Collaborative Couple Therapy With High Conflict Couples By Dan Wile, PhD on 4/16/11 - 11:40 AM

What’s hard, when dealing with high conflict couples, is getting their attention. If they do register your presence, it is to recruit you to their cause, confiding in you conspiratorily, “Look what I have to put up with.” And if they do acknowledge what you say, it is to turn your comments into ammunition against their partners, assuring you, “I do what you’re saying, but he never does.” High-conflict couples attack each other at such high velocity that you don’t have time to think. And you may not get much chance to talk, either, if, as sometimes happens, they keep interrupting you. Here are various methods I have heard therapists use to deal with these couples:
1. Take control from the beginning by doing individual therapy with each in turn in the presence of the other or taking them through a structured sequence.
2. Separate the partners. See each individually for a session and then bring them together. Taking it a step further, some therapists tell certain high-conflict couples that they each need a course of individual therapy before even considering couple therapy.
3. Ask them how they met and what originally attracted them to each other. In so doing, you distract them from their fight and introduce something positive.
4. Establish and enforce ground rules such as “no name-calling.” In a videotape of her work with a high-conflict couple, Susan Heitler gave the couple two rules: 1) stop talking when I say to and 2) don’t interrupt when I’m talking to your partner.
5. Tell the partners “hold it” or “stop” or wave you hands between them. Forcefully take command, as does Terrence Real. Or wave off the interrupting partner (Robert-Jay Green does this, but then later adds the wonderful touch of apologizing to the partner he waved off).
6. Confront the partners with the counterproductive nature of their behavior, saying, for example, “Listen to yourself!” or “Blaming doesn’t help” or “Talk about yourself rather than about her” or “Do you want to be right or do you want to be married” or “You’re acting like a couple of three-year olds in a sandbox fighting over a pail and shovel.”
7. Hook them up to a heart-rate monitor and when either partner’s heart rate exceeds one hundred, get them to take a time out. John Gottman came up with this.
8. Interrupt a fight to play back the video of it. John Gottman and Stan Tatkin do this.
9. Pick up a book and tell them you’ll stop reading when they stop fighting and get down to business.
10. Tell them that things are going too fast for you to think. Rather than blame them for doing something wrong, you take responsibility for the need to slow things down.
11. Move in quickly when things suddenly erupt and say “What just happened?” Susan Johnson does this.
You have to be forceful when dealing with high-conflict couples who interrupt each other and interrupt you and thus make therapy difficult. My way is forcefully to enter on the side of both partners and develop what they are trying say rather than to confront them with the counterproductive nature of their behavior and urge them to restrain themselves.
Why do I want to develop what the partners are trying to say? Because anger is typically a fallback measure, in EFT terms a secondary emotion. It’s what you’re often left feeling when you can’t express what you need to say—you lose your voice—or when you can express it, but you can’t get your partner to listen. In a couple fight—and this is the definition of such a fight—there are two people who feel too unheard to listen.
So I try to get the partners to listen to each other. I try to show them how it would sound if they were to express what they needed to say and take in what the other is trying to say. I move over and speak for them, in a method similar to doubling in psychodrama. I try to turn their fight into an intimate conversation.
And I do something else. I try to shift the partners to the meta-level—what I call the platform—and get them talking collaboratively about their fight. I want to get them commiserating with each other about it.
So these are the things I try to do with high conflict couples (and, actually, with any couple):  
  • Help them express what they need to say,
  • Help them take in what the other is trying to say
  • Create this platform.
There is a natural sequence of things I do in my effort to accomplish these purposes.
The first is to catch the fight in its early stages before it builds up steam. If I see the emotional temperature rising or if one of the partners lets loose a zinger, I jump in. If George says something angry to Rose, I move next to him and, doubling for him, that is, speaking as if I were he talking to Rose, I say, “As you can tell, I’m angry and that’s because I felt hurt by what you just said.” I turn his angry comment into a confiding one. If I can’t think of how to do this, I repeat some version of what he said but in a nonangry tone. Alternatively, I might help Rose deal with what George has said by asking her, “How much does what George just said seem an accusation and how much an understandable concern?”
If I’m unable to catch the fight before it starts and it really gets going, I try to translate the fight into a conversation—that’s number 2. I go back and forth between the partners, doubling for each in turn, trying to detoxify each person’s comments. This can go on for some time. Sometimes the fight goes too fast for me to keep up with. When that happens, I wait until I regain my bearings and then go back over what they just said, but detoxifying it (“first you said…, then you said…., then you said….”). I bring out the conversation hidden in their fight. 
Third, if I am unable to translate the fight into a conversation, I make a statement for each showing how each partner’s position makes sense. “Jim, it’s understandable that you don’t like Brenda’s bringing up something you did 20 years ago. It makes you feel she’ll never let you live anything down. And Brenda, it’s understandable that you’re bringing it up because it’s the clearest example of what you feel Jim continues to do in more subtle ways today.”
If I fail to get the partners to appreciate how each of their positions make sense, I try to get the partners up on a platform—a meta-level—talking collaboratively about how they are being adversarial. That’s number four: talk about the fight:
  • I ask, “Are you getting something from this fight, a chance to say a few things or hear a few things? Or is this fight discouraging, what happens at home, and what you came to therapy to stop?”
  • Or I ask, “In what ways is this fight useful and in what ways is it not so useful?”
  • Or I ask, “You came in today feeling relatively good about each other, but little by little the good will disappeared and now you’re quite upset with each other. Do either of you have any idea of what brought about this shift?”
  • Or I ask, “What should we do about this fighting? Should I step in more quickly to stop it?”
  • Or I ask, “Am I doing my job in keeping things safe? Or am I allowing too much fighting.”
While I am doing all these other things, I look out for and focus on conciliatory moments. That’s number five. I say, “Hey, I want to go back to what happened just a minute ago. You made that sweet comment (or you had that sweet exchange). What allowed that to happen? What were you thinking and feeling just before you said it that led to it?” And to the other partner I say, “How did you feel hearing it?” I’m looking for moments when these fighting partners aren’t fighting—much like a narrative therapist or solution-focused therapist looking for an exception. At other times I try to create a conciliatory moment. When one of the partners says he or she feels lonely or disappointed, I harken back to earlier in the session, or earlier in the therapy, when the other partner expressed such a feeling. I jump at the chance to show that they share a particular reaction.
Turning now to the situation in which one (or both) partners makes long provocative statements, either repeating (belaboring) a complaint or stacking complaints one upon the other,  I try to find a collaborative way to interrupt them. That’s number six: “interrupt tirades in a collaborative manner.”
  • I say, “I’d like to interrupt you here because I’m afraid that we’re losing Linda; she seems to be sinking deeper and deeper into the couch”
  • Or “Let me interrupt you here to find out how Linda is doing hearing this”
  • Or “I’d like to interrupt you here because you’re making some important points but I’m concerned that they are getting lost; I’d like to repeat them and then get a response to each from Lois.”
  • Or, “In the last couple of sessions things got pretty intense when one of you laid out a number of complaints in a row, so I think when that happens this session that I’ll move in and interrupt so we can have more of a conversation. What do you think about my doing that?”
  • Or I move in after a partner has made one or two points (or has made one point but has repeated it several times) and before he or she can repeat it again or go on to make the next point and I say, “Let me work with that; you’re saying that…” Or, more simply, “Okay, so you’re saying…” or "Let me interrupt here."
If all these various efforts fail to rein in the fight, and I feel overwhelmed and powerless and don’t know what to do, I give myself a little pep talk—that’s number seven: “Console myself.”
  • I remind myself that although I don’t know what to do at the moment, I’ve always in the past been able to come up with something a little later.
  • Or I remind myself that partners who appear to ignore or reject everything that I and their partners say, often come to the next session having made changes that show that they had heard, but just weren’t in a position at the time to acknowledge it.
  • Or I remind myself that partners who fight the whole session sometimes come to the next session saying, “We needed that—a chance to let off steam. We feel better now.”
If it looks like the session is going to end with the partners angry at and alienated from each other, I talk with them about that. That’s number eight: appealing to the partners as consultants in evaluating and dealing with the situation.
  • I say, “Given what’s happened here today are you sorry you came?”
  • Or “What does a session like this leave you feeling about what we are doing here and whether these sessions are helping or just making things worse?”
  • Or “It looks like you’re going to end the session feeling angry and alienated. Is there anything either of you can think to do in this last couple of minutes to change that, or is it something that we shouldn’t even try to change?”
Another thing I do if it looks like the session is going to end with the partners angry at and alienated from each other is to ask what is going to happen after the session. That’s number nine. I try to create a platform—a vantage point above the fray—from which to speculate about what is going to happen.
  • I say, “Given how upset you are with each other, what is it going to be like driving home together, and tonight, and the next couple of days?”
  • “How are you going to get over this and how long is it going to take?
  • “Who’s the one more likely to reach out to the other?”
By anticipating with them what is likely to happen, I am trying to keep the aftermath of the fight from being the lonely, alienating experience it usually is. The three of us would be talking about it ahead of time. I follow up the next session by asking what did happen—what evolved from last session?
In this next session, I might ask whether they want to return to the issue they were fighting over the previous session? Or do they think that’s a bad idea because doing so will just get them back into the fight? That’s number ten: attempting a recovery conversation—revisiting the issue when they are not upset. If they want to make such an attempt, I guide them through it. And I jump in quickly if it does begin to turn back into the fight. Developing an ability to have recovery conversations is a premier goal of Collaborative Couple Therapy. In a successful recovery conversation, both partner come away feeling that the positions of each made sense.
To put all this together, I move in to keep the fight from happening. If it does happen, I try to turn the fight into an intimate conversation. If I’m unable to do that, I make an elegant statement for each partner showing how his or her position makes sense. If that doesn’t turn the session around, I try to get the partners on the meta-level talking collaborative about their fight. All the while, I draw attention to collaborative moments and interrupt partners (in a collaborative way) when they belabor or amass complaints. At various points in difficult sessions, I console myself. If it looks like the session is going to end with the partners angry at and alienated from each other, I appeal to them as consultants in dealing with this problem and ask what is going to happen after the session. In the next session, and if it is possible to do so without rekindling the fight, I conduct a recovery conversation. A major goal of Collaborative Couple Therapy is to enable partners to have recovery conversations in which they turn fights, problems, misunderstandings, and glitches into opportunities for intimacy. 

File under: The Art of Psychotherapy, Couples Therapy