Comprehensive Guide To Interpersonal Psychotherapy by Myrna M. Weissman & John C. Markowitz & Gerald Klerman

Author:Myrna M. Weissman & John C. Markowitz & Gerald Klerman
Language: eng
Format: mobi
Publisher: Basic Books
Published: 2008-08-01T04:00:00+00:00

CASE EXAMPLE

Mrs. R. complained that her husband did not show enough interest in their children. He agreed: he felt that he wanted to do more in this area, but did not know how to. In devising an exercise for them, the therapist gave Mrs. R. the role of “teaching” Mr. R. how to approach the children, while Mr. R. took the role of trying to play with them in a limited but specific format.

Several steps can increase the couple’s motivation to attempt the exercises. To counter excessive pessimism, the therapist can emphasize that performing the assignments will differ from methods that the couple has previously used in attempting to solve problems: they have not had as large a repertoire of techniques as they will now develop working with the therapist. Exercises should also include some reward or benefit for each partner, even if this is not readily apparent. How an assignment is described may influence the likelihood of its being undertaken and accomplished. For example, to a resistant couple, the exercise can be purposely described as important but small. For other, more crisis-oriented couples, it may be valuable to label it as “major” in order to instill the belief that the couple is accomplishing something just by completing the assignment.

The therapist should explore with the couple the possibility that the assignment will not be accomplished. An aspect of anticipating the possible failure to carry out assignments is making each partner aware that he or she is responsible for part of the work, even if the other partner does not perform his or her part properly. In addition, the therapist attempts to ensure that one member of the couple will not punish the other for failure to perform the exercise. After an exercise is assigned, the therapist discusses it in the next session.

If the couple has carried out the exercises, the therapist should foster a sense of accomplishment. He or she may congratulate them or even express surprise that they were able to do it. This can take the form of praise. When the couple has not tried to carry out the assignment, the therapist should avoid criticism. It is equally important to take it seriously and hold both spouses responsible for failing to perform the exercise. Frequently it is difficult to engage a couple in a discussion of why they did not do an assignment. They may simply repeat their initial statement that they “forgot,” etc. The therapist must not accept this explanation. One way to develop the discussion is to use the “false choice” technique, where the therapist poses a complex question with multiple possible answers but phrases it as a simple, forced choice with a small number of alternatives. For example, the therapist might say,

There are usually only three reasons for not doing a task: (1) either you don’t know how to do it; (2) you’re getting something important from the old way of doing things that you don’t want to give up; or (3) you find something frightening in trying to do something new.

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