Suggested Tips for Practice
- Develop flexible hypotheses for understanding family dynamics
- Collaborate with each family member around therapeutic goals
- Explore your countertransference around complex dynamics in family work.
Camille and Lance had been married for about seven years when I first met them. Their daughter, Hannah, was four at the time. I typically saw Camille and Lance twice monthly for about nine months. Their central goal for therapy revolved around managing anger during conflict and responding without reacting with defensiveness, criticism, or emotional withdrawal. They each expressed that
empathy, or an ability to hear, identify with, and validate each other, was lacking in their attempts to express and resolve conflict.
Conflict occurred for them in vicious, seemingly unavoidable, and endless cycles of attack and withdrawal. Neither Camille nor Lance experienced their relationship as supportive or safe, and both seemed to have little understanding of the cause of their conflicts or dynamics that kept them apart. Lance and Camille regularly experienced hurt and rejection, unable on their own to engage constructively with one another during moments or episodes of volatility. They reported a desire to grow in their marriage by experiencing togetherness, as well as understanding, in the midst of conflict. However, their pattern made it almost impossible to break or heal from these cycles, leaving each of them stuck in perpetual states of defensiveness, criticality, and ultimately the experience of rejection. Almost always, Lance and Camille seemed to be just a disagreement or wound away from their next blowout.
Assessing the Problem
Camille often expressed her emotion through anger, criticism, or a vigilant effort to draw out an empathetic emotional response from Lance, while his go-to responses were anger, defensiveness, or withdrawal. They described a mutual experience of “hopelessness” regarding navigating and resolving conflict.
Adding to their pain was Camille’s and Lance’s disconnect from social support, as they lived a considerable distance from both of their families and had struggled to build social connections as a couple. There were also pressures related to both finances and Lance’s work schedule.
Camille, having close ties with her family, described her childhood as one in which she was nurtured and supported. Lance, who had very little contact with his own family, characterized relations with them as chaotic and he described a childhood in which he was left on his own for almost everything, including meal and school preparation and doing homework.
A Working Hypothesis
The more Camille and Lance were able to communicate vulnerably with each other about their own emotional hurt—which we distilled down as feeling “misunderstood, unsupported, and unappreciated” — the more they would experience love and mutuality (that is, feeling understood, supported, and appreciated) during conflict and in their marriage in general.
It was clear that Camille’s and Lance’s emotional experiencing during heated conflict occurred at a secondary, reactive level (anger or withdrawal) rather than out of the more vulnerable, primary dimension of their emotion (simply feeling misunderstood, unsupported, or unappreciated). How they expressed their needs for closeness or identity in their relationship determined the ensuing cycles of emotion by which closeness or identity was negotiated.
While it was likely that their current emotional styles and patterns of conflict response were rooted in past experiences, my therapeutic approach was focused primarily on the ways in which they expressed their hurt to each other in the here-and-now of their marriage, especially during conflict.
Clarifying a Goal for Therapy
The central goal of therapy for Camille and Lance was to reach a place where they could begin to experience mutuality and togetherness, as well as understanding and acceptance around their differences, especially regarding their experience of conflict management.
In reporting on goals, the couple agreed that they would “like to be able to set goals and boundaries together,” as they had prior difficulty in meeting common ground. They said of themselves, “we fight mean,” and “we can both be Dr. Jekyll and Mr. Hyde.”
To optimize chances for therapeutic success, every session and intervention would need to be grounded in the goal of facilitating more satisfying emotional experiencing between them, particularly during conflict. The work of therapy would involve increasing expressions of vulnerability in place of reactive expressions of defensiveness and criticism during conflict.
This change was to facilitate the delay of gratification in their individual desires to experience immediate validation, and in its place to nurture the development of a more meaningful and effective way of processing emotion and staying connected through hurt and nurturing intimacy.
Clinical Reasoning
An emotion-focused approach theorizes that couples experiencing difficulties in their relationship often are hiding and or repressing emotions such as fear or a need for attachment, and instead expressing emotions that may be defensive or coercive — primary” and “secondary reactive” emotions.
When these negative interactions solidify into patterns, couples often experience a loss of trust or a heightening of fear in their relationship, therefore further burying the primary emotions.
I theorized that Camille’s and Lance’s pattern of becoming angry or emotionally withdrawn during conflict was a pattern of conditioned defense, covering up primary emotions, cravings for understanding and support buried below the surface of their experiencing.
Clients with whom I have worked typically have internal resources for repair and growth in relationships. Their negative interactional patterns, which often are adaptive, coping styles can therefore be transformed into positive and healthy interactions. In these cases, couples counseling that focuses on emotions can result in transformative experiences.
As a therapist, I don’t see myself as an intrusive mechanic who fixes couples. Rather, accepting and validating clients’ self-experience is a key element in my therapeutic approach. Empathic attunement with couples also involves taking care to provide appropriate validation to one person without marginalizing or invalidating the experience of their spouse. It is a balancing act.
With Camille and Lance, I attempted to provide empathy and safety, as well as to engage in our relationship in a way that was collaborative and in which roles and expectations were clearly defined. Through many challenging and white-knuckled therapeutic hours with conflicted and often disconnected couples like Camille and Lance, I have found that a clinical environment marked by empathy, safety, and occasional structured directives provides the opportunity to build corrective emotional experiences and reconnection. By working in the here-and-now with them, and by integrating their at-home experiences into our in-session work, Camille and Lance became increasingly able to reflect on both their respective inner and relationship experiences in a far more adaptive way.
Intervention and Therapy Process
The family therapist Carl Whitaker advocated a nonrational, spontaneous, and creative experiential presence with clients as a means of engaging them at the hidden symbolic dimensions of their awareness. He said that for real change to occur, insight won’t do the trick. We need to engage each other emotionally.
While encouraging the spontaneous and creative side of therapy, Whitaker also understood the importance of providing focus and structure, “the experience of our being firm,” as he called it. With Camille and Lance, I attempted to use in-session directives that would drive the client-centered and emotion-focused processes in therapy. I also labored to redirect from more-of-the-same conflict cycles to processing the experience of emotion in their relationship.
If they were tempted to explain why they were angry, I let them know that they could choose between carrying on explaining, remaining in the safe position of knowing what they already knew, or exploring how they experienced anger, taking them to what they did not yet know. This was effective with Lance and Camille in facilitating a shift between defending, criticizing, or debating facts to sharing emotional experiences by exploring their own internal processes.
The following is an overview of the therapeutic process.
Sessions 1 & 2
My hope for these early sessions was to establish a working relationship with Camille and Lance, to open up the space for them to tell their story, to nurture understanding and relationship with them by listening empathically, and to begin to establish a therapeutic vision. At this time, I was focused on noticing and stirring curiosity about emotional experiencing in their marriage.
Camille and Lance described their reason for coming to counseling as “conflict.” They described the early family contexts that shaped them and theorized about their problems in marriage. They described their cycle of conflict as erupting when Lance experienced Camille as being “nagging, preachy, or undermining.” Camille compared Lance to her father many times, which frustrated him. She said she wished, in some ways, that he were more like her father.
Camille and Lance had, in these sessions and in sessions thereafter, described successful experiences of empathy during conflict. Early on, they communicated that when they experienced feeling heard or understood, they felt closer with each other and experienced more successful conflict. I hoped to begin to interact with and facilitate experiences of empathy between them, not merely by talking about these successful experiences of conflict but enacting them in-session.
Session 3 & 4
My approach during these sessions was to facilitate in-session interaction with their emotions in conflict. During the third session, Camille and Lance reported having a “not-so-good last couple of weeks.” They found themselves frequently getting into heated arguments around Camille, forcing Lance to have conversations with her about subjects that he did not want to talk about.
Lance described feeling “like my whole life is ‘I’m sorry,’” because Camille always “nagged” him about the things that she thought he should be doing. Lance described the conflict as being over “small things,” while Camille argued that they were over “bigger things.”
Lance frequently felt overwhelmed when Camille approached him about multiple concerns at once. Lance said he needed “time and space to breathe and think.” Camille said she wanted to process through these issues immediately.
A large portion of the third session was spent negotiating between them a way of giving mutually satisfying time, space, and understanding while in the heat of conflict. Between sessions three and four, I had them work together on a list of “rules for fair fighting,” which was used as a way of engaging them to establish boundaries and appropriate responses for conflict, a goal that they expressed early on.
Camille and Lance came to our fourth session still emotionally charged from a fight. Both described not feeling heard. I coached them to listen actively, and they reported feeling more heard by the end of session as a result of a slower, less reactive style of communicating around feelings.
Session 5 & 6
A goal during these sessions was to provide in-session experiences of communication between Camille and Lance, exploring and interacting with their emotional processes through emotion coaching strategies. Camille and Lance talked about the patterns of their fights and how they escalated quickly and got “off subject.” I facilitated the practice of active listening in an attempt to promote understanding and slow down arguments.
Session 7 & 8
During these sessions, we focused on the pattern of conflict between Camille and Lance.
Together we explored body language and other forms of meta-communication. Camille said, “He feels threatened by my body language, and I feel threatened by his.” Lance reported that he was frustrated and felt disconnected. He reported that when conflict is present, “I don’t want to talk about it.” During the conflict, Lance experienced “tiredness, numbness, deadness.”
During session seven, Camille and Lance reported having a conflict around finances after a trip to a wholesale store, where Camille spent a lot of money on things that Lance did not think they needed. During the session, I encouraged active listening and communication between the two of them as a way of assessing and intervening in their emotional processes during conflict.
During session eight, they described “hopelessness” as a common experience during conflict. Camille communicated that she experienced hope and safety when Lance looked at her in the eyes when she wanted to talk to him about something, rather than tuning her out. Lance communicated that he experienced hope and safety when he was given emotional and physical space to sit in the disagreement and then communicate about it again later.
They reported that they had experienced some dramatic and disappointing conflicts as well as “breakthroughs” in the past couple of weeks. During “breakthroughs,” they felt mutually understood and supported. At the end of the seventh session, Camille noted that she kept a record of Lance’s wrongs. I suggested that during the following week she keep a record of Lance’s “rights.”
Session 9 & 10
During these sessions, we explored how their personality differences affected their conflicts. Lance expressed difficulty in developing close friendships right now and in speaking up in groups, including with acquaintances and with coworkers. He also expressed being overwhelmed right now in his life, being busy with work, marriage, and parenting, among other things. I shared similar experiences of my own to normalize his experiences.
I noticed a lighter interaction between Camille and Lance during these sessions, which I pointed out. Even while discussing conflict, their conversation was more introspective and less frustrating. Previous conversations, especially about conflict, were less thoughtful and more reactive. I noticed a fresh team-based attitude in their in-session interactions and shared my observations. I also had a brief opportunity to observe both of them with Hannah, who had been waiting in the lobby during our session. They seemed gracious and loving with her.
Session 11
My hope for this session was to re-join with Camille and Lance after over a month’s break from therapy. Lance reported having begun taking medication for depression and social anxiety after communicating with his family doctor about his concerns. He originally began taking one medication but switched to another shortly after he began experiencing negative side-effects.
Camille and Lance reported having an argument while Lance was feeling “numb” from his medication. During the argument, Lance had not felt attacked by Camille. Feeling unattacked, he had been able to support and validate her, which turned out to be a meaningful experience for her. He reported that it was not meaningful to him because he felt “out of it.”
I explored the differences in the quality of their interactions during that conflict that created a more successful outcome. Camille identified that Lance’s non-defensive stance disarmed her reactive emotions, and they were both able to communicate more thoughtfully and vulnerably.
We explored the difference between primary emotions, such as hurt, sadness, or feeling misunderstood and unsupported, and secondary reactive emotions, such as frustration, anger, feeling “pissed off,” or feeling emotionally numb and withdrawn. After drawing a diagram of these dimensions of emotion, I explored the effects of communicating out of each dimension during conflict.
When one of them communicated out of anger or refused to communicate out of emotional withdrawal, the other either became frustrated or emotionally withdrew as well. During this sort of interaction, they mutually felt misunderstood and unsupported.
We then explored the possibilities of communicating vulnerably and honestly out of the oftentimes buried, primary emotion of feeling hurt or sad. When one of them chose to communicate non-defensively about an experience of feeling misunderstood or unsupported, the resulting mutual experience tended to be feeling “joined together” and “heard.”
Utilizing emotion-coaching and other experiential interventions, I hoped that they would begin to experience a restructuring of their patterns of interaction and of their experience of intimacy based on new understandings and meanings.
Session 12
Lance and Camille had a fight immediately before this session. Lance had been feeling exhausted and overwhelmed earlier in the day. When Camille brought him coffee as a gesture of love and support, Lance told her, “That’s the last thing I need right now.” This started an escalation, in which Lance quickly distanced himself and became emotionally withdrawn.
As I attempted to coach Lance to explore his own emotional process of wanting space, he seemed to become increasingly short in his responses and visibly uncomfortable. I found myself compelled to press for responses from Lance, almost demanding cooperation.
At some point, I began to come back to reality, noticing what had been a parallel process between my own experience of interaction and Lance and Camille’s. Changing course, I began to speak with Camille in a reflective way about what Lance may have wanted to say to her.
By the end of session, Lance began to speak for himself, became more engaged in dialogue around emotion, expressed regret for his own behavior, and was verbally supportive of Camille.
Session 13
Lance and Camille had canceled three sessions since we had met two months prior.
At the beginning of this session, I invited Lance and Camille into a dialogue concerning their commitment to counseling. This carefully initiated confrontation carried a message with it: that they, the couple, were responsible for their investment in counseling, and that I was committed to being invested with them only as long as they were themselves invested.
It was clear that they had discussed this concern among themselves and were already considering termination due to both of their work schedules. I noticed myself feeling proud of my own investment in their therapy and, in retrospect, my own sense of disappointment at their shortage of attendance distanced me from the reality of the two persons before me. And so, I did not expect the explanation Lance would give.
He began to reflect on their experience in therapy over the last year, telling stories of how they had become more capable of engaging with each other in satisfying ways despite disagreement. Having more positive experiences with each other around personal differences and beginning to develop more meaningful social relationships, Lance and Camille expressed feeling less energy towards counseling and more energy in life itself and with each other.
Lance commented, “Before we came in today, I told Camille we might be in a place where it would be better just to sit down with each other over coffee and discuss our relationship by ourselves.” Even though they continued to experience conflict—in fact, they reported having a significant fight earlier in the day—they were becoming more able to be with each other in such a way that was growth-inducing, having developed an increasing ability to self-soothe and remain nonreactively present with one another, rather than growth-inhibiting, reacting defensively to one another out of anxiety experienced in the moment.
At the end of the session, after talking about their progress and increasing sense of responsibility and capability in their marriage, they chose together to terminate counseling immediately. I celebrated with them by discussing their exciting future.
Reflections on Case Outcome
Camille and Lance, like so many other couples with whom I’ve worked, struggle in knowing how to manage the intense reactive emotions that they feel in the midst of conflict. They became better able to increase their capacities for emotional management and self-direction. They learned that they were not necessarily determined or defined by their impulses.
As Lance and Camille allowed me to sit with them in the midst of their anxiety, anger, and pain to search for bits of hope and seeds of change, I began to see a new paradigm evolving into being in their marriage: one marked by acceptance and stability and driven by intentionality.
Over the course of therapy, as we delved deeper into the intricacies of their emotional experiencing during conflict, Camille and Lance consolidated new positions, attitudes, and cycles of attachment behavior and began experiencing conflict in a more satisfying, growth-oriented way.
Lance and Camille began to take ownership of their own emotions and reactions. As Lance began to acknowledge and understand the ways that he withdrew from Camille at the whim of momentary anxiety, he began to act despite his anxiety, remaining engaged with Camille in an honoring way. As he did, he became more confident and less volatile.
As Camille began to acknowledge and understand the ways that she pressed for resolution on issues of difference, she began to make peace with anxieties that drove her behavior in the relationship. As she did, she became more confident and less volatile.
As intentionality increased little by little over time, confidence increased. As confidence increased, security, rather than anxiety, increased. As this security increased, Lance and Camille experienced an increasingly satisfying and loving relationship.
Questions for Thought
- What about the case of Camille and Lance challenged you?
- What did you think about the therapist’s approach to working with them?
- What are your own strengths and challenges when working with volatile couples?
- What night you have done differently than the therapist in this case?
- Did this case make you want to learn more or less about emotion focused therapy?
