As a result of this article on Solution-Focused Brief Therapy client types, I received this email from a reader:
"I came across your blog after a colleague and I were trying to remember the terms SFT used for the type of client. It really helped us understand a mutual case. It also got me thinking about couples therapy and when each person is a different type of client. I'm wondering if you wrote a blog addressing this?"
I had not yet written an article on the subject, and so... that’s the topic for today.
Client Types in Couples Therapy
The SFBT client types help us understand clients’ motivation for change as well as how to move forward with clients in ways that optimize connection with and acceptance of our clients. When our client is a couple, and each partner is a different client type (i.e., holds a different motivation for change), then we must constantly consider the dyad dynamic in our ongoing work and goal development.
Here are a few examples of dyad dynamics using the SFBT client types:
Visitor and Complainant
With this combination, one of the partners is complaining about problems and is most likely blaming relationship difficulties on his partner--the visitor. The visitor is in therapy, because s/he wants to please their partner in some way, doesn’t want to lose the relationship, or wants to avoid an unpleasant consequence, in general. The visitor, by definition, is not intrinsically motivated to pursue the change requested by the complainant. Their motivation is external--based on attempting to meet the complainant's needs.
Complainant and Customer
Customers are in therapy, because they have recognized their contribution to the problem(s), their essential role in developing solutions, and they are ready to do their part to create change. The complainant, in this dyad, may still be blaming the partner, external circumstances, or other third parties for problems, and has not yet moved to “customership.”
Customer and Visitor
This dyad dynamic is challenging, especially during the initial stages of therapy, because one of the foundational agreements of couples therapy is that both partners be interested in working toward improving their relationship. And, one of the presentations of this dyad is a partner who is ready to change (the customer), and another who is not yet invested in pursuing change (the visitor).
Connecting the Dyads
There are therapeutic techniques, processes, and postures that can aid in bringing couples together with differing client types. They come from a variety of theoretical backgrounds, but they all serve to: a) separate problems from persons, and b) establish a joint purpose for partners in therapy.
1 | Joining with each partner
In my master's training, I learned to have a neutral position in couples therapy--how to not be on the side of either partner, but instead, to be on the side of the relationship. This created a counter-stance, in a way, to each partner. Rather than encountering agreement when they came to therapy, partners encountered a therapist who would implicitly hold them to their larger goal--improvement in their relationship, however they defined it.
As a doctoral practicum student, I employed this neutral position in my work with couples, and my professor and clinical supervisor challenged me to consider a different option. He offered the idea of being one hundred percent on the side of each partner. Rather than holding an opposing position, what if each partner experienced me as on their side? This, in essence, is what Boszormenyi-Nagy (1973) described as multi-directional partiality.
Multi-directional partiality is a necessary pre-condition for systemic change in Contextual Therapy (Boszormenyi-Nagy & Spark, 1973); it refers to:
"the therapist's ability to adopt the position of each of the family members and even that of an absent member. The therapist is neither a neutral umpire, nor someone who stands ‘above the fray.’ He or she actively takes the side, during the therapy, of each of the family members, being guided in that task by his or her empathy and sense of fairness. This implies that he or she gives each person the sense of being someone important, someone who counts and whose desires he or she is trying to understand" (Miermont, 1995).
Ironically, my professor was a post-modern brief therapist, and I had received three years of post-graduate clinical supervision under a Contextual therapist. I am not sure why I had not transitioned from neutrality to multi-drectional partiality, but I embraced the invitation.
There is room for both neutrality and multi-directional partiality in our couples work. Partiality certainly takes nuanced skills related to empathy, ambiguity, and not aligning with one partner; it requires holding often conflicting positions in ways that lead to dialogue and connection for couples. In regard to the dyad dynamics already mentioned, a stance of multi-directional partiality will help each partner feel heard and is therefore more likely to aid partners in "moving toward" one another.
2 | Goal development
Goal development for therapists, when facing a variety of client opinions, can be tricky, and it's when therapists often get stuck. A reminder: Remain tentative, and make sure to develop a goal that incorporates hope and possibility for both partners. The foundational step for developing goals that elicit motivation for change is: not siding with a goal that isn't measurable (it can be loosely measurable, like a vision or hope; but it must include something tangible) or with one partner's idea. Each partner is in a specific position within a larger system, and therefore each of their goals is based on this position.
How to develop goals that promote teamwork
In Narrative Therapy, externalization is used "to enable people to realise that they and the problem are not the same thing" (Carey & Russell, 2004). Two techniques are used to accomplish this goal: a) changing adjectives into nouns, and b) personifying problems.
Changing adjectives to nouns
For an individual client, this is an example of changing an adjective to a noun:
Client: As a depressed person, I have difficulty holding down a job.
Therapist: How long has depression been affecting you in this way?
In this example, the therapist separates the client from "depression" by externalizing the problem as a noun (Carey & Russell, 2004). When externalizing depression, a description I often use is "the cloud of depression." The metaphor works well for expanding on depression's characteristics such as its color, size, shape, heaviness/lightness, etc., and result affects on clients.
Continuing with the same presenting problem, depression can be personified as Mr. Sadness, The Bully, The Boss, The Enemy, or, alternatively, My Best Friend, My Companion, and so on. Clients will likely have metaphors and/or names for the problems that accompany them, and these can be used by therapists to externalize and personify.
For partners who present with mismatched motivation for change, therapists can use externalization to personify aspects of the mismatch, such as blame, unfairness, conflict, among others. For example, the following questions and statements personify and/or generally externalize aspects of the couple dynamic:
- How long has blame been getting between the two of you?
- Distance seems to win, even when your goal is connection.
- When did conflict first show up in your relationship?
- I wonder, when is a time the two of you have overpowered anger?
The couple dynamic: Create a common enemy
An often-cited origin of couple distress, by couples therapists, is the pursuer-distancer dynamic. A quick summary of this dynamic is offered by Gerson, Hoffman, Sauls, and Ulrici (1993):
"One partner wants more closeness in the relationship and pursues the other partner. The other partner wants more apartness and independence and distances from the pursuer. The more the pursuer pursues, the more the distancer distances, and vice versa" (p. 343).
Certainly, some SFBT dyads are likely to experience this dynamic (e.g., the complainant and visitor couple). Whether the pursuer-distancer dynamic fits with the couple, or not, the couple dynamic can be externalized as "the enemy," in order to help partners come together to "fight" the dynamic (or a similar metaphor/personification). Examples of couple dynamics include parent-child, boss-employee, brother-sister. Use your creativity and tune your ear to clients' language to find more personalized metaphors for each couple, as well as to reframe them for therapeutic impact.
Gerson et al. remind clinicians, "The challenge for the therapist is to point out this dynamic in a way which validates both positions while showing the vicious cycle to be self-defeating for everyone involved" (p. 343). In this way, the therapist invites partners to come together to defeat a common enemy--the unwanted dynamic.
Develop a joint desired outcome
A desired outcome is a preferred future that couples envision for their relationship. It is an agreed upon answer to SFBT's miracle question--it is one miracle. Helping couples articulate a joint desired outcome that meets both of their needs (at least for now), offers reassurance that they are capable of working together and thereby creates incentive for moving forward, together. For more on developing a joint desired outcome with couples, see this post.
Focusing on the larger purpose
Rather than connecting couple dyads through externalizing or desired outcomes, therapists can choose to hold each partner's goal independently. Instead of bringing the couple together through explicit techniques, you, the therapist, can hold the larger purpose of therapy for clients by finding the common denominator of all the stated problems. The process of therapy is then focused on continually clarifying each partner's goals, evaluating their sense of the progress made toward their goals, and perhaps, adding new goals to the "list." The larger purpose changes as the change requested by each partner changes. For more on finding and deepening this larger purpose, see this post.
Facilitate joint goals in couples therapy by using concepts from a variety of systemic approaches, such as externalizing, couple relational dynamics, desired outcomes, and others. While partners may present to therapy as differing client types, how we help them discuss and view their relationship to their problem(s) will help or hinder their sense of teamwork and hope.
I originally shared the ideas in this post in the Get Refreshed Facebook community for psychotherapists.
Boszormenyi-Nagy, I., & Sparks (1973). Invisible loyalties. New York, NY: Routledge.
Carey, M, & Russell, S. (2002). Externalising: Commonly asked questions. Journal of Narrative Therapy and Community Work, 2. Retrieved from https://dulwichcentre.com.au/articles-about-narrative-therapy/externalising/
Gerson, R., Hoffman, S., Sauls, M., & Ulrici, D. (1993). Family-of-origin frames in couples therapy. Journal of Marital and Family Therapy, 19(4), 341-354.
Miermont, J. (1995). The dictionary of family therapy. Hoboken, NJ: Wiley. Retrieved from http://www.blackwellreference.com/public/tocnode?id=g9780631170488_chunk_g978063117048816_ss1-46#citation