Instructor’s Manual

THE ANGRY COUPLECONFLICT-FOCUSED TREATMENT

with

Susan Heitler, PhD

by

Randall C. Wyatt, PhD&

Erika L. Seid, MA

2

THE ANGRY COUPLE

3

Psychotherapy.net

The Instructor’s Manual accompanies the DVD The Angry Couple: Conflict-Focused Treatment (Institutional/Instructor’s Version).Video available at www.Psychotherapy.net.

Copyright © 2006 Psychotherapy.net, LLC. All rights reserved.

Published by Psychotherapy.net

150 Shoreline Highway, Building A, Suite 1 Mill Valley, CA 94941 Email: contact@psychotherapy.net Phone: (800) 577-4762 (US & Canada) / (415) 332-3232

Teaching and Training: Instructors, training directors and facilitators using the Instructor’s Manual for the DVD The Angry Couple: Conflict-Focused Treatment may reproduce parts of this manual in paper form for teaching and training purposes only. Otherwise, the text of this publication may not be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher, Psychotherapy.net. The DVD The Angry Couple: Conflict-Focused Treatment (Institutional/Instructor’s Version) is licensed for group training and teaching purposes. Broadcasting or transmission of this video via satellite, Internet, video conferencing, streaming, distance learning courses or other means is prohibited without the prior written permission of the publisher.

Wyatt, Randall C., PhD & Seid, Erika L., MA

Instructor’s Manual for The Angry Couple: Conflict-Focused Treatment

with Susan Heitler, PhD

Cover design by Sabine Grand

Order Information and Continuing Education Credits: For information on ordering and obtaining continuing education credits for this and other psychotherapy training videos, please visit us at www.psychotherapy.net or call 800-577-4762.

4

THE ANGRY COUPLE

5

Psychotherapy.net

Instructor’s Manual for

THE ANGRY COUPLE Conflict-Focused Treatment

with Susan Heitler, PhD

Table of ContentsTips for Making Best Use of the DVD 7

Session-by-Session Group Discussion Questions 9

Reaction Paper Guide for Classrooms and Training 11

Suggestions for Further Readings, Websites and Videos 13

Session Transcript 15

SeSSion 1 16

SeSSion 4 32

individual SeSSion 40

SeSSion 7 45

SeSSion 13 50

Video Credits 55

Earn Continuing Education Credits for Watching Videos 57

About the Contributors 59

More Psychotherapy.net Videos 61

6

THE ANGRY COUPLE

7

Psychotherapy.net

Tips for Making Best Use of the DVD

1. USE THE TRANSCRIPTS Make notes in the video Transcript for future reference; the next time you show the video you will have them available. Highlight or notate key moments in the video to better facilitate discussion during the video and post-viewing.

2. SESSION-BY-SESSION DISCUSSION QUESTIONSPause the video after each session to elicit viewers’ observations and reactions to the development of the therapy. The Discussion Questions provide ideas about key turning points during the therapeutic work that can stimulate rich discussions and learning.

3. LET IT FLOWAllow the sessions to play out some so viewers can appreciate the work over time instead of stopping the video too often. It is best to watch the full video since issues untouched in earlier sessions often play out later. Encourage the viewers to voice their opinions; no therapy is perfect! What do viewers think works and does not work in the sessions? We learn as much from our mistakes as our successes and it is crucial for students and therapists to develop the ability to effectively critique this work as well as their own.

4. SUGGEST READINGS TO ENRICH VIDEO MATERIALAssign readings on working with couples from the Suggestions for Further Readings and Websites prior to viewing. You can also time the video to coincide with other course or training materials on related topics.

5. ASSIGN A REACTION PAPER See suggestions in Reaction Paper section.

6. ROLE-PLAY IDEASAfter watching the video, organize participants into groups of four. Assign each group to role-play a session with an angry couple. Each role-play shall consist of one therapist, one couple and one observer. After the role-plays,

8

THE ANGRY COUPLE

have the groups come together to discuss their experiences. First have the clients share their experiences, then the therapists, and then ask for the comments from the observers. Open up a general discussion on what was learned about both the practical and the emotional aspects of doing therapy with an angry couple.

Another alternative is to do all of this in front of the group with just the therapist and the couple; the entire group can observe before discussing the interaction. After a while, the professor, trainer, or another student may jump in as the therapist if the therapist gets stuck and reaches an impasse. Follow up with a discussion that explores what works and does not work with couples in conflict.

7. PERSPECTIVE ON VIDEOS AND THE PERSONALITY OF THE THERAPISTPsychotherapy portrayed in videos is less off-the-cuff than therapy in practice. Therapists or clients in videos may be nervous, putting their best foot forward, or trying to show mistakes and how to deal with them. Therapists may also move more quickly than is typical in everyday practice to demonstrate a technique. The personal style of a therapist is often as important as their techniques and theories. Thus, while we can certainly pick up ideas from master therapists, viewers must make the best use of relevant theory, technique and research that fits their own personal style and the needs of their clients.

9

Psychotherapy.net

Session-by-Session Group Discussion QuestionsProfessors, training directors or facilitators may use a few or all of these discussion questions keyed to certain sessions or those issues most relevant to the viewers.

SESSION ONE1. Previous Therapy: Why are Heitler’s questions about the clients’

previous experience in therapy important and how do they inform current therapy? Why is it so important to learn about past therapy experiences?

2. Interruptions and Crossovers: Heitler employs direct interventions to deal with the clients’ interrupting and what she calls crossovers. Do you think her interventions are effective here?

3. Safety in the Session: How well do you think Heitler does at creating a safe environment for this angry couple?

4. Symmetry: How does Heitler maintain symmetry in her work with the couple? What is so important about symmetry in couples therapy?

5. Heitler’s Stop Signs: Why does Heitler stop arguments and angry outbursts that occur in the session? Does it work? Why does she reject the notion that the best way to handle anger is to get it all out? How would you react if you were in therapy with Heitler and she employed her “Stop” methods?

6. Client Attacks on Heitler: Client attacks on a therapist are tough to handle but provide opportunities for therapeutic moments. How well do you think Heitler handles direct and indirect challenges to her in the session? What are other ways you would handle such attacks in a therapy session?

7. Beyond Anger: Heitler moves beyond Judith’s anger to learn about the couple’s reciprocal interaction pattern? Does it seem to work?

10

THE ANGRY COUPLE

INDIVIDUAL SESSION 8. Individual Sessions: What is the role of individual sessions during

this course of therapy? Are they valuable? When is individual work indicated in couples therapy and when should it be avoided? What are the risks and opportunities of doing individual work while seeing a couple together?

SESSION SEVEN9. Rescue Trap: Heitler stops herself from falling into the trap of rescuing

the couple from their own confused decision-making. What are the dangers of trying to rescue clients or assertively making decisions for them? Is it ever indicated?

SESSION THIRTEEN10. Ending Couples Therapy: How do we know when to terminate

therapy? How does Heitler engage the experience of the clients in this decision? What other key issues are relevant when ending therapy?

11

Psychotherapy.net

Reaction Paper for Classrooms and Training• Assignment:Complete this reaction paper and

return it by the date noted by the facilitator.

• SuggestionsforViewers:Take notes on these questions while viewing the video and complete the reaction paper afterwards or use the questions as way to approach a discussion. Respond to each question below.

• LengthandStyle:2-4 pages double-spaced. Be brief and concise. Do NOT provide a full synopsis of the video. This is meant to be a brief reaction paper that you write soon after watching the video--we want your ideas and reactions.

What to Write: Respond to the following questions in your reaction paper:

1. Key points What important points did you learn about working with high conflict couples? For example, how is the alliance developed? What stands out in the way Heitler works?

2. What I am resistant to. What issues/principles/strategies did you find yourself having resistance to, or what approaches made you feel uncomfortable? Did any techniques or interactions discussed push your buttons? What interventions would you be least likely to apply in your work? Explore these questions.

3. What I found most helpful. What was most beneficial to you as a therapist about the therapy presented? What tools or perspectives did you find helpful and might you use in your own work?

4.HowIwoulddoitdifferently.Where did you find yourself feeling that you would proceed differently than Heitler? Describe these areas and explain why.

5. Other Questions/Reactions What questions or reactions did you have as you viewed the therapy in the video? Other comments, thoughts or feelings?

12

THE ANGRY COUPLE

13

Psychotherapy.net

Suggestions for Further Readings, Websites and Videos

BOOKSBader, E. & Pearson, P. P. (1988). In Quest of the Mythical Mate:

A Developmental Approach to Diagnosis and Treatment in Couples Therapy. Brunner/Mazel.

Heitler, Susan (1997). The Power of Two: Secrets of a Strong and Loving Marriage. New Harbinger.

Heitler, Susan (1994). From Conflict to Resolution: Skills and Strategies for Individual, Couple, and Family Therapy. W. W. Norton.

Wile, D. (1992) Couples Therapy: A Nontraditional Approach. Wiley.

WEB RESOURCESwww.Psychotherapy.net Three in-depth interviews with Master

Couples therapists John Gottman, Insoo Kim Berg, & Susan Heitler

www.therapyhelp.com Heitler’s TherapyHelp.com

www.danwile.com Dan Wile’s Collaborative Therapy

www.couplesinstitute.com Couples Institute: Bader & Pearson

www.gottman.com Gottman Institute

RELATED VIDEOS AVAILABLE AT WWW.PSYCHOTHERAPY.NET Couples Therapy: an Introduction

Couples Therapy for Addictions: A Cognitive-Behavioral Approach

Emotionally Focused Couples Therapy with Sue Johnson, EdD

Experiential Therapy with Gus Napier, PhD

Irreconcilable Differences

14

THE ANGRY COUPLE

15

Psychotherapy.net

Complete Transcript ofThe Angry Couple: Conflict Focused Treatmentwith Susan Heitler, PhD

Heitler Introductory Commentary: Hello, I’m Susan Heitler. Angry couples pose difficult challenges for a therapist. Their turbulence and impulses to hurt can be frightening to them, and to the therapist, as well. Anger creates an unpleasant atmosphere, yet it signifies that a problem exists. Conflict-focused therapy utilizes anger to guide treatment.

Conflict-Focused Treatment

• SymptomReduction

• ConflictResolution

• SkillBuilding

This approach includes three main thrusts: Symptom reduction—the main symptom in this case being anger, resolution of existing conflicts, and improvement of conflict resolution skills so that subsequent problems can be resolved without arguments. These three dimensions of treatment form a structure for organizing the diagnostic data that a therapist collects in the first session.

When Anger is Prominent

• PhysicalViolence

• Drugs/Alcohol

• FixedIdeationalSystem

When anger is a prominent symptom, I want to know if it escalates beyond words to physical violence, if drugs and alcohol complicate angry episodes, or if either partner is angry in a paranoid fashion, with a fixed ideational system. These conditions would need additional attention for therapy to proceed productively.

As to the content of their conflicts, I ask couples to create a list of the topics that generate tension. This laundry list serves as a basic treatment outline.

16

THE ANGRY COUPLE

With regard to the process of conflict resolution, I identify skill deficits and reciprocal interaction patterns. In addition to this diagnostic assessment, a successful first session also needs to show the couple that treatment will be safe and worthwhile.

Judith and Richard have been married 2 and 1/2 years. He is 34. She is 32. Before their first session, I ask new patients to fill out intake forms. These include a symptom checklist. I quickly review these checklists as the session is about to begin.

SESSION ONERichard: I would say more heavily in the last half a year to a year.

Heitler Commentary: Richard and Judith both have noted anger and communication problems.

Heitler: And have you been to therapy before?

Judith: Yes.

Heitler: For these problems?

Judith: Yes.

Heitler: You want to tell me what your experience was there?

Judith: Well, we had four sessions with another therapist, and every time we would go to this therapist, my husband and the therapist would talk about my problem, and they would… It was like he didn’t even have anything to do with this. It was all about me. And I felt they were talking about me—

Heitler Commentary: Asking about previous treatment can alert the therapist to potential problems.

Heitler: What are you feeling right now?

Judith: I’m angry. I’m angry because nobody is listening to me. I mean, I go to a therapist trying to get something done and it’s not working.

Heitler: So it’s very important for this therapy to work, that if you begin to feel that angry feeling in here, will you be sure to tell me right away?

Judith: Okay.

17

Psychotherapy.net

Heitler: Good.

Richard: We should also let you know, I think–

Judith: What do you mean?

Heitler: Hold onto… hold…

Richard: You’re gangbusters. I mean you, a—

Heitler: Richard, hold on a sec.

Richard: Sorry.

Heitler: Let me just finish with Judith. I just want to be sure we are absolutely clear.

Heitler Commentary: Angry spouses will often talk for or about one another. These crossovers are almost always inflammatory. I intervene immediately to prevent them. Quick intervention shows Judith and Richard that here they will be safe and will be heard.

Judith: Yeah, I feel like he is accusing me of getting angry when I have every right to be angry.

Heitler: Okay, the things are going fast. Let’s slow down just a second. I can see that you are cooking.

Heitler Commentary: Judith ripples from topic to topic. Letting her continue picking up speed and anger would be counterproductive.

Heitler: What’s going on?

Judith: Okay.

Heitler: With your anger? I want to catch up though and find out from you, Richard, what was your experience in the prior therapy?

Heitler Commentary: Symmetry is essential. It needs to be established right from the beginning of treatment with special attention to symmetry of airtime.

Heitler: What was the problem for you?

Richard: The fact that she was… There is this anger that comes and comes and comes…

Judith: Where do you think it comes from, Richard?

18

THE ANGRY COUPLE

Richard: It comes in waves.

Heitler: Hold on Richard. Hold on, hold on, hold on. So you felt that the last therapy was unfulfilling? You didn’t accomplish what you wanted?

Richard: In my mind, that’s the reason we’re here, because we want to fix this problem.

Heitler: Okay, good. Let’s look at how to do that. Let’s look first at exactly what the problem is and then we will look at how to fix it. Before we get into it, I’d like to make a recommendation, which is that usually in therapy sessions here we tape sessions.

Heitler Commentary: Repetition of the therapy sessions by listening to audiotapes during the week can significantly accelerate treatment.

Heitler: Okay, we’re on. Let’s clarify what it is that you want to get out of treatment here and I’d like you to turn to each other and share with each other why you are here.

Heitler Commentary: Suggesting that the couple face each other and dialogue about their treatment goals serves multiple purposes. I look initially for a quick assessment of basic dialogue skills and deficits. I also evaluate ability to bring different viewpoints to consensus.

Heitler: Could you do that?

Richard: Well, uh, one thing that Judy has—

Heitler: Try talking with Judy and telling her what you want to get out of therapy here.

Richard: We’ve got to get your anger under control. This is getting ridiculous.

Judith: Oh, we have to get my anger under control. That’s why we’re here? That’s why you think we are here? No, no…

Richard: To come to grips with the fact that even the smallest discussion escalates into an argument based on the fact that you can’t seem to handle your anger.

Judith: Oh, why don’t – No, no, see—

Heitler: Hold on just a second, hold on.

19

Psychotherapy.net

Judith: It’s because of his failure to commit to something that’s very important to me.

Heitler: So you’re saying that, for you, there is something that you’re wanting him to commit to?

Judith: Yes.

Heitler: What is that that you want?

Judith: To have a family. He can’t commit to that, at all.

Heitler: Tell me about your feelings about having a family?

Heitler Commentary: Rather than allow Judith to speak for Richard I invite him to express his viewpoints.

Richard: I come from a big family myself. I love having a big family. I just don’t think that this is the time to have a child yet.

Judith: Why isn’t this a time to have a child? When is it?

Richard: Because—

Judith: When I’m 45 years old, Richard?

Richard: Please—

Heitler: Hold on. How frequently do you get this upset at home?

Judith: A lot.

Richard: I would say frequently.

Heitler Commentary: Even when I am trying to understand the diagnostic picture, I don’t allow fights to escalate.

Heitler: What would have been the next step?

Judith: Well, he probably would have left the room because he doesn’t want to talk about it.

Heitler: And you would have…?

Judith: Well, I would have kept talking about it. I don’t just run away. I talk about things.

Heitler: So you would have tried to keep talking about things.

Judith: Yes.

20

THE ANGRY COUPLE

Heitler: And is her hunch accurate? Would you have tried to leave the room or what would you do?

Richard: Not because I don’t want to talk about it but because it’s the tone, it’s the, that she comes at me with gangbusters.

Heitler: [to Judith] Wait, wait, wait. Hold on just a sec.

Judith: How do you…?

Heitler: Hold on. When I say hold on here I really like that you stopped just now, because one element in making this therapy a positive experience for both of you is that you’re not going to repeat, in this room, what goes out of there. Now, when I say cut that’s it; you quiet down. And I was very impressed, Judith, that you did stop when I asked you to. Is that an agreement you are willing to make with me?

Judith: Yes.

Heitler: Good.

Richard: And may I…?

Heitler: Hold on.

Richard: Sorry.

Heitler: I just want to ask the exact same question of you. If you get agitated or are doing something and I say cut, are you willing to stop?

Richard: Of course I’m willing to stop.

Judith: But I still want to say what I have to say and I don’t feel like I’m getting to say it.

Heitler: Uh-hmm. Go for it.

Judith: Well, he can’t commit to a family.

Heitler: So, what is it that you are saying about what you want? Why are you here?

Judith: I want Richard to be able to commit to a family and to be able to listen to me. We have talked about this—

Heitler: Okay, stop just a minute. I am getting a little struck by the fact that both of you invest a whole lot of energy in talking about the other

21

Psychotherapy.net

person, and in doing that you miss the opportunity to convey what you want. Now I am going to ask the question one more time and let’s pretend there’s a wall here, so that you can’t see Richard; that he’s not even here.

Judith: Okay.

Heitler: And instead all you can see is you and what you want. Now, what is it that you would like to get, what you want by the end of this treatment, for you? “I want…”

Judith: I want a family.

Heitler: Ah…

Judith: I want to be listened to.

Heitler: Hold on a sec. I want to write those two down: “listened to” and “want a family.”

Judith: Okay.

Heitler: Do you feel like I heard the critical piece about what you want?

Judith: You know, I have so much anger in me, and I have so much—

Heitler: I see that.

Judith: —I need to get out, and I feel like I have to… I get there and then you say stop, and I get there and you say stop, and I need to get it out, because he certainly doesn’t listen. You are supposed to listen to me.

Heitler: Right. Yes. This is a dilemma. Let me think for a minute. On the one hand, you want to get all of that fire out.

Judith: Yeah, I want to get it out. I want—

Heitler: At the same time, at home when you get it out, does it seem to result in some change, something good happening?

Judith: No, because he doesn’t listen.

Heitler: Right.

Judith: He walks away. He leaves.

Heitler: Right, and that’s a common thing, that most people don’t like to receive the fire. It’s like you’re a dragon breathing fire, if you’re angry.

Judith: Well, how else am I supposed to get what I feel out? I can’t—

22

THE ANGRY COUPLE

Heitler: Ah, that’s exactly what we’re here to learn. How else can you get out what you want, without being…?

Judith: But that’s not why I’m here. I’m here because I want a family, and I want Richard to commit to me, and I want to find out why he can’t commit to me.

Heitler: Things get going real fast here. We’re going to slow down a bit. Not because I don’t want to hear you, but because I do want to fully understand this problem that is a very real one, of wanting to be heard, and of wanting to have a family. I don’t think more explosions of anger, if they haven’t worked at home, they’re not going to work here, and besides, we know that that’s not what makes changes.

Judith: But I am angry. I am angry. I’m not somebody who’s just coming in and I just want a family, and I just—

Heitler: I really do understand. I see that you are very angry. Tell me, when you’re that angry, what helps you to calm down?

Judith: I don’t know. I’m, I—

Heitler: Do you have trouble calming down once you are angry like that?

Judith: [to Richard] Oh, does that look like I have trouble calming down?

Heitler: Hold on, hold on. I want to know from you, because you’re the only one that knows what goes on inside of you.

Judith: I don’t think about it. I just do it. It’s like I’m mad now so I’m letting it out. I don’t think about it.

Heitler: And then after you let it out, what do you experience?

Heitler Commentary: I address the common misconception that releasing anger is positive because it “gets it out” by focusing Judy on the actual result of her anger outbursts.

Judith: You understood—

Heitler: You are saying that, after you let the anger out, your belief while you’re doing it is that somehow this is going to be helpful; and, after the anger is out, you’re still left with a not very good feeling. So that’s—

Judith: Right, because he doesn’t listen to me. If he’d listen to what

23

Psychotherapy.net

I’m saying, if he heard exactly what I’m saying, we could talk about it afterward. Then I would feel better.

Heitler: I think that that’s exactly right. Now, I want to switch to Richard to find out what he experiences and whether he is hearing you when you are letting it out, and I don’t know until I ask him.

Judith: Okay.

Heitler: Okay, good. Richard, what have you been experiencing as you have been listening to us talk?

Richard: Is this wall still up here? Is it safe to be over here?

Heitler: Sure.

Richard: Okay.

Heitler: Okay, in fact that’s a good idea. Just focus on you, not on Judith or what she has been doing but on what you have been experiencing over the last few minutes.

Richard: Well it’s somewhat embarrassing to share certain things like this.

Heitler: So you feel embarrassed; that’s one piece.

Judith: We’re in a therapist’s office. We’re not at some country club.

Heitler: Judith, Judith, Judith—

Richard: What can I tell you? What can I tell you? It’s a stranger and it’s embarrassing a little.

Heitler: Richard, hold on. I want to practice just for a minute to cut off and set an additional rule. The rule is going to be, when you are talking or talking to me your role is to listen, to listen to try to understand and not to react verbally. I will ask you your reactions later. If you interrupt, it’s pretty hard for us to get forward momentum and Richard, the same for you. When the wall is up and I am talking with you, Judith, it’s not for you to interrupt. Can you follow that rule, both of you?

Judith: Yes.

Heitler: Second, if there is a slippage, do you remember what I said about when I say stop? I really mean it. I don’t mean one or two sentences later. I mean stop means stop.

24

THE ANGRY COUPLE

Richard: I can do that.

Heitler: Are you both clear about that?

Richard: Yes.

Judith: Okay.

Heitler: Okay. What went on within you during those few minutes while Judith was being angry?

Richard: It made me feel uncomfortable.

Heitler: You were feeling uncomfortable?

Richard: It’s incessant.

Heitler: No, wait. You’re talking about her again. I can see this is fairly difficult for you. What I am asking you to do is focus on you, with the sensations that were going on in front, within you.

Richard: It makes me feel uncomfortable.

Heitler: You were feeling uncomfortable. Now what I would like you to do is to describe that uncomfortable feeling; like, did a thought go with that?

Richard: Stop. And I want to withdraw.

Heitler: Okay, that’s what I wanted to know. So, let’s backup. When something happens that reminds you how much you want a family and the difficulties you two are having making that happen, then you get quickly very angry. Is that how you experience it?

Judith: Yes.

Heitler: Okay, as you get very angry, you experience an uncomfortable feeling.

Judith: Can I say something?

Heitler: And the thought that comes to mind is something like “stop.”

Richard: Yeah.

Heitler: Alright?

Judith: But can I…?

Heitler: Remember our rule? We had two rules so far. Why don’t you tell

25

Psychotherapy.net

me what they are?

Judith: I feel like we are in kindergarten here. I know the two rules. It’s just that—

Heitler: Ah, I like your comment. I’m feeling a little like we are in kindergarten, also. That is, this constant interrupting. It’s like little kids fighting. Do you feel sometimes like you two are little kids fighting?

Judith: No, I don’t. I feel like we are two adults and one of them doesn’t listen.

Heitler: Judith, there are a number of things that we are going to have to change if you are going to get what you want.

Heitler Commentary: I feel myself getting impatient. Rather than express irritation, I pause for a moment to calm myself and think. My irritation signals that I need to focus more on Judith’s escalations.

Heitler: These are changes that must stop if we are going to spend our time together productively.

Judith: Okay.

Heitler: Rule #1?

Judith: Stop talking when you say stop.

Heitler: Thank you. Rule #2?

Judith: Do not interrupt when you are talking to him.

Heitler: Right, thank you. I can see that that urge to get into a… what word for you? I mean, you use the word anger but it sounds like—

Judith: I just get angry. It’s like I am on a train track that doesn’t stop. I mean it’s going faster and faster and faster and I just I can’t stop until I say everything that I have to say.

Heitler: Okay. That’s a lovely description of it. That really fits. That’s how it looks for me, as well. What’s your hope about what’s going to happen if that train goes faster and faster?

Judith: I hope that I can get everything out and that—

Heitler: And what would getting everything out accomplish?

26

THE ANGRY COUPLE

Judith: All my feelings, all the anger that I have so he can hear me. I mean, I feel like if I talk loud and if I say everything I have to say, that he’s going to hear me, because if I talk softly—

Heitler Commentary: By framing Judith’s anger as an attempt to accomplish something positive, we can explore more effective means of attaining her goals.

Heitler: So your goal in the train going faster and faster is twofold: to get everything out of you, and to have him hear it?

Judith: Yes.

Heitler: Is that correct?

Judith: Yes, that’s exactly right.

Heitler: Would you be willing to find a more effective way to get the information and feelings inside of you out so that he really will hear them?

Heitler Commentary: At this point I switch the focus of the intervention from gathering diagnostic information to demonstrating the kind of communication that the couple will be learning if they go ahead with treatment.

Heitler: We are going to try an exercise to convey information in a different way.

Judith: Okay.

Heitler: Without any trains and with you feeling safer.

Judith: Okay.

Heitler: Judith, let’s begin with you trying one more time just to say in a gentle way, a gentle way, one sentence to get to the essence on what you want Richard to hear. So before you talk, you actually have to pretend that he is going to hear you. Your job is to listen. So you just take in, with as much understanding as you can muster, what Judith is telling you. Even if you have heard it a thousand times before, this time let it really sink in. Can you share with him what it is that you want?

Judith: [to Richard] I want to have a family with you now, and I want children, but I want them now. I don’t want them—

Heitler: [to Richard] What did you hear? All the elements of what you heard?

27

Psychotherapy.net

Richard: [to Judith] You told me that you would like to have children now—not in years, but now—and that’s what you need.

Heitler: Oops, there was one other important piece there I heard. Who does she want to have children with?

Richard: Ah, well, with me. Sorry.

Heitler: Do you feel that he heard you that time?

Judith: Yes. I feel that I was heard and that he was really listening to me.

Heitler: Good, let’s build from there.

Judith: Okay.

Heitler: Richard, what do you want Judith to know about your feelings about having children and what you want in this relationship?

Richard: This is tough. Well, I want you to know that I want this to… I want this to work out.

Heitler: What would “work out” mean to you? That’s still kind of vague.

Richard: It probably is. I want this to flow. I want this to…[expels big breath]…to happen nicely. I want this, and I want us to be a family, and I don’t want there to be speed bumps. You know, there’s too much—

Heitler: Okay, hold on just a minute. We’re slipping into what you don’t want rather than what you want.

Richard: I want Judith to be—

Heitler: Oops, just a minute. Try once again; rather than “I want Judith…,” what you want to experience in this relationship.

Richard: I’m sorry. I would like you to be less angry.

Heitler: Hold on, hold on, let me help you. Who are you talking about right now? Are you talking about you, or are you talking about Judith? You’re talking about Judith. I would like to help you out here.

Heitler Commentary: I move my chair in to help Richard along, serving as his mouthpiece, so that the dialogue can keep moving forward.

Heitler: I want to try to say what I think I’m hearing. “Judith, I want to raise a family with you.” Is that what I hear?

28

THE ANGRY COUPLE

Richard: Yes.

Heitler: “And I want it to be in an environment that’s calm and happy.”

Richard: That’s what I have been trying to say. I would like our environment to be calm so we can raise a family. That would be important, and that’s what I need.

Heitler: What are you hearing?

Judith: What do I feel, or what—

Heitler: What did you hear?

Judith: I hear that he wants a calm life; I mean, a calm family life.

Richard: It seems very simple to have just a happy family, but in order to have the calmness, it’s I think maybe a give and take, and, uh—

Judith: I agree with that.

Richard: And it will be a wonderful environment for little ones to run around, you know.

Heitler: This dialogue felt different to me.

Heitler Commentary: As the dialogue about therapy goals comes to a resolution, Judith and Richard soften, shifting from confrontational stances to collaborative affection. With this shift comes a restoration of hope.

Heitler: And although I am sure that that shift happens at times at home—otherwise you wouldn’t be together—what we’re going to learn in this therapy is how to make an environment where you are most of the time, virtually all of the time, in this modality. For now, I am concerned about those episodes when you are in the fighting-withdrawing interaction. And I want you to hear how I said that: fighting-withdrawing. The problem is not just your freight train. The problem is also the running away. Here’s how I would like you to do it this week and then we’ll talk more next week. If you feel yourself beginning to accelerate like that—

Judith: Okay.

Heitler: —just excuse yourself and go in the other room. Could you do that? Try it this week.

Judith: Without resolving anything.

29

Psychotherapy.net

Heitler: Right.

Judith: Just, just, when I get that way, just go in the other room.

Heitler Commentary: Before the first session ends, it’s vitally important to address emotional and physical safety with an angry couple. They need to at least begin to develop a disengagement strategy, so that moments of anger no longer escalate into hurtful fights.

Heitler: I want you to understand Judith, and you to understand, Richard, that we are going to learn to talk together. For now, your job, Richard, is to get back to good humor. Your job, Judith, is to get back to good humor. You are responsible for soothing yourself, and you are responsible for soothing yourself. So my sense, seeing these last few minutes, is that you have a lot of potential to have a real quiet and comfortable and happy, and yet still kind of open and talkative household. To get there, you’re going to need to learn some skills: skills not for just casual talking with each other, but skills for talking about tough issues.

Judith: Communication skills.

Heitler: Yeah. So I would like to recommend that we begin treatment by building skills, and then we move into actually using those skills to resolve the conflict.

Judith: So, okay.

Heitler: I’ve got a question for each of you: In your gut, what’s your sense of how long it’s going to take to accomplish the calm and the clarity about having a baby that you both are looking for?

Richard: I… How do we know something like that? How do we know how longer we should go?

Heitler: Okay, just close your eyes and check inside. There will be some inner time table within you. I know it sounds kind of crazy. Try it.

Judith: I know already. I mean, I think that, I mean, I would like it to be resolved in like four or five weeks.

Heitler: Four or five weeks?

Judith: Yeah.

Richard: I suppose four to six weeks would be—

30

THE ANGRY COUPLE

Heitler: You were thinking four to six weeks?

Richard: Somewhere in there.

Heitler: Okay, I was thinking more like four to six months. So we have a pretty big discrepancy here. Let’s figure out what to do about it.

Heitler Commentary: I guide a quick process of conflict resolution, clarifying our concerns and then determining a mutually agreeable solution.

Judith: I just –

Heitler: What about you Richard? Would you be willing to do a two-step process and to have a short-term goal, plus a longer term commitment to treatment?

Richard: I am in this for the long haul. I think it’s—something needs to be done.

Heitler: Great. Now I have one more question for you both: If you’re going to show dramatic progress in those first four to six weeks, you’ll have to do some homework that—

Heitler Commentary: In response to my concerns about how much they had to learn in so little time, Judith and Richard agreed to do homework. They would devote at least a half-hour of every weekday night to listening either to a skill-building audiotape or to their session tapes.

Heitler: I’d like to summarize what I see that we’ve accomplished and we will be able to—

Heitler Commentary: I am careful to frame the summary in terms of reciprocal interactions.

Heitler: First, I’m struck that you’ve had a pattern of these big explosions, with a lot of residue. Second, that you’ve been withdrawing, in order to get some kind of calm. We’re instituting a new way to get calm, which is a mutual disengagement rather than one person withdrawing and the other being left screaming alone.

Judith: Okay, right.

Heitler: Third, there is—

31

Psychotherapy.net

Patterns of Conflict

• SingleIssue

Strategy: Address Issue

• MultipleIssues

Strategy: Address Issues

Communication and Conflict Resolution Skills

• ChronicHostility

Strategy: Address Process, then issues.

Heitler Commentary: For many couples, one issue is like a tack in a shoe. Addressing that one issue eliminates most of the couple’s fighting. Other couples can specify a list of provocative issues. For these, a laundry list strategy is useful; that is, addressing the issues one-by-one, and learning communication and conflict resolution skills en route. A third group of couples exist in a state of chronic hostility. For them, the process is usually the problem and needs to be addressed first.

Judith and Richard combine the first and third types. They have one major conflict: her desire for children now versus his for calm before kids. At the same time, their poor communication skills result in frequent day-to-day living arguments. Conflict-focused treatment includes insight, behavioral, and systemic components. So a therapist needs three types of intervention techniques:

Intervention Techniques

• Visualization

• CoachingandTeaching

• Negotiation

Visualization techniques access subconscious concerns, coaching and teaching exercises build new communication habits, and negotiation skills guide the resolution of conflicts. I may use several interventions within one session. The key is to be clear at every point what my objective is: symptom reduction, resolving a specific conflict, or skill-building.

32

THE ANGRY COUPLE

SESSION FOURHeitler: Welcome. What would each of you like to focus on today?

Richard: I would like to work on our skills.

Heitler: Skills, which is what we had said we would focus on these first six sessions.

Judith: Um, I am having a problem with the disengaging.

Heitler: What’s the problem?

Judith: Well, the other night we, well, actually Richard disengaged… we were having… we started having an argument, and I felt like I was escalating, I guess, and right as I felt like I was going to make a point, Richard disengaged it. And I want to talk about that because I have real problem with the other night.

Heitler: I see. And I am remembering that I had said if something bothered you, it was important to bring that in here and we would follow up.

Judith: Right, and so today I want to talk about that. I don’t want it to go, you know, unnoticed.

Heitler Commentary: I begin every session with agenda setting, asking each spouse to identify what he or she wants to focus on, and also asking myself what seems to be important based on prior sessions.

Heitler: So we have two agenda items: skills, and talking about whatever it was that was on your mind and you wanted to—

Judith: When he disengaged.

Heitler: Let’s do both. And the way we will do both is we will start talking about that incident.

Judith: Okay.

Heitler: As soon as I hear something that sounds like a skill that we need to focus on, we’ll work on that skill, and then we’ll use that new skill to make it easier for us to continue talking about that. Let’s go for it.

Judith: Okay.

Heitler: Okay?

33

Psychotherapy.net

Judith: Okay.

Heitler: As quietly and gently as you can, share with Richard now what you have been trying to tell him before.

Judith: I would like to come in to your space and feel needed and wanted and not feel like…that I am a guest in there. I feel like I am a guest when I come into your study.

Richard: Well, the study is in the house. It’s a part of our house. That is fine, yes, but that is a particular day, Sunday, where I make the—

Heitler: Stop for a sec, please. What happened just then?

Judith: Because he’s not listening to what I am saying again. I feel like—

Heitler: Do you know what you did?

Judith: I feel like—

Heitler: Excuse me. Do you know what you did that made her think you weren’t listening? You said the word “but,” which sounds pretty innocent and yet is remarkably potent. Let’s look what happens with the word “but.” I will say something… No, you say something to me; just a short sentence about anything in a room, whatever.

Richard: Well, you look very nice today. Thank you for dressing up.

Heitler: Uh-huh. Oh, but this is just something I wear all the time. What happened to the information about how I look?

Richard: It was actually a compliment, and you turned it around, and—

Heitler: Yes, it turns it around. And your hands did something interesting as you were saying that. They went like this [moves arms as if throwing something off]. It’s almost as if I threw out the information. The information was kind of—

Judith: I was just going to say that. It seems you threw it out.

Heitler: Uh-hmm. Let’s do some more. You say something to me. Notice what happens with my word “but.”

Judith: Excuse me, but I don’t feel like I have to do that. I understand “but.” I understand this and you need to understand this.

Richard: But I don’t.

34

THE ANGRY COUPLE

Heitler: Stop, stop. Good. Thank you. I appreciate the way you two are stopping right away. I have a hunch you do understand “but,” especially because you react so strongly to it. And—not but—and you can help us out by participating in this. Richard does need work. And one of the critical pieces that went wrong in the prior therapy was too much focusing on you and your anger, and not that, the same degree of focusing, or not focusing, on Richard. Until Richard learns to hear you more effectively, you are going to feel alone and unheard. Does that make sense to you?

Judith: Yes.

Heitler: Yeah. So, did you feel criticized or like I was saying you have a problem with “but” when I started this drill.

Judith: No, but. No.

Heitler: Oops. You know what? I heard the “but.” You know what? Maybe you have a similar problem. Will you join us in working on this, for him, and also perhaps for you?

Richard: It would help me.

Judith: Okay.

Heitler: Okay.

Judith: Okay.

Heitler: Are you feeling calmer?

Judith: Yes.

Heitler: Uh-huh. It struck me as funny that you started with “but” when you were saying you don’t have that problem.

Judith: Contradicting myself.

Heitler: Okay, let’s go back to the drill. It’s real important to understand what “but” does.

Judith: Okay.

Heitler: So it’s your turn. Try saying something to me, and I am going to “but” it, and I want you to tell me what you feel as I say “but” to you.

Judith: You have a nice laptop over there.

35

Psychotherapy.net

Heitler: But the power keeps going out.

Judith: Again, it’s a negative word. You are not really listening to what I am saying. It’s an excuse.

Heitler: Okay, what we are going to work on is a different form of dialogue: additive dialogue. What three letter word suggests addition?

Richard: And.

Heitler: You got it. So instead of using “but,” which is like subtraction, we are going to use “and.” Give me those same sentences that you gave me before, or something similar, and tell me what you experience when I respond with “and” instead of “but.”

Richard: Well, like I said earlier, you look very nice today. You have a good eye for wardrobe.

Heitler: Thank you, and it’s something I wear almost everyday; really frequently. Got the idea?

Judith: Yeah.

Heitler: Okay.

Judith: I’m just, I’m getting frustrated and I am getting—

Heitler: Okay, let’s do “yes,” and only we’re going to do it, not talking about my clothes, [but] talking about what happened. Share with Richard now what you were trying to share with him, or say to him, the other night. “I…”

Judith: I want to be able to come into your space, your study, and just hang out with you, and just be with you, and feel that you want me there, and feel that you are not bothered or are not, you know… I just want to feel needed and wanted when I come in there. And I felt like there is…

Heitler: Let’s cut.

Judith: I said “and.”

Heitler: You did say “and.” There’s only so much information he can absorb at once. You said some real important things there, so—

Heitler Commentary: Long monologues give too much information for a listener to absorb. Speaking in short chunks prevents loss of information.

36

THE ANGRY COUPLE

Richard: You want to know that you can share the space in the study with me.

Judith: Right.

Richard: You want to be a part of that space.

Judith: Right.

Heitler Commentary: Reiteration of what the prior person has said, reassures the speaker that he or she has been heard. It also clarifies any misunderstanding.

Richard: In that room, you want us to be in that room together.

Judith: Right.

Heitler: Good. Did you want to add another chunk?

Judith: Yes.

Heitler: Go for it.

Judith: I know everybody has to have their own space, so to speak, but I feel that if you had—

Heitler: Hold on just a minute. Remember about “but.”

Judith: Oh, sorry.

Heitler: Let’s not even use it here.

Judith: Okay.

Heitler: Let’s try to keep it in. You know if one needs their one space—

Judith: I know everyone needs their space. I need my space. And I know that, I feel that if you just, if you had a chair in there that was, it would just welcome me in there.

Heitler: So you are saying you would like to have a chair in there?

Judith: Yes.

Heitler: I would—

Judith: I would like to have a chair in there.

Heitler: Great. And I would—

Judith: And I would feel welcome, and I probably–

37

Psychotherapy.net

Heitler: One sec. Stop, stop.

Judith: Did I say, “but”?

Heitler: Short chunks.

Heitler Commentary: My therapy goal has switched now from teaching skills to resolving a specific conflict. So when skill deficits emerge, I’ll just melt them enough to keep the dialogue on track.

Richard: First of all, I have no concerns about you being in that room. I never have.

Heitler: Wait a minute, wait a minute, wait a minute. Sounds a little easy. Stop and think about it. Because you’ve talked before about that study that’s your, kind of, retreat place, and it seemed to me, if I remember right, when you two disengage, that’s where you go. Is that right?

Heitler Commentary: I need to help Richard hear his own concerns, as well as to hear Judith’s.

Heitler: So, to stop and be sure, do you have any concerns about her coming into the study and—

Richard: I have a concern about her coming into the study. There, in essence, is no room for another chair. Uh, we have stacks and stacks of things, and it’s a little smaller than this office.

Heitler: [to Judith] So what did you hear?

Judith: That, well, that there wasn’t enough room in the room for a chair.

Heitler Commentary: I sense that the chair in the study is a metaphor for the space Judith occupies in Richard’s life.

Richard: There is not enough room for another chair.

Judith: Richard.

Heitler: So close your eyes for just a minute. Picture the chair in that space.

Heitler Commentary: Visualization helps to identify specific concerns.

Heitler: Notice what that chair looks like. Got it, for each of you?

Richard: Um-hmm.

Heitler: Okay, you can open up your eyes. Tell each other what chairs you

38

THE ANGRY COUPLE

were picturing. What kind of chair were you picturing?

Richard: The big, black chair with the big, thick arms that rocks back and forth.

Heitler: And what kind of chair were you pic—

Judith: Richard!

Heitler: Uh, uh, no, not to talk about him, but to talk about you. What kind of chair were you picturing?

Judith: A little, nice, dainty chair.

Heitler: Uh-huh. How big?

Judith: Like a, like a—not very big at all. Very small. I mean, just enough for me. It’s not for anybody but for me.

Richard: Well. I have to admit that I misunderstood you, that I thought you wanted me to picture the chair that was in there. My fault.

Heitler: It’s not so much that, you, no. There’s no fault here.

Judith: Give me a stool.

Heitler: Hold on just a minute, hold on just a minute.

Judith: It’s the principle.

Heitler: There’s no need to get so defensive or so apologetic. You simply had different information, and by getting at the specifics that each of you had in mind, we clear up the misinformation and we get good information. This is a pattern you’ve seen before. Getting specifics, rather than having vague ideas about what you are thinking or what the other person is thinking, makes a big difference. So, would it be possible with that small chair that Judith was describing, to fit a chair in the space?

Richard: I suppose there will be room for a chair that she described, [to Judith] you described.

Heitler: You suppose. Now when you said you suppose, it sounds like we potentially solved the space problem. And there is something else that’s holding you back. What’s another problem that could come up for you, if that small chair were there?

Richard: Well, Judith, you mentioned that you would like—

39

Psychotherapy.net

Heitler: Hold on. “I” what?

Heitler Commentary: I prompt I-statements to prevent crossovers.

Heitler: Okay go ahead. What’s the other—

Richard: I-I-I heard you say that you would like to spend more time in the space with me.

Judith: Right.

Richard: But quite honestly—

Heitler: Hold on just a moment.

Richard: And—

Heitler: Ta-da! Okay.

Richard: And I would enjoy that. I have no problem getting a chair for you, so you can spend time in there. And I must say that—and boy, this is not easy to say—there are times when, this is my space. I need to be… I need to be alone in there, and I—

Heitler: So you are saying there are times when you would like to be alone in there.

Richard: There are times when I would like to be alone in that room.

Judith: I understand that. I understand that. I know that, that there are certain times. I just want to know that I’m welcome anyway. You know?

Heitler: Uh…hold on just for a second. He is saying to you there are times when you are not welcome. Can you accept that? That it doesn’t mean he doesn’t love you. There are times when you are not welcome because—

Judith: He needs his own space.

Heitler: Right. He needs to be alone sometimes.

Judith: Okay, I can accept that.

Heitler: Let me say back to you what I hear as a potential solution at this point: that you’ll put a small chair in that space, and there will be an understanding that you are very welcome at many times. And there will be some times when Richard has needs of his own to have separate space.

Judith: Okay.

40

THE ANGRY COUPLE

Heitler: And let’s note that this issue of how much am I a part of your life, and for you, Judith, and for you [Richard] can I have some areas that are separate? This is a theme or concern that we’ll need to explore again and more deeply, also, because I have this sense that there are a lot of deep roots to those two issues.

Heitler Commentary: Occasional individual sessions can be helpful, especially while the couple is still combative. I schedule these sessions symmetrically: one for each spouse. I find it essential that the couple therapist conduct these individual sessions. That way, each individual’s progress can be intertwined with the work of the couple. In fact, when a couple begins treatment with me, I request that they take a temporary leave of absence from any individual therapy. This policy does not always endear me to their individual therapist, but it has proven to be in the patient’s best interest. I use individual sessions with Judith and Richard for symptom reduction, to help them each take responsibility for their own anger management.

INDIVIDUAL SESSIONSRichard: Well, Judith is mad at me, and I would like to talk about this.

Heitler: Okay. What’s been going on within you? I mean, obviously if she is mad, there is something going on within her, as well. Let’s focus on your part. What’s been going on?

Richard: I recently had a visit from my brother and his 6-year-old boy, and they took over the house, and it was just getting a little uncomfortable.

Heitler: So she was mad at you and you had the visit. There is something missing for me. What was she mad about?

Richard: Well she was mad at the fact that I didn’t put my foot down when they took over the house.

Heitler: Oh, okay.

Richard: This is our house, and—

Heitler: Okay, can you close your eyes for a moment please? Picture your house. What do you see as you see that scene?

Richard: We just purchased a new piece of furniture—a sofa—and as any normal 6-year-old would like is to have some ice-cream. But you don’t eat

41

Psychotherapy.net

ice-cream out of the container on the new sofa.

Heitler: What were you experiencing as you were watching Ken and Jeff?

Richard: I was experiencing disbelief. I was getting a little annoyed.

Heitler Commentary: Closing his eyes enables Richard to track his inner experience with a new level of clarity.

Heitler: You weren’t happy about it, and you were annoyed, concerned. So what did you do?

Richard: I found myself beginning to say something, like, “Ken do me a favor and”—and just walked out.

Heitler: So you did put your foot down, only you put your foot down in the direction of—

Richard: I went over to the study, yeah, yeah.

Heitler: Right. Where would you rather have put your foot down?

Richard: Well, it’s then and there. It’s my brother. I can talk to him about these things, and uh—

Heitler: And yet there was that sense of block.

Richard: Uh-hmm.

Heitler: Let’s go back to that moment when you are watching the ice-cream, the sofa. What are you feeling as you are focusing in on that moment? What was going on within you, that feeling? Can you feel that anger, that irritation?

Richard: I can.

Heitler: You can feel it right now?

Richard: Uh-Hmm.

Heitler: Yeah, and the more you watch it, the more you watch them, what happens to that feeling?

Richard: The more upset I am getting.

Heitler: Okay. Now, as you focus in on that feeling within you, allow Ken and Jeff to fade out, and some other scene from earlier in your life, when you had a similar kind of feeling, allow that to come up. What are you picturing?

42

THE ANGRY COUPLE

Have there been other times in your life when you held back from saying something and felt an upset within you, an irritation within you?

Richard: Well, my father had quite a temper. He came home from long, hard day’s work and dinner was not ready, and he began to scream at my mother.

Heitler: So, when your father got in those states, what would your mother do?

Richard: She retreated and just, we would all wait until it just, the sky cleared, you know.

Heitler Commentary: This intervention uses a moment of intense feeling in a recent incident as a key to the sources of a counterproductive behavior pattern: in this case, Richard’s withdrawal when he is angry.

Heitler: So if you look back on that scene in your family when your dad would get upset like that, you would have that feeling of tightness, your mother would be cowering or retreating. Now let’s look at what happened between you and your brother. What was the same in that scene for you? Was the feeling the same in that scene?

Richard: I was… I was pissed at him for conducting himself in my house the way he was. You don’t do that as an adult in someone’s house.

Heitler: So you were feeling an anger, pissed at him?

Richard: Yeah.

Heitler: What’s the same about that moment, your feelings at that moment and what was going on at that moment, and when you used to see those outbursts of anger that you described your father had, what’s the piece that’s the same?

Heitler Commentary: The two questions, what is the same in the past and present and then, what is different, enable the patient to recognize the patterns of anger in his family of origin. Later, we will discuss how these experiences have shaped his behaviors today.

Richard: I would get angry and then want to avoid it and just go away.

Heitler: Avoiding impulse and going away. Now, as you look at those two scenes, what’s really different?

Richard: What’s different? My father was filled with this power. There was

43

Psychotherapy.net

a lot of anger inside him and he just let it out all the time.

Heitler: Uh-hmm. And you felt, next to all that power, how did you feel?

Richard: Often helpless.

Heitler: Helpless. Big or little?

Heitler Commentary: Helplessness tells me that Richard experiences what I call a depressive collapse in the face of anger.

Richard: The bigger he seemed, the bigger his anger, the smaller we all felt.

Heitler Commentary: I focus him on his subjective experience of size because I regard depression as a disorder of power that accompanies anger suppression.

Heitler: Now look at the relationship between you and Ken. How do you usually feel toward Ken: bigger or smaller?

Richard: [holding out his hand] Well, it’s not that—

Heitler: Your hand is saying, “Pretty much the same.”

Richard: Yeah.

Heitler: Notice what happens as he begins doing something that you want him to stop. What happens to your sense of your size in that scene when his son is eating the ice cream?

Richard: I became small because I didn’t do anything about it.

Heitler Commentary: Here I use visualization to discover new behaviors.

Heitler: Okay, so let’s run that scene a couple of new ways.

Richard: “Guys, would you mind not doing, not eating the ice cream in the living room? Would you mind going into the kitchen and finishing?”

Heitler: How did you feel as you said it that time?

Richard: Relieved that it seemed so simple and pleasant.

Heitler: Uh-hmm. Is that a way of acting that you use in a lot of your life, in other parts of your life?

Heitler Commentary: I am struck by how easily Richard visualizes this reasonably assertive behavior.

44

THE ANGRY COUPLE

Heitler: How about with Judith? What might you convey to her?

Richard: Well, I’ll tell her that, “Judith, I am just as upset as you are. There is no need for you to get on my case about this. Just a second here; I am going to talk to him, I can talk to Ken, and we’ll get this problem straightened out. But for us to have an argument over this is senseless.

Heitler: How do you see her responding when you say that?

Richard: I think… I think… I think that she would appreciate that. I really do.

Heitler: Bravo. You can open your eyes. I want to be sure we understand what just happened. You learned a way of responding to people who are angry or doing something you don’t like from growing up in your family.

Heitler Commentary: Family of origin exploration can also be done with both partners present, with the added benefit of facilitating deeper understanding by the other partner.

Heitler: If you look at your mother’s way of responding to your dad, it was similar to what you as a kid were doing. So you had the modeling from her in the sense that you are replaying with Judith what your mother used to do with your dad.

Heitler Commentary: I will encourage Richard to share his audiotape of the session with Judith or to discuss what he has learned with her.

Heitler: —that lead you to have that urge to tighten up and walk away, and yet you went beyond them today in this visualization. You could see that there are other parts of you that you can summon up, that you do use in other circumstances.

Heitler Commentary: In Judith’s individual session, we explored the roots of her tendency to flare up. In her large family, it had taken loud shouts to call attention to problems. I validated her use of anger as a child’s effective mechanism for getting parents to attend to needs. Hearing that angry outbursts had at one time been a reasonable strategy made it easier for Judith to accept that now, a different approach might work better.

Effective conflict resolution results in a win-win solution. That is, both parties end up feeling that their concerns have been heard and met.

45

Psychotherapy.net

Conflict Resolution

• InitialPositions

• Underlyingconcerns

• MutuallySatisfyingSolutions

This process includes three phases: expression of initial positions, exploration of underlying concerns, and selection of mutually satisfying solutions. With this process, conflict is transformed into collaborative problem-solving. Throughout this problem-solving process, it’s up to the therapist to ensure that information is given in a way that’s non-toxic and non-invasive, and that information is digested by both parties. It’s also up to the therapist to ensure that the emotional intensity stays within a moderated range so that thinking can flourish.

• Symmetry

• Specifics

• ShortChunks

• Summarizing

It’s important to monitor what I call the four S’s: Symmetry (equal airtime), Specifics (exploration of the details of the situation), Short chunks (that is, speaking in brief segments rather than lengthy monologues, and Summarizing (in a way that validates both partners’ inputs).

SESSION SEVENHeitler: Good morning.

Judith: Good morning.

Heitler Commentary: Although Richard and Judith had made unusually rapid progress in their first six weeks of treatment, there was considerable tension in our seventh session, as this was the moment we had agreed to discuss their hottest issue: starting a family.

Judith: I want to know if Richard has made a commitment to starting a family.

Heitler: Okay.

Richard: My agenda is that I would feel more comfortable working on

46

THE ANGRY COUPLE

more of the skills, fine tuning them, and—

Heitler: Okay, and the agenda that I bring is that, it’s important to me if I make a commitment with the two of you, or a plan, to make a decision that X date, that we go ahead with that. So, how about if we go ahead with the decision-making, that you and I agreed we had—

Judith: Right. Okay.

Heitler: —said we would do on this session. And pay real attention to skills as we do that, which means you’ll have to focus on what? What you have to keep reminding yourself to do?

Richard: To listen.

Heitler: And to listen, like we have said before, for what makes sense in what she has said, not just for what’s wrong with it so that it can be brushed away.

Heitler Commentary: Review consolidates skills and helps prepare Richard and Judith for the difficult dialogue ahead.

Heitler: And the second half for you is going to be sure that you actually keep doing that insight where you check in with yourself and really say what’s there. Even if the voice is very quiet, you are going to be sure to listen and speak it out. Judith what’s your skill that you need to keep a focus on.

Judith: I need to remain calm and to not explode, and to talk—to speak gently to Richard.

Heitler: Right, and what’s going to help you stay calm?

Judith: Focus on myself, or what I want. Not focus on myself, but what I want.

Heitler: Exactly. Both of those two. Keep the focus on you rather than going into talking about him, and keep asking yourself, what is it that I want? Not what do I not want. Not what did he do wrong, but what do I want right now, what do I want? But gently. Those are your two biggies. Okay, in a gentle way now, go ahead and share with Richard what it is that you are wanting or ask for the information you want from him.

Judith: Well, I want to tell him what I want, and I want to ask him, too.

47

Psychotherapy.net

Heitler: Good. How about one sentence of what you want, and then ask him a question.

Judith: Richard, I want a family. I mean, I really want a family and I want to know if you want a family with me now. I mean, we’ve been here six sessions.

Heitler: Hold, that’s a very good question. Let’s let him answer.

Richard: I would like to have children with you and I do see that happening, but I hope you understand that it’s—

Heitler: You want to see that happening “and” or “but”?

Richard: And.

Heitler Commentary: I do believe that Richard wants a family. His hesitations and use of “but” remind me that we will need to explore his additional concerns.

Judith: I feel like I am being stalled again. I feel like it’s like, “Okay, Judith,” you know, six… Maybe I feel like you are going to say six more sessions. “Let me get everything in order,” and then six more sessions, and then six more, and then I am going to be 40 years old, and we are never going to have kids, and then what?

Heitler: What did you hear her say? What’s her concern?

Richard: I hear that your concern is that you think I am stalling. You think I am putting this off.

Judith: I feel like you are.

Heitler: Well, let’s take it away from you personally, that she is afraid that that is a pattern that could happen, that it could be six more weeks, then six more weeks. What makes sense to you about her concern? Let’s digest it.

Heitler Commentary: To negotiate a mutually comfortable plan of action, each party needs to fully digest the other’s underlying concerns.

Richard: Perhaps it does look as if I am trying to find ways to delay this. I will be honest with both of you that I suppose I was until I came here to see you. We came here to see you.

Heitler: Maybe you can share, then, with Judith, what’s changing for you

48

THE ANGRY COUPLE

from having come here or what’s changed so far? If you share that with Judith, that could be helpful.

Richard: Uh, I think we’ve both changed.

Judith: I do, too. I feel like—

Richard: I mean, our altercations, flare-ups at home are less, which makes me feel a lot better. I would like to have this nice, consistently calm household where I can retreat. For example, when I am in my office I can come home and I don’t have to go to my study. I have my home that I can retreat to, because the whole place is calm. I suspect we will always have our timeouts, and we’ll always—

Judith: Right.

Richard: —try to do our thing in that respect. But when we have a child—

Judith: And.

Richard: And–

Judith: Sorry.

[Laughter]

Richard: And when we have child, and children, it will be nice to have the whole house that way.

Heitler: Does that vision appeal to you as well if? Maybe you could share that with Richard—

Judith: Of course, yeah. I mean, I feel the same way, Richard, and I feel that I have worked toward that, and I feel that like things are okay, are getting better.

Heitler: Right.

Richard: I need, apparently, a lot more time to adjust to changes. As a result of that, I am adjusting from the turmoil and the anger and the constant tension that we had, all the angst that was in our house, to suddenly getting some help and acknowledging that we have now made great strides. I feel I have, and I feel you have.

Judith: I do too. I do too.

Richard: Before I not only withdrew to my study, I withdrew inside. It’s

49

Psychotherapy.net

not easy to sort of admit that, and it’s hard, it’s hard what I’m doing. It’s hard what we’re doing.

Judith: I am willing to go on if you feel that progress is being made. I need some sort of…I need some sort of timetable so I know, you know, what I am dealing with.

Richard: I know that you need that timetable, and I am not sure I know how to get to that position.

Heitler: I can see you’re a little bit stuck. Let me offer some ideas that might help loosen things up. Let’s see. Judith, you say you need something more concrete, some sort of a timetable. [To Richard] You’re saying you still have this inner feeling of needing some more time. And we don’t want it to be another postponement. Wait, you’re both are looking at me as if I am going to come up with it—

[Laughter]

Richard: I sure hope so.

Heitler Commentary: I realized I had almost fallen into the trap of rescuing them from their own decision-making. People generally know what’s best for themselves, and they will feel more ownership of the solution if it comes from them.

Heitler: Are you being completely honest with yourself? Are you going to move ahead toward having children?

Richard: Yes, I would need… I’m fearful that… that things are going to revert back.

Heitler Commentary: We continue to piece together their underlying concerns.

Judith: If you feel it’s—

Heitler Commentary: Judith realized that her panicky feelings about time grew out of watching her older sister, now 40, struggle with infertility.

Judith: I need some sort of timetable so I know, you know, what I am dealing with.

Richard: If I could see for a month or so that—[turns to Heitler] How am I doing?

50

THE ANGRY COUPLE

Heitler: What would you like to see in that month?

Richard: I would like to see just, a nice calm sea.

Heitler: And, Richard, in order to keep that calm sea, it’s important that you also really clarify a commitment, because otherwise the continued non-commitment is itself provocative.

Heitler Commentary: With these deeper understandings, they designed a plan of action responsive to both of their concerns.

Heitler: —if you’d like a month’s more of consolidating, and then to go forward?

Heitler Commentary: They would stop using birth control after an additional one month of calm, and they would remain in therapy for as long as either of them felt the need.

Judith: [to Richard] I love you so much right now. [to Heitler] I have to tell him that.

SESSION THIRTEENHeitler Commentary: We continued to explore issues and to consolidate skills, practicing with minor controversies that had occurred during each week. Their emotional tone was quite benign. Consequently, Judith and Richard were surprised and distressed when suddenly, seemingly out of the blue, Judith erupted with another angry episode.

Heitler: What happened?

Richard: We had a little problem.

Judith: Big problem.

Richard: Big problem.

Heitler: Big problem?

Judith: Big.

Heitler: Have you two talked about it yet?

Judith: No.

Richard: No.

51

Psychotherapy.net

Heitler: Okay, so it’s still pretty live. We’ve talked before about the pattern to go through to help you talk over upsetting things. This sounds like one where I’ll need to walk you through the steps, Does that sound right?

Richard: Uh-hmm.

Judith: Okay.

Heitler: Okay, remember, we start with one of you. [to Richard] Why don’t you start, since you look pretty upset. Share with Judith what you were experiencing during the time of this upset. You don’t need to tell me about it first. Just talk with each other.

Richard: If you recall, we had chosen a perfect day. We got lucky with the weather, put the skis on the car, and off we went. We found this great trail. I picked up some speed, I go down the little rise, and I am ahead of you, and I sort of slow down, look around, check my watch. Oh, she’ll be by any minute. At that moment, it was time; you should have been there. I began to counter, to go back up, to find you. And I turned around and see these eyes. Your eyes were… there was fire, there was hatred in them.

Judith: There was not hatred in my eyes, Richard.

Richard: I am telling you. Please, I’m telling you what I saw.

Heitler: Ah, Richard, Richard.

Judith: That’s not fair.

Heitler: Yeah, especially when Judith is feeling so tense. The rule about crossover is about staying in your—I mean, in talking about you—is really important. So what I am hearing you say is that, what seemed like out of the blue, Judith was there and really angry?

Richard: Yes.

Judith: I was angry.

Heitler: Okay, how about if we pick up what your experience was.

Judith: I was angry. I don’t know why exactly I was angry, but I can tell you exactly what happened in a nutshell.

Heitler: Share with Richard, because there are clearly some pieces that he doesn’t know about.

52

THE ANGRY COUPLE

Judith: We were cross-country skiing like we regularly do, and Richard, there was a huge part that I couldn’t get down. I mean, there was that, remember that bump?

Richard: Uh-hmm.

Judith: That last part? And I couldn’t get down that, and I waited for you for about two seconds. I called your name out about four times and you weren’t there, so I just did it by myself I could have broken my leg, I could have done anything, it was very, it was just a very hard point for me and I needed you to be there.

Heitler: There is something missing for me here. Judith, can you close your eyes for a minute and let’s track this. You said just now, “It was a very hard point for me.”

Judith: Yes.

Heitler: “And I needed you to be there.”

Judith: I was standing there all by myself, I was waiting for him to come back and get me and he didn’t come.

Heitler: And you were standing there all by yourself, a hard point, and you needed him to be there. Allow an image to come up with some other time in your life, when you had that same intense feeling and you needed someone to be there.

Judith: I don’t want to go there.

Heitler: Then what’s the scene that is coming up? Can you to talk about that?

Judith: It’s too hard for me to go there.

Heitler: You saw something pretty strong.

Judith: When my father died.

Heitler: Are you ready to go there now?

Judith: [nods] When my father died, I was all alone. And I felt abandoned and nobody was there for me, and that’s how I felt when I was at that hill. I know it sounds stupid, but I was all alone.

Heitler: You’re not stupid at all. It sounds very similar. Can you tell

53

Psychotherapy.net

Richard some about what happened when your father died, even if he knows some about it already. Share what’s the same.

Judith: It’s just when my dad died, no one was around to do anything, and I was so young and everybody expected me to do everything. My dad was always around for all the good stuff, but when he died, that was it, and I feel like you’re around for the good stuff, but when something is important to me— And when I was all alone, you weren’t there. And that’s why I was angry because I felt like you were abandoning me.

Heitler: Judith, what would have been helpful at that moment from Richard? Can you share with him what it is that you were wanting?

Judith: I just I wanted him to be there. I wanted you to be there. I wanted you to be looking out for me because you went over that spot before me. So I wanted, in my mind, I just thought, well that’s going to be difficult for her; let me go back and help her. And I just felt like you weren’t, like you weren’t there.

Heitler: This is sad, because it sounds like, had there been a few more minutes, you would have been there. Is that accurate?

Richard: It is accurate. I don’t even think it was a couple of minutes.

Judith: It felt like forever.

Heitler: Yeah.

Judith: I don’t even know how long it was.

Richard: If you had stayed where we had separated?

Judith: Yeah.

Richard: Because you were afraid to continue on?

Judith: Well, I just… I thought I had to keep going because I felt like I had to be with you. I just wanted to find you.

Richard: I would have circled back, as I had begun to circle back.

Heitler: How do you feel as you hear what Richard is saying? Can you share with him?

Judith: Well, I feel silly that I didn’t trust you.

Heitler: Uh-huh. And if you weren’t feeling silly, because I sure don’t want

54

THE ANGRY COUPLE

you to feel bad about this, what would you be feeling?

Judith: Well, I feel that he wasn’t actually trying to abandon me.

Heitler: Uh-huh. And when you hear that he wasn’t actually trying to abandon you, and really let that—take a look at him and let that sink in—what happens to the anger?

Judith: It goes away.

Heitler: And what’s in its place?

Judith: I feel taken care of and that makes me feel good.

Heitler: Well, I don’t know about you guys—

[Richard and Judith hold hands]

Heitler: Go ahead. But I have just learned something that I hadn’t really appreciated before about your anger, and about what you can do differently to be more helpful when Judith is getting angry. What I see now that I didn’t see before is, you get angry when you’re afraid. Is that accurate?

Judith: Yes.

Heitler: If you could just tell him you’re afraid instead of getting angry at him, that you feel scared… If Judith says to you, “I feel scared,” tell me what your impulse would be to do?

Richard: I’d protect you. I don’t want you to be scared.

Judith: I don’t want to be scared.

Heitler Commentary: Judith and Richard’s therapy lasted 21 sessions over a period of six months, and including two individual sessions for each of them. In a follow-up session six weeks after treatment, Judith and Richard expressed pleasure and relief their progress was holding. They had had several minor upsets. In each case, they were able to disengage, quiet themselves down, re-engage, and talk through the problem. In this calmer home environment, Richard felt increasingly comfortable, and Judith felt she had received the long-desired commitment from Richard to begin raising a family.

55

Psychotherapy.net

Video Credits

SCRIPT: Joshua Holland

EDITORIAL CONSULTANTS:Arthur Freeman, Ed.D., ABBPProfessor, Core Doctoral Faculty and Director

Cognitive Therapy Training Program

Adler School of Professional Psychology

Chicago, Illinois

Barbara Geller, MAPrivate Practice

Denver, Colorado

Leo Goldberger, PhD.Professor of Psychology

New York University

New York, New York

Howard Lambert, PhD.Private Practice

Denver, Colorado

MUSIC: Dave Holland

JUDITH PLAYED BY: Marika Brand

RICHARD PLAYED BY: Bob Goodman

FOR NEWBRIDGE PROFESSIONAL PROGRAMSGRAPHICS: Ellergy Engala

PRODUCTION ASSOCIATE: Joseph Craig

PROJECT EDITOR AND COORDINATING PRODUCER: Marge Lurie

EXECUTIVE DIRECTOR:Lilian Schein

EXECUTIVE IN CHARGE OF PRODUCTION:Richard Kelley

FOR WHITEBIRCH PRODUCTIONSLINE PRODUCER:Joshua Holland

CAMERA:Ed Bowes

Roger Grange

Richard von Kaenel

SOUND:Larry Provost

LIGHTING:John Dorosh

EDITING:Caleb Oglesby

Pola Rapoport

Laure Sullivan

MAKEUP:Denise Boccia

PRODUCTION SERVICES:PTI BETACAM

POST PRODUCTION SERVICES:VIDEOGENIX

PRODUCED AND DIRECTED BY:John Holland

©2006 Psychotherapy.net, LLC.

Originally published in VHS, 1996, Newbridge Communications, Inc.

56

THE ANGRY COUPLE

Notes…

57

Psychotherapy.net

Earn Continuing Education Credits for Watching VideosPsychotherapy.net offers continuing education credits for watching this and other training videos. It is a simple, economical way for psychotherapists—both instructors and viewers—to earn CE credits, and a wonderful opportunity to build on workshop and classroom learning experiences.

• VisitourCECreditssectionatwww.psychotherapy.nettoregisterfor courses and download supplementary reading material.

• Afterpassingabriefonlinepost-testyouwillreceiveyour CertificateofCompletion via email. Voila!

• CE Approvals: Psychotherapy.net is approved to offer CE courses for psychologists, counselors, social workers, addiction treatment specialists and other mental health professionals.

Psychotherapy.net also offers CE Credits for reading online psychotherapy articles and in-depth interviews with master psychotherapists and the leading thinkers of our times.

Tofindoutmore,visitourwebsite,www.psychotherapy.net,andclickon the CE Creditslink.Checkbackoften,asnewcoursesareaddedfrequently.

58

THE ANGRY COUPLE

59

Psychotherapy.net

About the Contributors

VIDEO PARTICIPANTSusan Heitler, PhD, Featured Therapist, is a clinical psychologist in Denver, Colorado, with a practice specialized in anxiety, depression and marriage difficulties. Dr. Heitler has been helping individuals and couples for over 25 years. She has written a book, a workbook, and workshops called The Power of Two to help more couples learn the skills that lead to marriage success. Her theory of treatment is presented in her book for therapists, From Conflict to Resolution.

Dr. Heitler has lectured on her therapy methods nationwide and abroad, including in Spain, Austria, Lebanon, United Arab Emirates, Israel and Australia. She is frequently interviewed in magazines such as Fitness, Men’s Health, Women’s World, Parenting and Ladies Home Journal, and on television.

MANUAL AUTHORSRandall C. Wyatt, PhD, is Editor-in-Chief of Psychotherapy.net. He is the Director of Professional Training at the California School of Professional Psychology, San Francisco at Alliant International University and a practicing psychologist in Oakland, California.

ErikaL.Seid,MA,MFT, Educational Programs Manager at Psychotherapy.net, is a practicing psychotherapist in the San Francisco Bay Area, specializing in cultural issues and sexual offender treatment.

60

THE ANGRY COUPLE

61

Psychotherapy.net

More Psychotherapy.net VideosNew videos are added frequently. Visit us at www.psychotherapy.net or call (800) 577-4762 for more information.

Ackerman Institute Couples and InfertilityGender Differences in Depression

Constance Ahrons Making Divorce WorkEllyn Bader & Dan Wile Couples Therapy: An IntroductionInsoo Kim Berg “I’d hear laughter”

Irreconcilable DifferencesStephanieBrown Treating Alcoholism in Psychotherapy (2–

DVD series)James Bugental Existential-Humanistic Psychotherapy in

ActionJames Bugental: Live Case Consultation

Tian Dayton Trauma and the BodyHealing Childhood Abuse through Psychodrama

George De Leon The Therapeutic Community (3–DVD set)Pamela Dunne Exploring NarradramaGeorge J. DuPaul & Assessing ADHD in the Schools Gary Stoner Classroom Interventions for ADHDBruce Ecker Down Every YearJohnEdwards Tools and Techniques for Family TherapyStephen Feldman Legal and Ethical Issues for Mental Health

ProfessionalsArthur Freeman Depression: A Cognitive Therapy ApproachLinda Gask Suicide and Self-HarmGlendon Association Sex, Love and Intimate Relationships

Invisible Child AbuseVoices About RelationshipsVoices of Suicide

KennethV.Hardy The Psychological Residuals of SlaveryKarin Heller & Bill Domonkos

Coming Out

HarvilleHendrix Harville Hendrix on the Healing Relationship

62

THE ANGRY COUPLE

Evan Imber-Black Family SecretsArnoldLazarus Arnold Lazarus: Live Case ConsultationSteve Lerner She’s Leaving MeRonald Levant Effective Psychotherapy with MenHanna Levenson Time-Limited Dynamic PsychotherapyMarcoJ.D.Maida Jacob Levy Moreno: His Life and His MusesRolloMay Rollo May on Existential PsychotherapyMonicaMcGoldrick The Legacy of Unresolved LossDonaldMeichenbaum Mixed Anxiety and DepressionScottMiller What Works in PsychotherapyJacobMoreno Moreno Movies (4–DVD series)ZerkaT.Moreno The Zerka T. Moreno Series (3–DVD series)RodMullen Encounter Groups for Addictions Frank Ochberg Explaining PTSD

PTSD and VeteransThe Counting Method

George Papageorge Connecting with Our KidsErving Polster Psychotherapy with the Unmotivated PatientRon Scott (Producer) Psychotherapy with Gay, Lesbian and

Bisexual Clients (7–DVD series)MartinSeligman Positive Psychology and PsychotherapyLenore Walker The Abused WomanIrvin Yalom The Gift of Therapy

Irvin Yalom: Live Case ConsultationUnderstanding Group Psychotherapy (3–DVD series)

HarryWexler Therapeutic Communities in Prisons

COUPLES THERAPY WITH THE EXPERTS SERIESJon Carlson & MaryArnold

Culture-Sensitive Therapy

Pat Love Imago TherapySue Johnson Emotionally Focused TherapyGusNapier Experiential TherapyRichardC.Schwartz Couples Therapy

Internal Family Systems Therapy

63

Psychotherapy.net

BRIEF THERAPY FOR ADDICTIONS SERIESBruce S. Liese Cognitive Therapy for AddictionsG.AlanMarlatt Harm Reduction Therapy for AddictionsBarbaraS.McCrady Couples Therapy for AddictionsWilliamR.Miller Motivational InterviewingJohnC.Norcross Stages of Change for AddictionsRobert E. Wubbolding Reality Therapy for AddictionsJoanEllenZweben Integrating Therapy with 12-Step Programs

CHILD THERAPY WITH THE EXPERTS SERIESJon Carlson Adlerian Parent ConsultationJanet Sasson Edgette Adolescent Family TherapyGerald Koocher Psychotherapy with Medically Ill ChildrenTerry Kottman Adlerian Play TherapyStephenMadigan Narrative Therapy with ChildrenBruceMasek Cognitive-Behavioral Child TherapyJohnJ.Murphy Solution-Focused Child TherapyVioletOaklander Gestalt Therapy with ChildrenDavid Scharff Object Relations Child TherapyAninUtigaard Person-Centered Child TherapyRobert E. Wubbolding Reality Therapy with Children

PSYCHOTHERAPY WITH THE EXPERTS SERIESInsoo Kim Berg Solution-Focused TherapyJames Bugental Existential-Humanistic PsychotherapyJon Carlson Adlerian TherapyMaryGoulding Transactional AnalysisKennethV.Hardy Family Systems TherapyAllen Ivey Integrative TherapyJeffrey Kottler Integrative CounselingJohnKrumboltz Cognitive-Behavioral TherapyArnoldLazarus Multimodal TherapyDonaldMeichenbaum Cognitive-Behavioral TherapyNatalieRogers Person-Centered Expressive Arts TherapyErnest Rossi Mind-Body TherapyJill Savege Scharff Object Relations TherapyLenore Walker Feminist TherapyRobert E. Wubbolding Reality Therapy

64

THE ANGRY COUPLE