Couples Counseling:

Finding the Tipping Points of Change

Gerald Parr, Loretta Bradley, and Bret Hendricks

Facts about Couples

• Worldwide abut 90% people pair and eventually marry at least once by age 45

• 93% of Americans rate having a happy marriage is the most important

objective for their lives

• 20% of married couples report being distressed at any given moment in time

• About 50% of all marriages fail

• About 40% who seek counseling of any kind report marital distress

Marriage and Couples Therapy: An Integrative

Model

• Assess Problem Identification: SFT Miracle Question and Scaling

• Assess Motivation for Change: MI Stages-

• Precontemplation: not ready to change

• Contemplation: aware there is a problem but not ready to take action

• Preparation: ready to take action is small ways

• Action: takes relevant and significant steps to change behavior

• Maintenance: consulate change and prevent relapse

Signs of the Precontemplation Stage

• Discrepancy of miracle question

• Example: wife sees family spending time as a family in the den each evening while the husband envisions more frequent sex and social time at the country club

• Discrepancy of scaling

• Example: wife rate marriage state of happiness as a 3 while husband rates it at a 7

• Discrepancy in willingness to focus on marriage vs. denial, quick fix, or blaming

How to Address Precontemplation Stage

• Be empathic to both parties as in Roger’s core conditions

• Highlight examples of exceptions to problems identified

• Reframe differences as having the potential for synergy

• Create positive expectations for change, e.g., normalize and share examples

of other couples who overcome distress

• Establish the foundation for how past issues influence current relationships

Signs of Contemplation Stage

• Both parties identify dissatisfaction with status quo but are uncertain how to change it

• Both parties identify the need for change but each sees what and how change is to occur in sharply different ways

• Both parties agree the goal is to save and improve the relationship but neither has faith it can happen

• Both parties are dimly aware that their personal issues influence their current relationship but fail to see how to address such as a couple

How to Address the Contemplation Stage

• Identify what needs or wants are unmet in the relationship, e.g., John

eventually tells Jane that wants some down time before being with family

upon coming from work; Jane does the same regarding her wants and needs

• Help the couple refine wants and needs if too vague

• Help the couple negotiate what is change is possible; e.g., John, Mary is fine

with you taking a 30 minute break before spending time with the family but

for her an hour to too much given the children’s bedtime; same done for

Mary

Signs of the Preparation Stage

• Establish contractual agreements about negotiated changes, e.g., so, John

you have agreed to taking only 30 minutes of down time upon coming home

from work. Where in the house will that occur? What if the children

demand time during this time? Same done with Jane.

• Clarify how each couple can be supportive of the other during this period of

change, e.g. Jane, if John has an unusual stressor at work and needs your

time to debrief immediately upon coming home, how might you

accommodate to this? Do same for John.

Signs of Action Stage

• Couple accepts homework and follows through with agreed upon behavior

changes

• Couple supports each other in their attempts to change even if imperfect

• Couple displays increased levels of mutual caring during their visit

• Couple can articulate how the changes have affected their relationship and

those around them

• The self-efficacy of the couple as a partner increases

How to Address the Action Stage

• Reinforce efforts and highlight the couples’ agency (self-efficacy)

• Example: Your steps to become closer really speaks to your motivation and skill

• Reframe setbacks as normal

• Example: You may find times when you slip back to the past, but now you have tools

to never be stalemated for long

• Address strategies to recover from setbacks

• Example: If you find yourself being critical, remember to re-focus on I statments

The Couple is Stuck• Look for nonverbal cues that indicate unresolved past issue

• Joan, I wonder if you remember another time when you felt someone didn’t keep their promises. It might help to shut your eyes and picture this in detail

Offer Individual Work• Employ Gestalt imagined dialogue to address past

unfinished issues

• Help the partners understand how the past colors the present relationship

Reset how to respond to

past ghosts• Create nondefensive and helpful ways the couple can react to each others’

ghosts

• Example: John, when you come home later than expected, instead of thinking Joan is attacking you, could you realize that this is a emotional trigger from her past instead of an attack on you and thus offer your support to Joan

Strengthen

Communication Tools

• The power of I messages

• Eliminate cross overs, i.e., telling the other what they

think or feel

Communication Tools

Continued• The power of feeling your partner hears and understands by

using basic communication skills: summaries, reflections, open-ended questions, clarifications, non-verbal responsiveness such as eye contact, being personal and specific vs. impersonal and vague

Addressing Conflicts:

Another Tool• Each partner states what they want with clarity and specificity

• Each partner can re-state with accuracy what the other wants

• Each partner states what they are willing to do to meet each other’s needs

Addressing Conflict

Continued• Fine tune what is acceptable in terms of giving and receiving gifts

• Example: So, John you agree to watch one show Joan prefers each evening, and you, Joan, agree that John can watch two college football games on Saturdays while you have lunch with friends and shop, right?

References

• American Counseling Association. (2014). ACA Code of Ethics. Alexandria, VA:

• American Counseling Association.

• Bass, B. & Quimby, J. (2006). Addressing secrets in couples counseling: An alternative approach to informed consent. The Family Journal 14 (1),77-80.

• Britzman, M. & Sauerheber, J.D. (2014). Preparing couples for an enriched marriage: A model in individual psychology. The Family Journal, 22(4), 428-436.

• Cordova, J. V. (2014). Adapting therapeutic assessment, motivational interviewing, and

• integrative couple therapy to a marriage checkup. In , The marriage checkup practitioner's guide: Promoting lifelong relationship health (pp. 43-72).Washington, DC, US: American Psychological Association. doi:10.1037/14321-004

• Cordova, J. V., Warren, L. Z., & Gee. C. B. (2001). Motivational interviewing as an intervention for at-risk couples. Journal of Marital and Family Therapy, 27, 3.

• Eckstein, D., McRae, S., & Sperber, M. (2009). Forgiveness: Another relationship “f word”-a couple’s dialogue. The Family Journal, 17, 256-262.

References Continued

• Englar-Carlson, M., & Shepard, D. S. (2005). Engaging men in couples counseling: Strategies for overcoming ambivalence and inexpressiveness. The Family Journal, 13(4), 383-391.

• Hahn, R. A., & Kleist, D. M. (2000). Divorce mediation: Research and implications for family and couples counseling. The Family Journal, 8(2), 165-171.

• Hendricks, B., Bradley, L., Southern, S., Oliver, M., & Birdsall, B. (2011). Ethical code for the international association of marriage and family counselors. The Family Journal, 19, 217-224.

• Mahaffey, B. A., & Lewis, M. S. (2008). Therapeutic alliance directions in marriage, couple, and family counseling. In G. R. Walz, J. C. Bleuer, R. K. Yep, G. R. Walz, J. C. Bleuer, R. K. Yep (Eds.) , Compelling counseling interventions: Celebrating VISTAS' fifth anniversary (pp. 59-69). Alexandria, VA, US; Ann Arbor, MI: American Counseling Association.

• Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guilford Press.

• O’Brien, E.R., & Young, M.E. (2014). The big reframe: Helping couples develop and interactive definition. The Family Journal, 22(3), 347-349.

• Prochaska, J. O., Rossi, J. S., & Wilcox, N. S. (1991). Change processes and psychotherapy outcome in integrative case research. Journal of Psychotherapy Integration, 1, 103 -120.

• Shurts, W. M., Cashwell, C. S., Spurgeon, S. L., Degges-White, S., Barrio, C. A., & Kardatzke, K. N. (2006). Preparing counselors-in-training to work with couples: Using role-plays and reflecting teams. The Family Journal, 14(2), 151-157.

• Watts, R. E. (2003). Reflecting" as if": An integrative process in couples counseling. The Family Journal, 11(1), 73-75.

Couples Therapy: Strategies to Activate the Tipping Points of Change 

 

Program Summary: 

This program will present an integrative approach to couples therapy.  This model includes modified 

aspects of the following: experiential therapy to build rapport, motivation interviewing to access 

readiness for change, attachment theory when insight is needed for the couple to accept their role in 

the change process, couples behavior therapy to establish what needs to change, gestalt therapy 

whereby requests for change can be directly expressed and negotiated, and homework.  The final 

“tipping” point culminates in the couples’ decision to renew their bond or to part with grace.   

 

Rationale: 

Counseling couples is challenging.  Couples who seek help often have destructive patters of 

communication that is imbedded in hurtful feelings, unrealistic expectations, irrational beliefs, and 

failed, but repeated, attempts to heal the relationship. An integrative blend of several theories provides 

a viable model to meet this challenge includes experiential therapy, attachment therapy, motivational 

interviewing, behavior therapy, and gestalt therapy.  

 

Educational Content: 

The integrative model in this approach draws upon several major theories.  Building on Rogers’ core 

conditions, experiential therapy informs counselors how to reach out to connect with, and build the 

trust of, each member of the couple such that both feel affirmed and valued.  The next step is to have 

the couple identify what brings them to counseling.  Often, they are vague or disjointed (having very 

different views) in what they see is behind the deterioration of their relationship.  Motivational 

interviewing is a seamless transition from rapport building to the problem exploration stage.  If this 

stage fails to yield clarity, attachment theory allows the counselor to refocus on what dynamics from 

past relationships may be intruding upon the couples’ relationship.  Individual sessions may be 

considered for this, but the purpose is have the couple see themselves more in a supportive role rather 

than an adversarial role with each other.  If successful, the couple becomes less defensive when issues 

from the past emerges to sabotage the couples’ relationship. Once the couple accepts that their partner 

is not always the cause of their distress, the couple focuses with increasing clarity what they want from 

their partner.  A gestalt framework allows the couple to negotiate change in the here‐and‐now.  A 

problem‐solving perspective allows the couple to request change with increasing specificity. Once this 

phase of the counseling has solid footing, homework assignments are developed jointly by the couple 

and the counselor.   Finally, the couple faces the final “tipping point” of their work where they commit 

to renew their relationship or gracefully end it.   

 

Learning Objectives 

1. Participants will be able to demonstrate how Rogers’ core conditions can be extended to 

couples in ways that validation is felt equally by the members of the couple. 

2. Participants will be able to demonstrate how to use motivational interviewing in helping couples 

explore what brings them to counseling.  

3. Participants will understand how brief interventions form attachment theory can lead to insights 

into how the couples’ relationship is assailed by past unresolved issues.  

4. Participants will be able to utilize gestalt‐like encounters to enable couples to negotiate change.  

5. Participants will be able to formulate homework assignments that are doable and relevant.  

 

Bibliography 

American Counseling Association. (2005). ACA Code of Ethics. Alexandria, VA: Author. American Counseling Association. Multicultural competencies. Retrieved January 21st, 2009, from    http://www.counseling.org/Resources/  American Counseling Association. Advocacy competencies. Retrieved January 21st, 2009, from  

http://www.counseling.org/Resources/ American School Counselor Association. (2004). Ethical Standards for School Counselors. Alexandria, VA:    Author. American Association for Marriage and Family Therapy.  (212). AAMFT Code of Ethics. Washington, DC:    Author. Benson, L. A., Mia, S. & Andrew, C. (2013). The Impact of Behavioral Couple Therapy on Attachment in 

  Distressed Couples.  Journal of Marital & Family Therapy Vol. 39, Issue 4, (pp 407-420). DOI: 10.1111/jmft.12020 Brown, J. R. (2007). Gestalt therapy.  In A. B. Rochlen (Ed.). Applying counseling theories: An online    case‐based approach (pp 127‐141).  Upper Saddle River, N. J:  Pearson Prentice‐Hall  

Cordova, J. V., Warren, L. Z., & Gee. C. B. (2001). Motivational interviewing as an intervention for at-

risk couples. Journal of Marital and Family Therapy, v27, 3,. Cordova, J. V. (2014). The marriage checkup practitioner's guide: Promoting lifelong relationship   health.(pp. 43‐72). Washington, DC, US: American Psychological Association.  Hendricks, B. E., Bradley, L. J., Southern, S., Oliver, M., & Birdsall, B. (2011). Ethical code for the    International Association of Marriage and Family Counselors. The Family Journal, 19, 217‐224.   doi: 10.1177/1066480711400814 Framo, J. L. (1992). Family‐of‐origin therapy. New York: Brunner/Mazel.  Hahlweg, K., Bauccom, D. H., & Markman, H. (1988).  Recent advances in therapy and intervention.  In I.    R. H. Falloon (Ed.). Handbook of behavioral family therapy. New York:  Guilford. Miller, W. R., & Rollinick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.).    New York: Guilford Press.  

Prochaska, J. O., Rossi, J. S., & Wilcox, N. S. (1991). Change processes and psychotherapy outcome in integrative case research. Journal of Psychotherapy Integration, 1, 103 - 120. Yontef, G. (1995).  Gestalt therapy.  In A. S. Gurman & S. G. Messer (Eds.). Essential psychotherapies:    Theory and practice (pp. 261‐303). New York: Guildford Press.  

Wittenborn, A. K.., Faber, A. J., & Keiley, M. K. (2012). An Attachment and Affect Regulation   Based Multiple Couple Group Intervention for Couples Transitioning to Marriage/Commitment.   

  Journal of Couple & Relationship Therapy. Vol. 11, Issue 3, (p189-204). DOI: 10.1080/15332691.2012.692941.  

The Case of Fred and Ada

Marjorie is a licensed professional counselor who has been in private practice for 20 years. Her specialty is family counseling. She has been counseling Fred and Ada for the past 6 months. Fred and Ada have been married for 12 years. They have a son who is 8 years old and a daughter who is 6 years old. Fred and Ada describe their marriage as in the beginning, a good marriage. They report their jobs were and continue to be satisfactory. Fred is an accountant and Ada is a financial planner. However, after the children were born, they found themselves “torn” in trying to balance their time between their family and career. Fred told Ada that she might consider working part-time to which Ada replied “not me but you can work part-time”. Fred said he was not interested in a part-time career. Despite their marriage being characterized as good during the first three years, they now describe their marriage as very challenging. They further report their time together is sparse, their time with their children is limited, and their time at work is more demanding, resulting in longer hours at work. When Marjorie asks them why they came to counseling, they report “we want to save our marriage”. When Marjorie responds, “Tell me what you are willing to do to save your marriage”, both Fred and Ada reply “anything”. Fred reports that while he has never had an affair, he has gone to dinner with a co-worker twice. Ada said this would be ok except Fred lied and said he had to work late on both nights. Ada reports that because of what Fred did, the thought of an extramarital affair has occurred to her, although she has never done this. The couple reiterates that they care for each other. Further, they state they want to remain married providing that counseling helps them. Analysis Using the 2011 IAMFC Code of Ethics, the 2014 ACA Code, and a theory of your choice, how would you conceptualize this case if you were the counselor, Marjorie? Is there anything from today’s presentation that you would use in your conceptualization? Questions 1. If you were the counselor (Marjorie) what counseling theory would you use? 2. Assuming you are the counselor, describe your next 3 sessions with Fred and Ada. 3. Assuming you are the counselor, do you perceive any ethical issues? Legal issues? 4. Assuming Fred asks to see you for individual counseling, how would you respond? 5. What outcomes would you expect for you to conclude counseling was or was not successful for Fred and Ada.