May 2010  << Back  

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Doing Couple Therapy: Craft and Creativity in Work with Intimate Partners

Richard Balon, MD

Wayne State University, Detroit, MI, USA

By Robert Taibbi. New York, NY: The Guilford Press; 2009; ISBN 978-1-60623-244-6; pp 276; $35 (hardcover).

For a long time I have felt that psychiatry has given up on or abandoned 2 important areas of mental health care—human sexuality and relationship issues, either family or couple ones. Whatever the reason for this trend, it is unfortunate. Any experienced clinician knows that harmony in both of these areas contributes to patients’ well-being, and disharmony can contribute to worsening of symptoms of mental illness, trigger relapse, or even trigger serious problems, such as depression. We still officially subscribe to the biopsychosocial model and teach our students to examine all aspects of their patients’ lives, including their relationships. However, we do not teach our students what to do with pathology within a relationship. Most of the time we do not know what to do ourselves. Should one be dealing just with the patient or should the patient’s partner who is depressed over the couple’s problems be brought in? Should one be proactive when listening to a family’s or a couple’s problems or should one just listen and let the couple/family attempt to resolve the issues themselves? Many would argue that these are issues to be addressed by therapists, not by psychiatrists. Maybe. However: (a) We should be able to answer questions about relationships posed by our patients; (b) We should be able to consult therapists; and (c) We are supposed to be able to supervise therapists and judge their work with a family or couple. We would not be able to do so without training and/or practice. Arguing otherwise is patronizing and paternalistic. There are various ways of learning about this area, either by practicing under supervision or by studying practical, rather than theoretical, texts.

Robert Taibbi, an experienced therapist, wrote a basic, beginner’s guide for couple therapy. He points out that couple therapy is more complicated and complex than individual therapy. It “can seem more like a two-ring circus, with each of the partners doing his or her own act for the therapist. Instead of the one voice and one side you have two. While one is enthusiastically motivated for therapy, the other is likely to be as enthusiastically ambivalent” (p 2). As he points out, one needs confidence in oneself and one’s clinical skills. The author states that he wrote this book to help new clinicians, as well as experienced ones, who are new to couple therapy to know the terrain and not feel lost and to offer a clinical map for treating couples.

In the first chapter, “Into the fray. Theoretical foundation and overview,” the author outlines the rest of the book. In the first section (chapters 2 to 8: “The basics: Clinical goals and tasks,” Beginnings: Presentations, assessments, and goals,” “Beginnings in actions,” “Clearing the clutter: Improving communications skills,” “Drilling down: Core issues,” “Termination,” and “Of money, sex, and children: Handling the power issues”), the author looks “at the fundamental structure of couple therapy, the basic skills and concepts that you need to successfully navigate doing couple therapy—managing opening sessions, doing assessments, developing initial goals and treatment plans for the most common presenting problems” (p 12). In the second section of this volume (chapters 9 to 13: “Challenges of the early years,” “Re-creating the vision,” “Battle and loss: Managing the teenage years,” “One big happy family: Working with stepfamilies’” and “The challenges of old age”), the author focuses on “specific challenges that couples face as they move through the adult life cycle—newlyweds, couples with young children, and then teenagers, the empty nest, the remarried and elderly couple” (p 12). Finally, the last section (chapters 14 and 15: “One helping two, two helping one: Working with individuals in relationship” and “Life in the details: The nuts and bolts of couple therapy”), the author discusses “ways of repairing relationships when only working with one partner,” looks “at how the couple can help the individual,” and concludes with the “nuts and bolts of practice and good self care” (pp 12-13). The chapters are illustrated by a number of scenarios or vignettes. Each chapter also concludes with various exercises and questions to help the reader increase his/her skills and clarify his/her style.

The book is written in “you style” in which the author tells the reader what “you are going to do, experience, face.” The text is full of simple, practical advice about the most common or complicated aspects of therapy. The author emphasizes that “Couple therapy is not couple mediation” (a common misconception about couple therapy). The author emphasizes the couple therapist’s 4 core tasks or concepts: demonstrating leadership; stopping the dysfunctional process; drawing out and labeling emotions; and being honest. The chapter on the beginnings of couple therapy is especially useful. Taibbi presents the 6 most common couple patterns—the crisis couple, the stale couple, the fix-my-partner couple, the fine-tuning couple, the problem-with-children couple, and the no-problem couple. He also outlines initial goals, such as establishing rapport, determining what is and who has the problem, clarifying expectations, and creating something new. The following chapter on beginnings in action also contains a lot of useful detailed information about the initial contact and first several sessions. The chapter on core issues discusses, among others, the advantages and disadvantages of seeing the couple together vs doing couple therapy by working with individuals separately.

The chapters in the book’s second section provide relevant information on handling special situations mentioned previously. The last chapter discusses some important issues usually omitted in various practical guides. It focuses on supervision (individual, group, and self-supervision for which the better term may be, as the author suggests, “self-reflection”), training, personal therapy, cotherapy, and everyday strategies for self-care (be in charge of your caseload, your schedule, the time; relax; create a comfortable workspace; dress for success). The book ends with a brief Epilogue.

This book definitely is what it intends to be—the beginner’s guide to couple therapy. It is simple, easy to read, and filled with a wealth of clinical information. It is almost too simple at times. Nevertheless, I think that this volume would be appreciated by most therapists interested in starting to do couple therapy and by those teaching couple therapy and looking for an easy-to-read text for students. Unfortunately, only a few psychiatrists probably will be interested in reading this text and will find the book useful. The field of clinical psychiatry is still waiting for a good text addressing the issues I outlined at the beginning—how couple strife contributes to other pathology and what to do about it, how to appropriately consult and supervise couple therapists, and how to answer/how to react to patients inquiring about or reporting their couple’s problems when talking to their psychiatrists.