May 16, 2019
By Terence Patterson, EdD, ABPP
Ben and Keisha, married eight years, present at their first therapy session saying, “We can’t communicate anymore!” Idina, the therapist, begins to work on “I-messages” and Ben rolls his eyes and interrupts while Keisha is talking and she turns away, displaying contempt at his comments. Although Idina continues to encourage active listening, the discussion quickly escalates into crying and shouting. The couple doesn’t return for their next session.
What do we really know about our clients when we first meet them and hear their presenting issues? Do we have insight into the milieu of their lives and the complex circumstances that led them to seek professional help? When couples present for therapy, therapists often assume that both partners want to actively work on their relationship, when in reality one or both may have a foot out the door and are looking for validation so they can say, “We tried.”
In other situations, couples are seeking either a brief consultation on a particular problem, or feedback on how they’re doing with communication or other dynamics. As therapists, we want to avoid applying our usual set of techniques stereotypically to whomever walks in the door.
Evidence-based practice and ethical standards require us to conduct some form of assessment that helps us understand the total context of our clients’ presenting issues. And assessment tools allow us to hone in on the exact problem areas that need to be targeted in treatment. Forgoing an assessment is akin to the internist prescribing medication without doing lab work when a patient comes in with flu symptoms, or the orthopedic surgeon recommending back surgery without ordering an MRI.
In couple therapy, it’s best to combine assessment with a relationship history that explores basic dimensions of couple dynamics such as clear communication, effective problem-solving, and sharing of joint tasks. This focus can keep us from wandering through a thicket of momentary complaints or last night’s arguments and lead us to a broader contextual understanding and a comprehensive treatment plan.
If, for example, we assume that communication problems (the most frequent issue couples present), can be addressed mainly through the use of “I-messages” alone, we can easily fail to address the resentment and frustration partners may have built up over nagging, or refusing to accept the other’s habits and preferences. On the other hand, if we blithely proceed with a course of therapy with a couple who only wants brief consultation to cope with intrusive in-laws, we risk them skipping sessions since their most pressing issue is not being directly addressed.
Consumers of therapy today are much more aware of the nature and impact of therapy through popular media, and they expect more incisive approaches to address their concerns. Busy, fast-paced lives packed with travel, deadlines, child care, commuting, 24-7 access to information, and other pressures intensifies the need for focused, efficient treatment.
Perhaps most importantly, evidence-based therapies that utilize outcomes assessment throughout the course of treatment are associated with better treatment outcomes. Assessment allows the therapist to track treatment progress over time and respond early when problems arise. And research has consistently shown that when therapists gather assessment data at the start of treatment and track outcomes data throughout the course of treatment, clients are far likelier to benefit from therapy.
While this discussion is focused on assessing couples, clinicians would do well to identify the assessment tools that fit their own practice model and use them regularly. These tools will not only provide more insight and penetrating grasp of clients’ lives, but will also forge clearer paths to planning relevant treatment on a session-by-session basis, and prevent wandering down roads that our clients do not want to travel.
For those of you interested in exploring assessment in couples therapy, here are some recommended resources:
Paper and pencil or automated inventories, such as:
Systematic observation, such as:
Beavers, W. R., Hampson, R. B., & Hulgus, Y. F. (1985). Commentary: The Beavers systems approach to family assessment. Family process, 24 (3), 398-405.
Grotevant, H. D., & Carlson, C. I. (1987). Family interaction coding systems: A descriptive review. Family Process, 26 (1), 49-74.
Snyder, D. K. (1997). Marital satisfaction inventory, revised (MSI-R).
Spanier, G. B. (2001). Dyadic adjustment scale (DAS): User’s manual. MHS.
Stuart, R. B., & Jacobson, B. (1987). Couple’s Pre-counseling Inventory: Counselor’s Guide; CPCI. Research Press.
Yingling, L. C., Miller, W. E., McDonald, A. L., & Galewaler, S. T. (2013). GARF Assessment Sourcebook. Routledge.
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DISCLAIMER: The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
ABOUT THE AUTHOR
Dr. Terry Patterson is a licensed psychologist in San Francisco with decades of experience as a therapist, professor, and clinical trainer and supervisor. He is board-certified as a Couple & Family Psychologist and also treats depression, anxiety, and transitional issues in adults and adolescents.