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Happy Ever After?

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Much relationship counselling today is conducted by generalist psychologists, social workers, and counsellors. Yet there is a strong case for a greater role for clinical psychologists. Accurate assessment during couples therapy is essential, the dynamics between people are complex, and the process is potentially very demanding of clinical skills. This book provides an opportunity to make the argument for greater involvement in relationship counselling by the clinical psychology profession and to guide both clinical students and practitioners toward an informed and integrated approach to relationship counselling, drawing on the best evidence-based treatments.


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Published 12 April 2018
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EAN13 9781921513800
Language English
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Happy ever after?
A Practical Guide to Relationship Counselling for Clinical Psychologists
Bruce Stevens and Malise Arnstein
Happy ever after?
A Practical Guide to Relationship Counselling for Clinical Psychologists
Bruce Stevens and Malise Arnstein
First published in 2011 Australian Academic Press 32 Jeays Street Bowen Hills Qld 4006 Australia www.australianacademicpress.com.au
Copyright © 2011 Bruce Stevens and Malise Arnstein
Copying for educational purposes TheAustralian Copyright Act 1968(Cwlth) allows a maximum of one chapter or 10% of this book, whichever is the greater, to be reproduced and/or communicated by any educational institution for its educational purposes provided that the educational institution (or the body that administers it) has given a remuneration notice to Copyright Agency Limited (CAL) under the Act.
For details of the CAL licence for educational institutions contact: Copyright Agency Limited, 19/157 Liverpool Street, Sydney, NSW 2000. Email info@copyright.com.au
Production and communication for other purposes Except as permitted under the Act, for example a fair dealing for the purposes of study, research, criticism or review, no part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without prior written permission of the copyright holder.
National Library of Australia CataloguinginPublication entry: Author: Stevens, Bruce A., 1950 Title: Happy ever after? : a practical guide to relationship  counselling for clinical psychologists  / Bruce Stevens and Malise Arnstein. Edition: 1st ed. ISBN: 9781921513794 (pbk.) eISBN: 9781921513800 Subjects: Couples therapy.  Psychotherapy.  Clinical sociology. Other Authors/Contributors:  Arnstein, Malise. Dewey Number: 616.891562
Acknowledgments
Contents
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Chapter 1 Introduction: Clinical psychology and relationship counselling ......
Chapter 2 Historical perspective, including systems theory
Chapter 3 The first interview and initial assessment
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Chapter 4 The assessment of the relationship, including conflict ....................21
Chapter 5 Emotional processes underlying relationship conflict ......................45
Chapter 6 The sexual affair ................................................................................59
Chapter 7 Sex therapy: The scope and the challenges ....................................77
Chapter 8 When personality disorder adds to relationship problems ..............95
Chapter 9 Additional considerations: Different happy couples ........................121
Chapter 10 Selfpsychology and couples therapy: The building blocks ............135 for a focus on couple interaffectivity
Appendix FamilyofOrigin scale ......................................................................169
Endnotes..............................................................................................173 References............................................................................................175
Acknowledgments
I want to thank my coauthor Malise Arnstein. We have written different sections and she has drawn on areas of specialist expertise that I lack. She contributed Chapter 7 on sex therapy, the domestic violence section at the end of Chapter 8, the therapy with gay and lesbian couples section of Chapter 9 and Chapter 10 on selfpsychology. I wrote the rest of the book.
I would like to express my appreciation to my students in the clinical program at the University of Canberra, and other stu dents and supervisees who have sharpened my clinical thinking. I also appreciate what workshop participants have added over the past 10 years, especially related to personality disorder. I have a wonderful family, Jennie (we have been married 38 years) and our four adult children: Rowena with Christian, Kym with Marty, Naomi, Christopher with Carol. Rowena and Christian have two children, so the next generation of the Stevens family is in good hands!
— Bruce Stevens, PhD
I want to express my thanks to Bruce Stevens, PhD, my long term colleague and friend, who finally managed to get me to do some writing. Without his initiative, energy, encouragement and insistence I would have never been a coauthor of any book.
My gratitude also goes to Jac Brown, PhD, in Sydney, without whose work on gay and lesbian couples my section on this topic would have not been possible. Similarly, I would like to thank the management committee of the Canberra Marriage Counsel ling Centre (now Relationships Australia ACT) for hiring me as Assistant Director of the agency in 1981 just after I married and
18 months after I moved to Australia. I want to thank all my teachers; in particular, Luigi Boscolo, MD, Laurie MacKinnon, PhD, Kerrie James, MA, Ron Lee, PhD, Robert Gordon, MD, Keryl Egan, MA, and Tom Young, PhD. I would also like to thank my supervisors, colleague, clients, family and friends for sharing their knowledge and life experience with me over the years. They all contributed in unique ways to my understanding of relationships and to the motivation to learn more and more about couples and how to help intimate partners to feel better about themselves and live more satisfying lives either together or apart. Finally, I want to thank John Hutchinson, PhD (Mathematics), my partner of over 30 years, for sharing our per sonal journey, the ups and downs of joint domesticity and two careers in very diverse fields. He has been a great source of support as a model of academic enthusiasm and discipline, as well as a reliable and pedantic editor.
— Malise Arnstein, PhD
Chapter 1
Introduction: Clinical psychology and relationship counselling
Much relationship counselling today is conducted by generalist psychologists, social workers, and counsellors; yet there is a strong case for a greater role for clinical psychologists. Accurate assessment during couples therapy is essential; the dynamics between people are complex, and the process is potentially very demanding of clinical skills. The purpose of this text is to provide an opportunity to make the argument for greater involvment in relationship counselling by the clinical psychol ogy profession and to guide both clinical and counselling stu dents on the necessary skills for effective treatment.
A clinical psychologist, like a psychiatrist, is well trained in the diagnosis of disorder, and relationship issues are often related to psychological disorders and comorbid conditions. Consider the following three scenarios.
Mary has brought Mark, recently returned from war service in Afghanistan, into counselling because of concerns for his gambling and how much it is costing the family. Is his military service playing some role in the increase in his gambling?
Kylie has a problem with her anger. Brett is threatening to leave if her aggression is not better contained. Is her irritability that of an untreated depression or perhaps the brooding anger of a borderline personality disorder?
Bettina is taking lithium for bipolar disorder and has just come out of hospital after a twoweek admission related to her anorexia, and there is a need to closely monitor her weight. Natalie, her partner, is feeling highly stressed. She loves Bet, but
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Happy Ever After
feels overwhelmed by a responsibility to keep her alive. What support and guidance is best for Bettina?
It is clear that while there are relationship issues with these three couples there are also psychological disorders, which add to a complex clinical presentation. It is important to have a good understanding of disorders such as addiction, posttraumatic stress disorder (PTSD), depression, borderline personality disor der, anorexia and bipolar disorder. We can also think about how such disorders might impact an intimate relationship. Perhaps it is to state the obvious, but such potential complexity demands greater clinical training — not less!
This is also a field in which relationship myths can dominate treatment, often for decades, and there is an urgent need for clarity of thought which comes through research. Our work as clinical psychologists needs to be informed by the best evidence based treatment (EBT). Only this will effectively guide the couples or individuals we might treat with relationship issues. At times it may be necessary to be able to offer individual ses sions and then coordinate with the work of relationship coun selling. For example, Mark, with a gambling problem, might have treatment with motivational interviewing. But first, should there be an assessment for PTSD? An effective treatment can be planned with the couple, perhaps drawing on the strengths of both, but this is best carried out by a mental health professional thoroughly versed in diagnostic and treatment experience. Additionally, some mental health problems follow the dissolu tion of an important relationship.
Not all relationship problems come from psychological or per sonality disorders; many are the result of differing needs in the relationship. There may also be dysfunctional patterns and fea tures of personality that defy change. In this book we will rely heavily on the research and recommendations of clinical psy chologist Dr John Gottman, a leading researcher and clinician in this area. His ‘Love Lab’ has provided years of data on couple processes that can helpfully inform our practice, with easyto
Introduction: Clinical psychology and relationship counselling
understand principles thoroughly grounded in extensive research. While there has not yet been randomised, controlled trial (RCT) evidence from Gottman and his colleagues, I believe his work would meet the criteria of the American Psychological Association’s (APA) policy statement on evidencebased practice in psychology (EBPP): ‘… the integration of the best available research with clinical expertise in the context of patient charac teristics, culture, and preferences’ (see APA, 2006).
Sexton and Gordon (2009) distinguished three levels: 1. Evidenceinformed interventions based on preexisting evi dence. 2. Promising interventions but preliminary results not repli cated. 3. Evidencebased treatments with systematic high quality evi dence demonstrating that efficacy with clinical problems the interventions are designed to address.
In his keynote address to the 27th International Congress of Applied Psychology, James Bray (2010) said that there is some level 3 support for the following therapeutic approaches: behav ioural marital therapy (Jacobson & Margolin, 1979), cognitive– behavour therapy (CBT) marital therapy (Baucom & Epstein, 1990), integrative couple therapy (Jacobson & Christensen, 1996), and emotionfocused couples therapy (EFTC; Greenberg & Goldman, 2008). EFTC has strong links to attachment theory. I will introduce this approach and commend it as worthy of prac tical application in the treatment of couples.
I remember an era when the basic assumption of relationship counselling was to encourage a couple to communicate as someone in therapy might talk to their psychologist; however, the reality is that this is too difficult for most couples to achieve, and not even typical of how happily married people tend to communicate! I wrote a couple of books based on this premise, and I am pleased to have this opportunity to update practice in light of more recent research.
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