Individual Assessments for Couples Treatment with HFCA

Transcription

1 Individual Assessments fr Cuples Treatment with HFCA Jennifer S. Ripley, Ph.D. Many appraches t cuples therapy include an individual assessment whenever a cuple cmes fr treatment. Therapists shuld be aware that there is sme risk invlved in meeting individually with partners during the assessment perid. It is my belief that there is mre benefit than risk, but the risk shuld be understd. Partners may use the individual time t attempt t triangulate with the therapist in their wn agenda fr treatment. Fr example, the partner may tell n the bad habits r hurtful actins f their partner during the individual intake meeting. Clients wh attempt t d this shuld be redirected twards a new pattern f interactin that is mre healthy and helpful t the gals f treatment. The therapist als pens the dr that a true safety issue, infidelity r intent t leave the relatinship can be shared in the individual intake with the expectatin that the therapist will keep the secret and nt address it in treatment. These risks shuld be managed with all ethical cnsideratins f benefits and risks t each partner as utlined in prfessinal ethical standards. Hwever the main gals f the individual intakes are t determine whether cuples treatment shuld be recmmended, r standard prtcls altered t fit the needs f the cuple. Therapists shuld at minimum address issues f safety, intent t leave, infidelities, individual psychpathlgy r health prblems and individual gals fr treatment. If the cuple is at lw risk such that safety, intent t leave, infidelities, and individual pathlgy are all negative then the therapist can either shrten the individual assessment time r spend sme time getting the knw the individual client s backgrund. Dmestic Vilence: I recmmend als using an assessment such as the Cnflict Tactics Scale -2 r yur wn vilence checklist. This can help screen ut cuples with n histry f dmestic vilence quickly, r fcus in n specific situatins if psitive. Therapists can use the individual interview t ask abut the cntext, histry, their pinin abut any vilence, and t assess fr safety. It is mst typical that the cuple will nt give the same infrmatin s there is n need t be extra-suspicius as they are bth likely inaccurate in ways that are self-prtective. If significant issues f vilence arise, then the therapist will need t smthly recmmend individual treatment and pstpne cuples treatment until issues f vilence are effectively addressed. Hwever, unlike ther times in cuples treatment, it may be imprtant that the therapist keep secrets arund issues f vilence as this is ne area where the therapist can harm the cuple by inflaming a vilent partner. The fllwing are issues that shuld be weighed as t whether cuples treatment is cntraindicated in terms f vilence: Is there substance abuse paired with vilence? If s, cuples treatment shuld likely be pstpned until there is n substance abuse and the partners shuld be evaluated whether a separatin wuld be recmmended fr the sake f safety Is there risk f significant harm? Vilence can be unlikely t cause harm such as cmmn cuples vilence that is milder and des nt invlve physical damage. Fr example pinning, thrwing things r pushing wuld generally be cnsider milder if it s never caused harm. If the vilence is mre likely t cause harmsuch as punching, kicking, bruising, leaving marks that last mre than a minute,

2 r use f a weapn- then safety becmes the nly gal f treatment, any cuples gals are secndary. Hw recent and frequent is the vilence? If the vilence has ccurred within the last year, and has ccurred mre than nce r twice a year, then cuples treatment may be cntraindicated, depending n the cntext and risk f harm. Can the cuple effectively use time uts when they are very upset? Fr all cuples with any kind f vilence, even the mildest frms, if they cannt effectively use time uts during the week t avid escalating arguments t the pint f vilence then cuples treatment shuld be pstpned. Time uts wuld be necessary t have a basic level f safety in the cuples relatinship, withut which cuples treatment will be severely limited. If cuples treatment is severely limited due t lack f safety, then individual treatment is preferred. Cuples shuld be tld abut this situatin as they are being taught the time ut prcedures, and then the success f the time ut shuld be assessed fr several weeks befre a curse f typical cuples treatment wuld begin. What is the male typlgy? Currently there is n female spuse abuse typlgy within the research. Hwever, sme f the male typlgy may apply t females given the lack f research. The male typlgy lks at varius factrs that predict hw much f the vilence is trait-based vs. situatinal. If the male has antiscial persnality traits, is vilent in varius situatins nt just with his partner, has little t lse by being arrested fr vilence, has cgnitive r memry deficits, has significant anger cntrl r impulsivity traits, and has a belief that vilence is acceptable r cntrlling ne s spuse is a necessary male rle in the relatinship then cuples treatment is unlikely t be effective. Unfrtunately, the nly treatments that appear effective with this type f situatin is lng-term wrap arund kinds f services that address a variety f issues and mdalities f treatment simultaneusly. Intent t leave the relatinship: It can be difficult t ascertain frm partners what their true intent is in regards t their cmmitment in the relatinship fr the future. Sme cuples will state that they have a strng intent t leave and yet the cuple will still be tgether mnths r years later. Other cuples will state they 100% are cmmitted fr the lng-term and yet mve ut 3 mnths later. Therapists can ask sme questins t help determine the cuples intent t stay r leave the relatinship. If ne partner is intent n leaving, and will nt put aside all plans r discussin t leave fr the curse f treatment, then cuples treatment is nt recmmended. If things get just a little better in yur relatinship in the next 6 mnths, wuld yu stay r g? Their relatinship may be difficult and they may be the kind f relatinship that is very slw t change. It s hard t tell what kind f effects therapy will have n the cuple until they begin sme treatment. S, if the wrst happens and things g slwly, wuld the partner stick arund? This questin als taps int their expectatins fr treatment. What are their barriers t leaving? This can ften be very enlightening fr the partner and therapist. Barriers can include things like difficulties with finances if living separately, difficulty with c-parenting separately, mral beliefs abut separatin, supprt f friends r family in leaving, and s n. While many cuples are unhappy in their relatinship, ften barriers t leaving will cause unhappy cuples t remain tgether.

3 D they have a plan fr leaving? If a partner has a definite plan fr leaving, has investigating husing, has cnsulted with a lawyer, is preparing children fr their leaving r mving ut, then the chances f imminent separatin are fairly high. Fr cuples in lnger term relatinships, hw lng have they felt like leaving? Sme partners stay in a perpetual wish-state t leave the relatinship but never take steps t actually leave. Yu can assess whether their intent t leave is unusually high cmpared t the past, r mre typical. Infidelities, in past r current: While individual assessments can ask abut this, sme partners feel unsure whether their respnse will surface in meetings r a legal case and therefre may cnceal the infidelity frm the therapist. This area f assessment is als very difficult. If the client is nt willing t address infidelity, it can trap the therapist t be aware f it yet unable t address it in treatment. Therapists might cnsider assessing this area in persn with a questin like: I d nt like t keep secrets between partners, hwever if there is an infidelity ging n nw then cuples therapy is nt recmmended. Instead I wuld recmmend individual treatment if that were the case s each partner can srt ut what he r she wants at this time. Is there any reasn why I shuld recmmend individual treatment? If the partner answers yes, then the therapist shuld assess what that partner believes their partner knws abut the extramarital relatinship, and the histry f infidelity. The therapist shuld assess if the partner is willing t end r suspend the ther relatinship while in cunseling. If the partner des nt want t tell their partner abut the ther relatinship, then the therapist can encurage a cnfessin n the part f the partner having the affair but if he/she refuses, then individual therapy wuld be recmmended fr the cuple at this time. If bth partners are aware f the affair. Depending n the situatin and time since the affair is the affair the primary reasn fr seeking cunseling at this time? Hw much wuld they each individually feel the need t address the affair? If wrking twards frgiving the affair is the majr gal f treatment then I recmmend relying heavily n the treatment prtcl fr affairs develped by Baucm, Snyder & Cp-Grdn (2009) Helping cuples get past the affair with Guilfrd Press. Hpe fcused treatment can supplement this treatment prtcl fr general cuples treatment but HFCA is nt specifically designed fr treatment f infidelities like affairs. Is there a histry f infidelity? The therapist wh hears that there is n current infidelity shuld als ask if there is a histry f infidelity at sme pint in their histry. Infidelity is very cmmn in cuples, and particularly in sme types f cuples such as thse frequently physically separated due t deplyments r wrk duties. If there is a histry f repeated infidelities, r if the infidelity is recent enugh that partners are still fcused n it and haven t mved n frm it, then treatment shuld fcus n the infidelity. Individual psychpathlgy r health prblems: Therapists shuld assess each partner fr individual psychpathlgy and health prblems that may be cntributing t r interacting with the marital prblems. Depressin has a particularly high crrelatin with intimate partner prblems and shuld especially be assessed fr. Given the limited time within individual intakes I recmmend that therapists emply an effective clinical

4 symptmlgy checklist (such as the SCL-90, r the symptm checklist develped fr use in the Hpe lab which is available n ur website) t fcus n any pssible individual pathlgy. Depressin: Therapists shuld assess fr depressin symptms t determine if individual treatment specific t the depressin in additin t cuples treatment shuld be recmmended. Cuples treatment fr depressin can be an effective frm f treatment in and f itself, but sme individuals may benefit frm als addressing their depressin thrugh CBT, individual prtcls fr depressin r psychiatric treatment. In the Hpe lab we have used the Beck Depressin Inventry fr Primary Care which is a 7 item screen used in primary care settings that can be quickly added t all cuples intake frms t screen fr depressin. PTSD symptms: Symptms related t trauma can be especially difficult n intimate partners. Individual intake sessin shuld assess fr childhd abuse, sexual assault r abuse, military trauma r accidents that have left an individual PTSD type symptms and their partner with ptential secndary trauma symptms. Sexual dysfunctin and Bdy image issues: Since sexual dysfunctins r bdy image issues may especially nt be vlunteered by partners, symptms related t these issues shuld be specifically asked abut either in written r verbal frmat. Health cncerns: Fr many cuples their relatinship has changed significantly due t health cncerns, especially health cncerns that may affect md r their sexual intimacy. Individual gals fr cuples treatment: Therapists can assess what each partner hpes will ccur as a result f treatment. Since the dyadic intake has typically ccurred befre the individual intake, the therapist can address with the individual client whether they have additinal hpes r gals fr cunseling that were nt discussed in the dyadic meeting. The therapist can als begin t flat a preliminary treatment plan idea t the individual t determine what areas f the relatinship wuld be fcused n during treatment, especially the 9 C s in the Hpe apprach (Central values, Cre values, Cnfessin & frgiveness, Cmmunicatin, Cnflict reslutin, Changing cgnitins, Clseness, Cmmitment r Cmplicating factrs). If time, individual histry: If there is time, and there have been few cncerns fr all the prir screening issues then the therapist can spend time learning abut the individual histry f each partner such as family f rigin issues, experiences with psychlgical interventins r marital enrichment, faith histry, and issues f career r hbbies. Set f individual intake questins fr ptential use in cuples therapy assessment. 1. I see n yur screen that yu indicated n types f vilence between yu in yur histry. Is that crrect? If any hesitatin, reassure the individual that if safety is an issue at all yu will keep things t prevent stirring up their partner. 2. I see n yur screen that there s been sme (hitting, pushing, shving) can yu tell me mre abut that?

5 a. Get cntext, frequency, stry f mst recent interactin, what happened right befre the vilence, hw did the cuple repair things after the vilence, and stry f the mst scary r hurtful vilence ever in their histry, whether substances are invlved in the vilence, if it s 2 way vilence r 1 way, hw afraid the partner is f vilence reccurring in the next few weeks, plan fr getting ut f the hme/situatin if the persn sees vilence starting again, find ut whether the abuser has been in legal truble fr vilence in r utside f their relatinship, if there are children whether the children have witnessed r been physically abused (and whether CPS shuld be called), what the abuser wuld have t lse if he/she gt int legal truble, and the partner s need fr supprt in creating a safety plan. Even if the vilence has been relatively mild, ffer the client/s the number t lcal wmen s shelters r dmestic vilence htlines in case the partners need immediate cnsultatin t avid harm 3. Have yu thught abut leaving the relatinship? 4. If things nly gt a little bit better in the next 6 mnths, wuld yu stay r g? 5. What keeps yu frm leaving the relatinship? 6. I d nt like t keep secrets between partners, hwever if there is an infidelity ging n nw then cuples therapy is nt recmmended. Instead I wuld recmmend individual treatment if that were the case s each partner can srt ut what he r she wants at this time. Is there any reasn why I shuld recmmend individual treatment? 7. Has there been any kind f betrayals r secrets in yur relatinship? 8. I see n yur screen that yu indicated (this symptm), can yu tell me mre abut that? (Explre fr psychpathlgy r diagnsis) 9. D yu have any health prblems r medicatins that yu re n? 10. What d yu hpe t see change in yur relatinship as a result f cunseling? 11. (If time) Tell me a little bit abut yur histry grwing up, yur family and childhd.