Our previous blog posts explored some ideas on interpersonal and sexual intimacy issues and ways to promote couple health.
Today’s post will look at three therapeutic interventions for couples experiencing difficulties: Brief Solution Therapy, Ericksonian Hypnotherapy and EMDR.
Brief Solution-Focused Therapy
This therapeutic intervention draws from system, cybernetic and information theories which work together to understand a client’s dilemma. The therapist is in a one-down position so as to explore
the pragmatics of the situation; the therapist utilizes client symptoms and language to prescribe a different level of abstraction in order to target an intended level of abstraction. An intervention of
lowering expectations and going slowly will focus on stemming client disappointment. In this type of brief therapy, Ericksonian first sign of improvement helps couples keep facing towards the positive.
The therapist assesses for sexual issues by first asking in general about what brings client to session in order to help rule out medical problems. The therapist will have clients define the exact
nature of the problem, who has the problem, how the problem manifests, and what solutions have been attempted. During this time sexual issues may or may not arise. The therapist will continue to screen for them if they don’t come out right away. When appropriate, brief sex therapy will concentrate on the process of change, with any small shift in perspective or description about a problem sending out a ripple effect of change within the pattern of relating. This type of change process reinforces new perceptions and encourages breakthroughs by inserting paradoxical elements into understanding of problems. Encouraging couples to lower expectations so that they reduce disappointment makes hope more probable. When clients explore attempted solutions thoroughly and come to know how and why their solutions have been failing – and that their attempts have been a normal reaction – clients then can name worst fears and discover situations when problem is not present. Thinking in very small increments allows for change, as does proceeding very slowly. Therapists listen for any signs of improvement and continue to encourage only small steps. Therapists always remain in the one-down position so that clients are empowered to help themselves. Solution-focused therapy bypasses origins of problems and instead looks at how life can play out in a new way without the baggage of the problem. Whereas problem-solving and problem-focus involves assessment and data collection on the problem, and skills necessary to tackle the problem, solution building takes client strengths and encourages ways of looking at what’s already working for the client.
Ericksonian Hypnotherapy
Eriscksonian hypnotherapy, when applied to sex therapy, seeks to tap the deepest part of an individual, the unconscious, in order to discover new learning. This approach differs from prescription,
rote interventions which ask the conscious mind to direct old behaviors in a different way. Whereas attempts to understand motives and explain dilemmas may keep individuals stuck in dysfunctional ways of relating, unlocking the power of the unconscious makes way for experiential moving into the living out of new patterns. Ericksonina hypnotherapy taps into an indvidual’s innate abilities to utilize already exisiting inner resources; the mind can heal itself. Short greetings and messages sent to individual or partner recipients give gentle commands to allow the problem an externalization outlet. The therapist can guide the couple through imagining the arguing couple, or the dysfunctional couple, or the sexually dissatisfied couple to get up and leave the
actual physical couple and sit or stand somewhere out there, in the room, or beside them. The possibility to therapeutically attend to the now-externalized couple/problem is seriously considered; the actual remaining couple no longer needs the therapy, as per this intervention, since the couple is transformed through the suggestion and visualization itself.
Ericksonian hypnotherapy helps clients to focus on internal experiences while not attending to external realities. Within this hyper-focused and concentrated state, clients will access imagery pertinent to them and replace regular reality with unconscious mind realities. An Ericksonian-oriented therapist will redirect the client’s attention by creating confusion and surprise. Ultimately, the client will be able to hypnotize himself into learning new ways desired changes can come about.
EMDR
Eye Movement Desensitization and Reprocessing therapy reduces emotional reactivity, and reprocesses psychological and emotional baggage which couples have accumlated over their time together. EMDR as a client-centered modality can be used conjointly, with one partner undergoing memory retrieval and reprocessing while the other partner witnesses the session. Additionally, the witnessing partner who has previously occupied the one-up, or supportive partner position gains experiential awareness of the neglected or one-down position partner’s disturbances and how these
contribute to relational distress.
EMDR utilizes the AIP (adaptive information processing) model to access dysfunctionallystored information or disturbing events which continue to influence negative affect and perpetuate maladaptive beliefs. This AIP models engages physiologically directly and in a non-invasive manner with pathological material so that memories or experience changes imaginally; it also accesses the individual’s natural information-processing system to shift cognitions so that self-worth can be reestablished in a smaller amount of time than traditional therapies. In marital therapy, EMDR merges with various systems therapies to facilitate processing of beliefs and positions intrapsychically and within the interpersonal realms; EMDR can be utilized sequentially or concurrently with systems therapeutic interventions.
EMDR can also be used individually, with marital therapy taking place during conjoint sessions, and one partner undergoing EMDR at a time. Debriefing sessions can follow. Not only does EMDR work on past couple issues which may have been building for a long time, it is also utilized to target present triggers; adverse reactions and disturbances are gently allowed to dissipate. Future scenarios can be rehearsed for positive desired response and emotions, not unlike post-hypnotic suggestions. In EMDR, future scenarios emanate from what the client deems important and necessary. EMDR also foster resource development individually and in couples. Resources usually naturally occur within an individual’s past either through experience, imagery or ideas. With the cultivation of critical resources and positive qualities such as confidence or resilience, clients can draw from these newly-reinforced or installed strengths and apply them to the healing process and daily living.
With paired titration, where clients develop resources and then are guided towards the edge of disturbing material, shorter exposure times to the latter allows for more complete return to intact resouce states. Increased ability to remain in the observer role upends flooding and loss of control. This technique can be useful for partners who have difficulty maintaining self-soothing. Flash techniques may also be utilized with couples who are experiencing marital distress. This technique has the couple flash very briefly, for one to three seconds, on an image or thought, and then return to safe/calm or resourced state. In this manner, very disturbing material becomes neutralized so that further work is possible. EMDR differs from hypnosis in that clients reject suggestions which do not align with their inner states or purposes; beliefs and anxieties which the clients deem necessary can remain intact; and brain waves remain constant — they do not move into theta or alpha as in hypnosis.
References
Brooker, E. (2018). Transforming performance anxiety treatment : Using cognitive hypnotherapy and EMDR. Routledge. Capps, F. (2006). Combining eye movement desensitization and reprocessing with gestalt techniques in couples counseling. The Family Journal, 14(1), 49-58. Fraser, J. S.,& Solovey, A. (2018). The process of change in brief sex therapy. In D. Flemons & S. Green (Eds.), Quickies: The handbook of brief sex therapy (pp.70-98). W.W. Norton & Company. Greenleaf, E. (2018). An Ericksonian Approach to Sex Therapy. In D. Flemons & S. Green (Eds.), Quickies: The handbook of brief sex therapy (pp.323-341). WW Norton & Company. Hammel, S. (2019). Therapeutic interventions in three sentences : Reshaping Ericksonian hypnotherapy by talking to the brain and body. Routledge. Havens, R. A. (1992). The wisdom of Milton H. Erickson: Hypnosis and hypnotherapy. Irvington Publishers, Inc. Hornsveld, H. K., Houtveen, J. H., Vroomen, M., Kapteijn, I., Aalbers, D., & van den Hout, M. A. (2011). Evaluating the effect of eye movements on positive memories such as those used in resource development and installation. Journal of EMDR Practice and Research, 5(4), 146-155. Manfield, P., Lovett, J., Engel, L., & Manfield, D. (2017). Use of the flash technique in EMDR therapy: Four case examples. Journal of EMDR Practice and Research, 11(4), 195-205. Maxfield, L., Kaslow, F. W., & Shapiro, F. (2007)The integration of EMDR and family systems therapies. In F. Shapiro, F. W. Kaslow, & L. Maxfield (Eds.), Handbook of EMDR and Family Therapy Processes (pp.407-422). John Wiley & Sons, Incorporated. Raú, W. A., & Anger-Díaz, B. (2018). Don’t get too bloody optimistic: John Weakland at work. In D. Flemons & S. Green (Eds.), Quickies: The handbook of brief sex therapy (pp.343-378). W.W. Norton & Company. Shapiro, F. (2007). EMDR and case conceptualization from an adaptive information processing perspective. In F. Shapiro, F. W. Kaslow, & L. Maxfield (Eds.), Handbook of EMDR and Family Therapy Processes (pp.3-34). John Wiley & Sons, Incorporated. Shapiro, F. (2017). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford Publications. Smock, S. A., McCollum, E. E., & Stevenson, M. L. (2010). The development of the solution building inventory. Journal of Marital and Family Therapy, 36(4), 499-510.
http://dx.doi.org/10.1111/j.1752-0606.2010.00197.x