Work with Ambivalence in Couples Therapy

After completing your readings this week, write a treatment plan for the ambivalent couple in the given case vignette. Be sure to integrate the suggestions from the readings/video in your treatment plan. You may use your own treatment plan or one from the readings. Remember to give credit to the author(s) of the original treatment.Initial Phase of Treatment  1. Increase couple’s awareness of negative interaction cycle and the  primary emotions for each.  a. Identify the negative interaction cycle with both secondary and primary  emotions for each partner.  b. Reframe their conflict in the broader systemic context of the negative  cycle to help create a greater sense of unity and understanding.  Working Phase of Treatment  2. Increase emotional engagement and expression of withdrawn partner to  reduce avoidance.  a. Use empathy, validation, and conjecture to help withdrawn partner  express attachment needs and primary emotions.  b. Facilitate enactments to allow couple to directly communicate about  attachment needs and to facilitate acceptance by partner.  3. Reduce criticism by pursuing partner and replace with increased  nonblaming expression of underlying attachment needs.  a. Heighten pursuer’s primary emotions to help facilitate softening of critical  position. Header_0  b. Facilitate enactments to promote acceptance and prompt new healing  interaction cycles.  4. Increase the ability of both partners to respond to each other and create  a sense of relational safety.  a. Track interaction cycle to help couple develop new interaction patterns.  b. Use enactments to help couple develop new ways of responding to each  other.  Closing Phase  5. Increase couple’s ability to effectively respond to new stressors in the  relationship.  a. Track positive interaction cycles to identify what worked and how they  affected each person’s sense of emotional safety.  6. Solidify secure bond by increasing the consistency of the positive  interactions.  a. Facilitate enactments that highlight how safety is created for each  partner.  b. Heighten new emotional responses.  Case study – Barbara and Ron
Barbara and Ron attended therapy following multiple disputes that became recurrent in their couple. Barbara stated that she was irritated by Ron’s inability to be respectful of their home environment. It seems that he did not care about keeping the house clean. While both partners were working, Barbara took charge of the household by performing main housekeeping tasks. She took as a great offense Ron’s inability to be respectful of her time and his inability to keep the rooms and bathrooms clean. Ron stated that he was surprised about Barbara’s reactions and found that she was exaggerating. He stated that he could no longer tolerate Barbara’s nagging about his behavior and was ready to move out if they don’t find some of resolution.SAMPLE TREATMENT PLAN  PRIMARY PROBLEM: ANGER MANAGEMENT  Definitions: Expressions of anger that include threats, breaking objects,  violating others’ individual space, and refusal to speak  to certain family members.  Expressions of anger that are perceived by others as  demeaning, threatening, or disrespectful.  Disagreement among family members about the threat  created by the angry member.  Goals: Terminate expressions of anger that are demeaning,  threatening, disrespectful, or violent.  Get in touch with feelings of emotional pain and express  them verbally in appropriate ways rather than through  angry outbursts.  OBJECTIVES INTERVENTIONS   1. Each family member identifies  the destructive effects that  his/her uncontrolled anger has  had on all family members,  including self.  .devreser sth 2. Identify any secondary gain that  gir llhas been derived through  A .deexpressing anger in an  taropintimidating style.  rocnI ,snoS  3. Family members sign a contract  & yestipulating that they will attempt  liW nto manage their anger with the  hoJ .support and guidance of family  410therapy.  2 © thgirypoC 1. Have each family member  describe how his/her respective  uncontrolled expression of anger  is counterproductive to  himself/herself and to other  family members; assist them in  identifying the negative effects of  uncontrolled anger (e.g., fear,  withdrawal, guilt, revenge, etc.)  on others.  1. Assist family members in  identifying what secondary gain  (acquiescence to demands, fear based service, etc.) is derived  from uncontrolled anger.  1. Urge family members to sign a  contract agreeing to accept  responsibility for containing  their own anger and managing it  effectively. Dattilio, Frank M., et al. The Family Therapy Treatment Planner, with DSM-5 Updates, 2nd Edition, John Wiley & Sons, Incorporated, 2014. ProQuest  Ebook Central, http://ebookcentral.proquest.com/lib/ncent-ebooks/detail.action?docID=1891004. Created from ncent-ebooks on 2022-02-23 18:32:31.  4. Implement assertiveness as a  INTRODUCTION 9  1. Clearly define examples of  replacement for angry aggression  to declare independence.  nonassertive, assertive, and  aggressive expressions of anger  and then have each family  member give personal examples  of each to demonstrate their  understanding of the concept  (see Your Perfect Right by  Alberti and Emmons).  2. Use role-playing and modeling  to teach assertiveness as an  alternative to angry  aggressiveness used to declare  independence. 5. Identify the various cues for  anger as it escalates.   6. Verbalize an understanding of  the steps in using time-out as an  anger control technique.  .devreser sthgir llA .detaroprocnI ,snoS & y 7. Report on the use of time-out at  eliW home to control anger.  nhoJ .4102 © thgirypoC 1. Teach family members how to  identify the cognitive, affective,  behavioral, and physiological  cues of anger and how to  differentiate low, moderate, and  high ranges; recommend the  book Angry All the Time by  Potter-Efron.  1. Teach family members the five  steps in using time-out to control  anger: (1) self-monitoring for  escalating feelings of anger and  hurt; (2) signaling to another  family member that verbal  exchange is not a good idea;  (3) acknowledgment of the need  for the other family members to  back off; (4) separation to cool  down and use cognitive self-talk  to regain composure; and  (5) returning to calm verbal  exchange.  1. Assign family members to  implement the time-out  technique at home; review  results, reinforcing success and  redirecting for failures. Dattilio, Frank M., et al. The Family Therapy Treatment Planner, with DSM-5 Updates, 2nd Edition, John Wiley & Sons, Incorporated, 2014. ProQuest  Ebook Central, http://ebookcentral.proquest.com/lib/ncent-ebooks/detail.action?docID=1891004. Created from ncent-ebooks on 2022-02-23 18:32:31. 10 THE FAMILY THERAPY TREATMENT PLANNER   8. Implement the use of the “turtle”   1. Suggest the use of the “turtle”  technique of retreat to control  technique, in which family  anger escalation.  members imagine themselves  individually retreating into their  shells until they cool down. DIAGNOSIS  ICD-9-CM ICD-10-CM DSM-5 Disorder, Condition, or Problem  312.34 F63.81 Intermittent Explosive Disorder  

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