Couples therapy

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Couples therapy and marriage counseling are offers for people with relationship problems. In this context the concept of illness from the medical frame of reference is of secondary importance. Here one speaks more appropriately of work with relatives if one or more of the participants are clearly treated as patients who are mentally, psychosomatically and somatopsychically ill. There are several approaches to couples therapy that all share the view that relationships between people can contribute to the development of disorders. Couples therapy is seen as a modification of family therapy, although at the beginning it could be deepened individually in psychoanalytic work with couples and marriage counseling.

The boundaries between couples therapy and marriage counseling are fluid. In Germany, both activities are not legally separated as non-medical psychological activities . In terms of method, however, couples therapy with the therapist is often deeper and longer-term than is the case with pure marriage counseling, for example in a counseling center.

Psychologists , social pedagogues and pastors are mainly active as couple therapists or marriage counselors . The aim is for both partners to be included in the event of a marital crisis. However, the individual psychological work can also be part of the couples therapeutic process.

Influence on health

A permanently stressful interaction with the partner has been proven to lead to a psychophysiological abnormality in the hormonal stress reaction, as well as to cardiovascular problems. This suggests a direct influence on the health of the partnership through persistent couple conflicts .

In a study on the health effects of stress in a relationship, Fehm-Woltersdorf found that unhappily married people have a greater health burden than unmarried people.

Barlow and Craske have already discussed the importance of relationship problems and decreased relationship satisfaction as triggering situations for mental illness. Copper found that a lack of emotional and practical support and aggressive partner behavior are risk factors for the occurrence of depression, Rief and Hiller show in their research that people with somatization syndromes are often unmarried, separated, divorced or have significant marital problems. In a survey of 400 people suffering from agoraphobia, Doctor recorded that the separation or loss of a partner and relationship problems are the most common triggers of panic and agoraphobia. In her study, Röskamp shows that couples therapy has positive effects on mental health.

Topics in couples therapy

According to Rosmarie Welter-Enderlin (2007), the topics that lead couples into couples therapy are:

Relationship problems due to an imbalance between autonomy and the experience of attachment. Other topics include intimacy, sex life, fidelity and affairs, separation and divorce. The decision for parenthood or a childless partnership is also an issue. These issues are interrelated.

Topics for same-sex couples:

Topics for gay and lesbian couples include past experiences of violence and discrimination and the resulting strain on the relationship. Another topic is the formation of relationships. This has to be created individually due to the lack of social couple models and traditions.

Coming out is also an issue. The attitudes of the partners can be very different. A coming out of one partner always affects the other as well.

requirements

A prerequisite for successful counseling is the acceptance of the counseling person by the person seeking advice and the understanding that a problematic partnership is not just one of the partners ' fault . It is also helpful to understand that the couple therapist or marriage counselor is neither an arbitrator nor a problem solver, but rather a moderator and companion of the couples therapeutic process.

Action

Counseling does not mean teaching relational knowledge, but the mediation and implementation of relational competence in the respective individual life concept. The promotion and strengthening of the autonomy of people seeking advice is the central goal of every couple work.

Examples of methods used in couples therapy:

  • Conversation based on Carl Rogers ,
  • Mediation techniques ,
  • Role plays from psychodrama (or gestalt therapy)
  • Communication training

The main goal of counseling is to enable individuals, couples and families to process their conflicts and to achieve a higher degree of personal development, relationship and partnership skills, regardless of the specific form of the respective partnership.

Couples therapists usually first try to create a framework in which the partners can express and clarify their various needs, fears and fears. This can be the starting point for a mutual understanding process in which the partners gain a deeper understanding of the conflict dynamics, their own shares in them and the personality of the other, so that, ideally, a deeper emotional relationship with more flexibility, tolerance , openness and closeness is made possible . This process can create a new basis for living together (and not against each other).

Therapeutic approaches

Due to the large number of schools of psychological thought, there are also numerous different approaches in the field of couples therapy. Various explanatory models are therefore available for the development and maintenance of conflicts in couple relationships .

Psychoanalytic Theories

Psychoanalytically oriented approaches assume that chronic couple conflicts are based on neurotic dispositions of one or both partners.

For cases in which these neurotic dispositions like key and lock fit together, Jürg Willi coined the term collusion . In these cases (according to Willi) both partners have not dealt with certain central conflicts from earlier phases of mental development in their personality and are now living out opposing, but initially complementary "solutions" to these inner conflicts. In 1975, Willi orients himself in the formulation of his collusion types on the childlike-psychoanalytic development phases - later he adds more. For couples where z. For example, if a narcissistic disorder is in the foreground, there is often a constellation in which one of the partners wants to be admired and the other likes to admire him and idealize him, his own not lived narcissism - in the sense of an interpersonal defense - i.e. delegated to the other, while at the same time a piece of its grandiose reflection falls on him as a partner. In coexistence, over time there is often an increasing polarization within a collusive neurotic arrangement, with the result that the extreme positions then lived become stressful for one or both partners (if, for example, one partner is more and more dependent, the other is more and more independent and dominant becomes).

Humanistic psychology

In the tradition of humanistic psychology, especially gestalt therapy, the pair synthesis method developed by Michael Cöllen stands . Its central assumption is that love and intimacy are the early drivers of life. The emotional-intimate bond is seen as a decisive factor in personality development, especially in its effect on the couple's love and conflict dynamics. The therapeutic work focuses on the clarification and processing of narcissistic disorders that have a dynamic effect on couples, the promotion of intimate exchange on the dialogue levels of body, feeling, language, soul and time as well as an understanding of love as a meaning and life orientation.

Emotion-focused couples therapy

Emotion-Focused Couples Therapy (EFT) is an intervention that explicitly aims to improve a couple's relationship satisfaction by making their bond more secure. Emotion-focused couples therapy is about re-establishing a loving connection between both partners. Both partners learn to develop more openness and understanding for one another. Furthermore, the couples are helped to heal old bond injuries. Emotion-focused therapy is anchored in attachment theory and regards changing attachment schemes as essential for improving satisfaction in relationships

Multi-generation therapy

Another approach to couples therapy comes from multigenerational family therapy . Following this model, the starting point of the couple conflicts is assumed to be in the families of origin of the two partners. It is assumed that there is a "basic family conflict" over several generations, which the couple is reviving today. Central terms here are, for example, loyalty and the resulting ties, as well as the term delegation and the contradicting assignments from the families of origin.

Systemic therapy

In the systemic couples therapy , the question is the focus through which "circular process" the conflicts of the couple be maintained. A distinction is made between the level of behavior, the interaction pattern and the construction of reality. Central terms of systemic couples therapy include circularity , reframing , neutrality, solution and resource orientation and positive connotation .

Communication psychology

Communication psychological approaches in couples therapy try to improve the partners' forms of communication and thus develop a better emotional understanding for one another. The psychologist John Gottman has described typical communication patterns and described them as the "four apocalyptic riders of a couple relationship" that are capable of permanently ruining a marriage or intimate relationship:

  1. Criticism : Assignments of blame and accusations that culminate in a general condemnation of the partner
  2. Defense with justification and denial of one's own parts that contribute to the conflict
  3. Contempt and disdain of the partner
  4. "Walls" , closing the bulkheads and retreating

The demonstration of one's own power - also as a defense against feelings of powerlessness - is used at all stages of the course of a conflict and is occasionally referred to as the “fifth apocalyptic horseman” by the Berlin science author Bas Kast .

One criticism of these approaches is that the solution of partnership conflicts is reduced to the use of communicative techniques. This implicitly transports the attitude that a change in behavior can be trained. Differentiation-oriented approaches in couples therapy claim that a disturbance in the couple relationship is also communication and that this always represents an attempted solution in the context of the partnership, albeit with high follow-up costs. Failure to appreciate this communication usually means that the message eludes conscious discussion, but continues to influence the relationship.

Eclecticism

An eclectic approach is "Imago Therapy" by Harville Hendrix and Helen Hunt, which combines psychoanalytic theory, depth psychology, behaviorism, systemic theory, gestalt therapy, transactional analysis and cognitive therapy. In Imago Therapy, the traditional therapist-client relationship is placed in the hands of the couple themselves.

Modern approaches in couples therapy

Couples therapy and sex therapy have long been and are in many ways still understood as separate domains. Modern approaches to couples therapy no longer separate and assume that sexuality cannot be viewed in isolation and that couples' conflicts and problems often also have a sexual core. True to Watzlawick's axiom “one cannot not communicate”, the idea that one can change the quality of relationships or even sexuality by simply changing communication and communication behavior is contradicted. Even a non-existent sexuality is already a communicative message from the two partners in a relationship with a very specific meaning. These communicative messages can be used as the basis of a couple and sex therapeutic development process. Another feature of these approaches is that they tend to focus on previously unspoken aspects, differences between partners or unsafe areas of communication, such as taboo content / shadow aspects. These approaches can also be described as differentiation-oriented (as opposed to “bond-oriented”). Systemic sex therapy is one of the modern approaches in this sense .

effectiveness

80 to 90 percent of couples who say they are in a serious crisis or are getting divorced report that they do not take advantage of couples counseling or therapy. Due to the fact that many couples seek professional help relatively late, couples therapy has only a limited effectiveness rate, according to which around two thirds experience an improvement after the therapy, of which 40–50% can also be described clinically as improved.

Individual evidence

  1. ↑ R. Kreische: Psychoanalytic couple therapy. In: P. Kaiser (Ed.): Partnership and couple therapy. Hogrefe, Göttingen 2000, pp. 257-270.
  2. ↑ PSychThG § 1 Abs. 3 Satz 3.
  3. ↑ John M. Gottman: The Marriage Clinic: A Scientifically Based Marital Therapy. New York / London 1999.
  4. ↑ JM Gottman, RW Levenson: Marital process predictive of later dissolution: Behavior, physiology, and health. In: Journal of Personality and Social Psychology. 63, 1992, pp. 221-233.
  5. ↑ ACD Röskamp: effectiveness of couple therapy in the judgment of the patient. A follow-up study of couples therapy. Unpublished dissertation. University of Zurich, Faculty of Medicine, 2001.
  6. ↑ G. Fehm-Wolfsdorf, T. Groth, A. Kaiser, K. Hahlweg: Partnership and Health. In: Federal Ministry for Family, Seniors, Women and Youth (Ed.): Prevention of separation and divorce. Kohlhammer, Stuttgart 1998, pp. 261-279.
  7. ^ DH Barlow: Anxiety and its disorders. Guilford, New York 1988.
  8. ^ MG Craske, P. Miller, R. Rotinda, DH Barlow: Features of initial panic attacks in minimal and extensive avoiders. In: Behavior Research and Therapy ,. 28, 1990, pp. 395-400.
  9. ^ PJ Cooper, M. Tomlinson, L. Swartz, M. Woolgar, L. Murray, C. Molteno: Postpartum depression and the mother-in-fant relationship in a South African peru-urban settlement. In: British Journal of Psychiatry ,. 175, 1999, pp. 554-558.
  10. ↑ P. Joraschky, K. Petrowski: Anxiety and Depression. In: M. Wirsching, P. Scheib (Hrsg.): Couple and family therapy. Springer, Berlin 2002, pp. 325–338.
  11. ↑ W. Rief, W. Hiller: Somatization disorders and hypochondria. Huber, Bern 1998.
  12. ↑ P. Scheib, V. Speck: Somatoform disorders: body complaints without sufficient findings. In: M. Wirsching, P. Scheib (Hrsg.): Couple and family therapy. Springer, Berlin 2002, pp. 353-374.
  13. ↑ RM Doctor: Major results of a large-scale pretreatment survey of agoraphobics. In: RL DuPont (Ed.): Phobia: A comprehensive summary of modern treatments. Brunner & Mazel, New York 1982.
  14. ↑ P. Joraschky, K. Petrowski: Anxiety and Depression. In: M. Wirsching, P. Scheib (Hrsg.): Couple and family therapy. Springer, Berlin 2002, pp. 325–338.
  15. ↑ ACD Röskamp: effectiveness of couple therapy in the judgment of the patient. A follow-up study of couples therapy. Unpublished Dissertation. University of Zurich, Faculty of Medicine, 2001.
  16. ↑ Rosemarie Welter-Enderlin: Introduction to Systemic Couples Therapy. Carl Auer Systems, Heidelberg 2007, p. 87. ISBN 978-3-89670-472-6 .
  17. ↑ detailed information on topics related to couples therapy.
  18. ↑ Margret Göth; Ralph Kohn: Sexual Orientation in Psychotherapy and Counseling. Springer-Verlag, Berlin Heidelberg 2014, p. 170 . ISBN 978-3-642-37308-4 .
  19. ↑ U. Rauchfleisch, J. Frossard, G. Waser, K. Wiesendanger, W. Roth: Gay couples in: Equal and yet different. Psychotherapy and counseling for lesbians, gays, bisexuals and their relatives. JG Cotta´sche Buchhandlung, Stuttgart 2002, p. 153 . ISBN 978-3-608-94236-1 .
  20. ↑ Margret Göth; Ralph Kohn: Sexual Orientation in Psychotherapy and Counseling. Springer-Verlag, Berlin Heidelberg 2014, pp. 163-164 . ISBN 978-3-642-37308-4 .
  21. ^ Family constellations, couples therapy, family constellation, Zurich-Bern-Basel. (No longer available online.) Archived from the original on September 22, 2016 ; accessed on September 22, 2016 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.familienstellen-paartherapie.ch
  22. ^ TJ Wolf: Group psychotherapy for bisexual men and their wives. In: J homosex. 14 (1-2) 1987, pp. 191-199.
  23. ↑ M. Klein: Free Couples Counseling. Canadian Association of Couples Counseling, Oct. 11, 2011.
  24. ^ J. Willi: The two-way relationship. Causes of tension, disruption patterns, clarification processes, solution models. Rowohlt Verlag, Reinbek near Hamburg 1999, ISBN 3-499-60509-0 .
  25. ↑ M. Cöllen: Love your partner like yourself - ways for couples out of narcissistic crises . Gütersloher Verlagshaus, Gütersloh 2005, ISBN 3-579-06509-2 .
  26. ^ L. Greenberg, SM Johnson: Emotionally Focused Therapy for Couples. Guilford Press, New York 1988.
  27. ^ L. Greenberg, SM Johnson: Emotionally Focused Therapy for Couples. Guilford Press, New York 1988.
  28. ↑ SM Johnson: Attachment theory: A guide for couples therapy. In: SM Johnson, V. Whiffen (Ed.): Attachment processes in couple and family therapy. Guilford Press, New York 2003, pp. 103-123.
  29. ^ S. Johnson: Made to Measure: Adapting Emotionally Focused Couple Therapy to Partners' Attachment Styles. In: Clinical Psychology: Science and Practice. Volume 6, No. 4, 1999, pp. 366-381.
  30. ↑ A. Massin, G. Reich, Eckhard Sperling : The multi-generation family therapy. Vandenhoeck & Ruprecht, Göttingen 1992, ISBN 3-525-45740-5 .
  31. ↑ I. Boszormenyi-Nagy , M. Spark: Invisible bonds. The dynamics of family systems. Klett-Cotta, Stuttgart 1981, ISBN 3-608-91297-5 .
  32. ^ Helm Stierlin : Delegation and Family. Suhrkamp Verlag, Frankfurt am Main 1982, ISBN 3-518-37331-5 .
  33. ^ Arnold Retzer : Systemic couple therapy . Klett-Cotta, Stuttgart 2004, ISBN 3-608-94365-X .
  34. ^ Arist von Schlippe , J. Schweitzer: Textbook of systemic therapy and advice . Vandenhoeck & Ruprecht, Göttingen 1996, ISBN 3-525-45659-X .
  35. ↑ Love can be learned. ( Memento of March 8, 2016 in the Internet Archive ) and Die apokalyptischen Reiter. ( Memento of March 7, 2016 in the Internet Archive ) In: Sciencegarden . September 1, 2004.
  36. ^ Robert Coordes: The end of sexual abstinence. ( Memento of December 4, 2015 in the Internet Archive ) on: Zeitgeist-online. Accessed May 4, 2014.
  37. ↑ Ulrich Clement: Systemic Sex Therapy. Klett-Cotta, Stuttgart 2004.
  38. ↑ K. Halford, H. Markman, G. Kline, SM Stanley: Best practice in couples relationship education. In: Journal of Marital & Family Therapy. 29 (3), 2003, pp. 385-406.
  39. ↑ DH Sprenkel (Ed.): Effectiveness research in marriage and family therapy. American Association for Marriage and Family Therapy, 2002, pp. 163-190.
  40. ↑ DL Chambless, TH Ollendick: Empirically supported psychological interventions: Controversions and evidence. In: Annual Review of Psychology. 66 (3), 2001, pp. 53-88.

Web links

Wiktionary: Couples therapy  - explanations of meanings, word origins, synonyms, translations