amaze me the number of therapists who don’t want to work with couples because it’s so difficult. And this is the kind of work that I think that, as rewarding as it can be, it’s going to require extensive training and supervision. And hopefully, your supervisor will help you take it on. Just to begin with, it’s important to assess each partner’s position about the goals for counseling.
What I mean by that is that not all couples come in wanting to preserve the marriage. Not all couples come in with the same ideas about what it is to have a successful marriage or a successful relationship. But it’s important to find out from each one of them, either by meeting with them together or meeting with them separately, just what their aspirations are for couples counseling. To do so, then, is to clarify then a couples contract, which is different than an individual contract for therapy–
that there is some consensus about what we’re striving to achieve in the course of this couples therapy. And finally–
and this is a tough situation here–
where you have to decide whether or not you’re going to have a no secrets contract with the couple. And this no secrets contract is that things that are told to you in private, if you’re willing to even see one of the couples in private, if information is conveyed, whether or not that is fair game for the couples session or not. Some therapists believe in a no secrets contract. And others believe that it’s OK to keep secrets from one another, given that that secret is the individual’s responsibility to resolve and make a decision about how that’s going to impact the relationship itself.
Now I’d like to introduce Richard who is portraying a client who has court mandated therapy and how one might respond to his request for assistance and letters regarding progress.Hello, Richard. My name’s Duncan Wigg. Nice to meet you. My pleasure. My pleasure. So tell me a little bit about what brings you here to my counseling office.
I’m interested in talking with you about how I can be of help to you. I think you know why I’m supposed to be here. The courts tell me that I’m supposed to be here. Yeah.
I got into an altercation at a bar where I was defending myself, and that was seen as something else, where I actually ended up defending a girl in a bar, and had to push a guy off me, and get arrested. And now I am serving my time here. OK. Is it OK if I just take some notes here?
I just want to write down some things that you tell me. Sure. Why not? OK?
Yeah, that’s fine. I just don’t want you to–
I want to make sure it’s still OK with you. OK. Thanks. So you were unfairly arrested.
Yes. And now–
now what? And how can I be of help to you? You’ve been mandated to come for counseling, and what is it that I’m supposed to accomplish with you? I think this is just literally me doing my time now.
My probation officer tells me that something that I need is a letter to be drafted by you to say that I have come here and we have worked on my issues. And so I think the sooner that we can get to that, the better. OK. OK.
So let’s not mess around then. Let’s not mess around. OK. So my familiarity with other individuals in your situation, sometimes they want a letter just stating the dates that they’ve arrived.
And that’s good enough for the probation officer. They’ve come 10 sessions. No, I want it to be better than that. I do not want to be–
be here for a long period of time. It’s got to be something coming from you to say that I am doing better. You’re doing better. Making progress.
Yes, that I won’t do what they think that I’m going to do again. OK. Doing better, and won’t do it again. OK.
OK. Yeah, this is a familiar request, both the dates and this notice of some progress being made. And many psychologists are quite prepared to write these more comprehensive letters to probation officers and to the courts and saying, I have met with this individual on these dates, and I can tell you that he’s made great progress, and that I can predict–
likely to predict that he will not conduct himself or commit this crime again in the future. Great. Yeah. I kind of have a little bit of a different attitude about this, and I just want to talk with you about my approach to this kind of stuff.
And it sounds like you’re already disappointed in what you’re about to hear from me. But taking that risk with you, I think I want to describe something that I think actually works better, in my experience. But before I get there for just a moment, I’m just sort of wondering about what you think about having been arrested in this particular incident, and the unfairness of being required to come here. Is there anything else you might want to take up while you’re having to be here?
Any other kinds of things? What do you mean? Like, learning to juggle or what? Yeah, learning to juggle, or do you find yourself getting in other kinds of mixes, other kinds of aggravated kinds of situations?
You know, my wife and I have had arguments in the past, and she says that I have a quick temper. But I suppose if we can work on that, then maybe that will help me in my relationships in life. OK. That sound good?
Sure. Sure. OK. I mean, is that something–
I don’t know if that’s something–
are you just quoting her, or is that something that is something that you would carry with yourself as well? Of course, it’s something that I care about as well. OK. OK.
OK. I’m glad to hear that. Glad to hear that. Well, let me go back to your request for this letter, and my ideas about doing–
this is something I’ve been doing for quite some time now, is I find that a letter that is actually co-written by the client and the therapist and the psychologist in which we address together the concerns of the court, and over the course of counseling, attend to what the court might say is important to them. Because of the court not only represents the punitive or disciplinary actions of the client, but they also represent the needs of the community, and wanting to make sure that the community isn’t in jeopardy ever again. So what you’re asking for is for, like, me to apologize in the letter?
Is that what you’re saying? Not necessarily. Not necessarily at all. I’m asking–
It sounds like you’re just trying to cover yourself. [LAUGH]
–by having me a part of this letter instead of you just writing it yourself. No? I’ll tell you the difference. I’ll tell you the difference.
One thing is that I have a very, very difficult time believing that a therapist can predict what people are going to do, but I do believe that a client can do a much better job predicting what that client is going to do. But that’s not what’s important to the courts, right? They want you–
you’re the professional–
to say it. And I’m going to help you say that to the court. And I’m going to–
perhaps when we come to writing a letter and co-constructing this letter, maybe ask you some of the very same questions that the court might ask you. Like, would you ever do this again? No would be the obvious answer. But the court being a place that’s based on evidence would say, what evidence do you have to support that?
And that’s where they really want to get involved. So you might say something to the effect of, like, as we go through the counseling thing here, as we go through helping you with quick temper, we might want to talk about how you’ve come to just find ways to keep quick temper out of your life, and where the evidence is, and how you came to do that, and what steps you took to watch out for quick temper coming in and trying to convince you to resort to impulsive kinds of actions. And so I would quote you. I would quote you, not only about your position about not wanting to do whatever it is it led to your arrest again, but I’d want to quote you about why you believe the court should believe you.
And what evidence do you have to provide them of demonstrations that you’re already doing right now at the time that we write the letter that is evidence that the court could respond to? If that’s what you think is going to be good, then–
I’ve found it to be very successful with other clients in your situation. Matter of fact, I’ve had other probation officers tell me and courts tell me that they much prefer a letter that’s spoken from the client with the client providing evidence as a much more tangible and credible kind of thing, rather than just some letter from some therapist who says, well, because I’m a therapist, I can predict what people will do. I don’t believe that’s really true. I don’t believe a therapist can really predict what people are going to do.
So that’s what I’d like to propose to you, that we write that kind of a letter. And in the meantime, that we tend to things that you talk about that are important to you, like this quick temper that might be jeopardizing your relationship with your wife and your relationship in your jobs. What do you say? I think it’s the fastest way to do it too.
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