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Andrew Christensen's "Unified protocol for couple therapy" - the five principles (one, two & three)

I wrote yesterday about Andrew Christensen's interesting proposal for a "Unified protocol for couple therapy".  I mentioned that the protocol involves "five principles".  The first of these is to: (1) provide a contextualized, dyadic, objective conceptualization of problems. Good. This makes plenty of sense. It's seeing the "wood" rather than being lost in the "trees". Moving back out of hot emotional processing to cooler reappraisal is very likely to help people act more in line with their longer terms priorities and values. See posts like "Reappraising reappraisal" and "Self-control, conscientiousness, grit, emotion regulation, willpower ... " for more on this. So what kind of cooler, bigger picture "dyadic, objective conceptualization" is likely to be most helpful. Well, it's likely to be a frame that acknowledges people's underlying wishes for good outcomes, that doesn't blame, and that provides indications of better, more productive ways forward. This can link to assumptions like "By and large, people are doing the best that they know" and "Although the best that they know almost certainly makes sense to them emotionally, unfortunately their reactions may well actually make the current problems they're trying to address worse rather than better." Often each member of the couple's emotional responses and behaviours is very reasonable when viewed through the lens of their earlier life history - their family background, attachment status, childhood, and previous experiences in adult couple relationships. This is definitely not about blame. Through this "life history" lens, a more appropriate response to current self-defeating behaviours is likely to be a dawning understanding and compassion - both for oneself and for one's partner. It's important that this "contextualized, dyadic, objective conceptualization of problems" is arrived at cooperatively by therapist and couple, so that it is an overview that they all genuinely feel fits the facts.

Christensen's second unified principle is: (2) modify emotion-driven dysfunctional and destructive interactional behavior. There are a number of ways of achieving this during therapy sessions - many of them involving active intervention on the part of the therapist. Outside sessions, back "at home" one of the most widely used suggestions is to take "time out" to allow emotions to cool when interactions become too heated & distressing. It's also very possible to use mental contrasting and mutually arrived at implementation intentions as skilful ways of responding to subsequent couple "roadblocks".

The third principle is (3) elicit avoided emotion-based private behavior.  Christensen writes "Partners in couples may avoid emotionally charged aspects or issues in their relationships, such as their growing alienation from each other, the increasing lack of physical contact, a partner's increasing use of alcohol, or a partner's grim medical prognosis.  This avoidance may be internal to one or both partners, in that one or both avoid thinking about the issue or avoid emotional reactions to the issue although they have some dim awareness of it.  Or the avoidance may be only external, in that they focus on it internally but do not discuss it with the other.  This internal or external avoidance of the proverbial 'elephant in the room' prevents partners from experiencing shared emotional closeness and support about a difficult issue and prevents them from taking joint, corrective action."  Christensen suggests that it is likely to be important for the therapist to talk about the "elephant in the room", but care needs to be taken over when and how to discuss these upsetting areas.  He also points out that "Another kind of avoidance occurs when partners are aware - however dimly or acutely - of some vulnerable emotional reaction in themselves and avoid any revelation of their internal emotional experience to their partner, such as worry that the other might leave, fear that the other has lost interest, competition with the other over a child's attention, shame or embarrassment about their own behavior, or feelings of rejection or hurt in response to the partner's actions.  All these are vulnerable emotions that partners might avoid revealing to the other.  Not only do partners fail to reveal these emotions, they often reveal other, more accessible emotions that they experience - such as anger, annoyance, or irritation at the other's behavior.  Instead of any obvious emotional reaction, partners may alternatively withdraw from the other in response to these vulnerable emotions." 

See tomorrow's post for more on these five principles.

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