Common Client Issues in Counselling An Australian Perspective Relationship Difficulties

RELATIONSHIP DIFFICULTIES 149 Relationship Difficulties TRISH AND JOHN ABSTRACT Research into the impact of marriage and family breakdown abounds . Adverse effects on adults , children and communities range from increased mental health concerns , increased use , impoverishment , poorer outcomes for future relationships , to decreases in education and increased employment difficulties . Most consider couple therapy to be amongst the most difficult therapeutic areas to work . It is fraught with high emotion and complicated by individual personality and cultural differences , mental health , and the subjectivity of personal experience that can cloud an individual ability to accept their partner own internal experience . approaches to couple therapy , such as method couples therapy ( and emotion focused couples therapy for couples ( I ) provide therapists with , interventions , strategies , and skills to assist in the management of complex presentations . These include such as infidelity , addiction , and other mental health conditions . Learning Objectives Identify current approaches to couple therapy , Explore two of the most commonly utilised approaches in Australia . Identify common interventions utilised with couples . Explore a typical case example to deepen understanding of the flow and process of couples therapy . INTRODUCTION According to the Australian Bureau of Statistics ( ABS , 201 ) of the six million families living in Australia , almost five million consisted of couples living together with or without children . Intimate relationships are a vital aspect of human wellbeing . A longitudinal study by Harvard University concluded that happy relationships were the best predictor of improved health in older age . People in close relationships were also found to be more satisfied , have fewer physical and mental health concerns , and lived longer than those who were not in the long term , close relationships ( 2017 ) In Australia , the divorce rate was divorces per people which , in 2020 , represented divorces ( ABS , 2021 ) The divorce rate does not take into account the many de facto relationships that may also breakdown . Decades of research have established the negative impact of family breakdown on children and community ( 1994 , 1997 ) The Australian Government Department of Families , Housing , Community Services and Indigenous Affairs Social Policy Research Paper No 42 ( Rodgers et , 201 ) reinforced findings from previous international studies that family conflict contributed 149

150 the most to the differences between those children from divorced and intact families for depression , suicidal ideation , and opioid use . They also found that adults from divorced families of origin were more likely to report a wide range of adverse outcomes compared to their peers from intact families of origin and that those from divorced families were more likely to transition earlier to adult roles such as engaging in sexual intercourse before the age of 16 , leaving the parental home before the age of 17 , entering relationships before the age of 20 , and entering parenthood as a teenager . The odds for these outcomes were more than double for those from divorced families compared to those from intact families . Studies looking at the impact of relationship breakdown on communities routinely identify that this leads to the growth of more impoverished communities with the natural flow on to higher rates of crime , poorer educational outcomes , and higher use of drugs and alcohol ( et , 2019 ) Therefore , assisting couples in understanding how to create healthy , connected , close , and relationships can have a substantial positive impact not only on the welfare of individuals , couples , and children , but can also have important positive effects on community and society in general . Services for couples in contemporary Australia are widely available and highly sought after . Organisations such as Relationships Australia , Catholic Care , etc . offer a range of , services to couples and families . In addition , psychologists , social workers , counsellors , and in private practice also routinely provide couple therapy as part of their services to their communities . Many of these practitioners will have completed extensive training in approaches to couple therapy . Case study The stow Charlie and Blair have been in a committed relationship for 12 years , They have recently had their second daughter . Charlie has taken parental leave this time because Blair did that with their first baby three years ago . Charlie is becoming more and more depressed and complains that Blair works late too often , is withdrawn and unavailable on weekends and is not doing enough around the house or with the children . Blair reports that Charlie only gives orders and acts like a drill sergeant , that they barely talk to each other , except when they are screaming abuse . Blair is unsure about staying in the relationship but does not want to move out because of the children . Charlie desperately wants the relationship but feels too disconnected from and angry with Blair to feel any positive feelings , They both report their sex life has been since they had their first daughter , they barely touch each other , never hang out or go on dates , and that they spend long periods of time not talking to each other except about logistics , sometimes as long as a month to six weeks , before they escalate into very nasty fights and their cycle begins again . MAJOR THEORIES ABOUT THE TOPIC These days there is a substantial volume of books on how to have a successful relationship . In contrast , the amount of that literature based on empirical research is significantly less . Prior to the , help for couples was generally provided by older family members , religious , or community leaders . The advice provided was strongly linked to cultural mores and religious dogma without regard to the lived experience of the partners in the relationship . It was not until the 1950 that psychiatrists and psychoanalysts began working with couples in conjoint sessions on relationship issues . At that time , there were no theories , models , interventions , or techniques for providing couple therapy , so based their work on their own experience of relationships and their own ideas about what makes for functional couples ( 201 ) During the Systems Theory became the predominant approach based mostly on the theories of Virginia ( Don Jackson ( and Murray ( This approach focuses on what articulated as the self in the system ( Nichols , 1987 ) but while argued for the importance

151 of affect and attachment ( 1988 ) sadly her views were mostly at the time by more male therapeutic values such as rationality as opposed to emotionality and power as opposed to equality in relationships ( 2015 ) family systems theory arose as the primary approach in Australia to couple and family distress throughout the late and . According to Brown ( 1999 ) theory primarily focuses on patterns that develop in families to defuse anxiety which arises due to perceptions of either too much closeness or too much distance in a relationship . Stress is impacted by levels of external pressure and familial sensitivities . According to The Center , the main goal of therapy is to reduce chronic anxiety within the system by increasing awareness of how the system functions and by improving levels of differentiation with a focus on changing self as opposed to trying to change others . theory consists of eight interlocking concepts where change may need to occur emotional fusion and differentiation of self triangles nuclear family emotional systems and couple conflict which includes symptoms in a spouse as well as symptoms in a child family projection process emotional transmission process sibling positions . societal emotional process . made important contributions to the field of couple and family therapy , especially with the introduction of the importance of the legacy of emotional processes across generations and on an differentiation with the systemic context providing therapists with a view of the development and perpetuation of interactional patterns within the system ( Brown , 1999 ) concept of a family system describes how patterns , themes , and positions ( roles ) are passed down from generation to generation through the projection from parent to child . The impact will be different for each child depending on a number of variables such as position in the family , their specific relationship with each parent ( temperament , personality , and environmental factors . recommended a focus on at least three generations of a family when dealing with a presenting symptom . The attention to family patterns over time is seen as an intervention that helps family members see how they might change their own part in the transmission of anxiety over the generations , as well as an assessment tool for the therapist ( 1978 ) Major criticisms of therapy include the lack of clinical trials to assess the impact on couple and individual functioning ( Baker , 2015 ) its attention on the mother contribution to symptom development without reference to the role of father , and the labelling ofwomen as over concerned , and their relational roles as fused and undifferentiated ( 1988 ) Carter et al . 1988 ) argued model pressures women to while placating and supporting the notion of the distant male . 1988 ) also criticised for his focus on being rational and objective in relation to emotional processes which low priority to the expression of emotion in therapy . By the late 1970 behavioural therapists such as Weiss ( 1975 ) Stuart ( 1969 ) and and ( 1979 ) began extending their work to couple with a focus on skills development primarily in the area of communication , and behavioural change . The role of the therapist was primarily educational and directive . By 1995 , et al . 1995 ) had developed Integrative behavioral couple therapy which was the first approach developed through clinical observation and empirical research . In Australia , research on this approach has been spearheaded by Professor Kim , resulting in his development of ( et , 2006 ) a home study program for couples . This program was

152 designed for couples to use in their own homes with the use of instruction and telephone or video call assistance from a counsellor . In the program , the couple learn arrange of behavioural strategies and practical skills such as arousal regulation , active listening , empathy training , to enhance their relationship . During the and while studies continued into the mechanisms for change using behavioural approaches to couple therapy , a more emotionally based approach to couple therapy became the focus of several researchers , most notably John and Sue Johnson . While conducted extensive observational studies to understand what made relationships fail and what made them successful , Johnson focused on a move away from behavioural therapeutic approaches to an emotionally based approach for therapists to use with couples . Their research has resulted in the development of two highly effective , approaches to couple therapy method couples therapy ( and emotionally focused therapy for couples ( focused on conducting longitudinal observational studies to identify what couple dynamics and interaction patterns either destroyed relationships or strengthened them . He established what became known as the Love Lab , firstly at the University of Washington , and more recently at the Institute in Seattle , USA . is an integrative approach based on analytic , behavioural , existential , emotionally focused , narrative , and systems theory . It includes three broad phases . The first phase , assessment , begins with a thorough clinical assessment after which the therapist provides the couple with feedback about their assessment using the framework of sound relationship house , and together the therapist and couple formulate treatment goals . The second phase is the active therapeutic phase during which the therapist uses structured interventions to assist the couple to negativity during conflict increase positivity during conflict build more positivity during interactions increase understanding discrepancies between partners create and deepen a shared meaning system . The third phase targets relapse prevention during which the therapist is slowly phased out toward the end of therapy with sessions for up to two years post the active therapeutic phase . is not a limited program . For most distressed couples , sessions would be normal while couples with serious or recent infidelity , might require sessions ( et , 2015 ) was initially an integration of approaches with systems theory and was later heavily influenced by attachment theory . consists of three tasks for the therapist and three stages of therapy . According ( 2004 ) the three tasks are to create a safe , collaborative alliance to access , reformulate , and expand the emotional responses that guide the couple interactions to restructure interactions in the direction and responsiveness that build secure and lasting bonds . Its three stages are changing Interactional position consolidation and Integration of new constructive interaction patterns . is a approach to couple therapy and may take sessions on average , more distressed ,

153 complex couples may require sessions . and are currently the two most prevalent approaches to couple therapy utilised in Australia mostly because comprehensive training in both approaches is now readily available around the country . Counsellor reflections Having undertaken training in both and I , I find an integration of both approaches is highly successful in working with couples regardless of presentation . provides easily accessible , structured interventions that make sense to couples and can be successfully replicated by the couple outside the therapy room . In contrast , I provides me , the therapist , with the skills to safely and successfully process deep emotion with the couple experientially during the structured interventions . Working with couples would be one of the most rewarding experiences for a therapist . Bearing witness to the emotional vulnerability and courage couples demonstrate while often repairing broken relationships is one of the most touching and fulfilling professional opportunities a therapist can experience . I feel highly privileged daily that couples trust me and my therapeutic approach enough to allow me to be part of their recovery . For more information on my experiences as a couples therapist , go to The Method and couples therapy with Clinical Psychologist Trish . METHOD COUPLES THERAPY ( Assessment Many doing couples therapy do not use formal assessment . When presented with a couple in high levels of distress and pain , are often motivated to immediately attempt to help the distressed couple by moving straight into therapy . strongly recommends the opposite . It is essential to understand the couple presenting issues as seen through their eyes to know their relationship history , individual histories , and any contra indicators to couple therapy before engaging in therapy . argues the importance of a comprehensive assessment to ensure the clinician understands the couple strengths and areas of concern before beginning treatment . methods also include a feedback session with the couple to both explore with them the assessment findings and also to work collaboratively with the couple to develop clear and shared treatment goals . The following is a brief description ofthe assessment phase and will assist in organising this phase and , importantly , communicating the plan and the treatment plan . The assessment is completed in four initial session , an individual session for each partner and finally the feedback session . Early in the assessment phase a range of assessment questionnaires completed by the couple provide significant individual and relationship data that assists with the formulation ofa treatment plan . Furthermore , in this phase , the clinician needs to decide when couple therapy is . indicators involve the following Ongoing affairs , secret or reveals the interviews and questionnaires attempt to collect this data . Ongoing Characterological domestic violence . two types of domestic violence situational and characterological . Situational violence is defined as an argument that escalates out of control where low level violence occurs . It is symmetrical and does not cause physical injuries or generate fear and intimidation . Characterological violence is defined as extreme violence , both emotional and physical . There is a clear perpetrator and clear target , and the aim is to create fear and intimidation . Within couple therapy , situational violence can be treated Characterological violence can not ( 1994 )

154 Significant mental health that may need to be treated prior to couple therapy if the symptoms are florid . Initial conjoint session Following the completion of the client information form and disclosure statements and explanation of the assessment and therapy stages , the initial session incorporates three distinct components . Couples narrative In this component , the clinician asks a series of questions to understand the presenting issues as seen by the couple . Questions such as a . What brings you to therapy now ?

What are your main concerns and issues in the relationship ?

What your hopes and concerns about attending couple therapy ?

Have you attended couple therapy prior to now and what was that experience like ?

It is essential the clinician exhibits understanding and empathy and maintains a balance between each partner . The narrative generally takes 15 minutes of a session . The clinician then moves the conversation to the oral history interview . Oral history Interview This component is a interviewed aimed at gaining the couple relationship history including , their first meeting , dating , commitment engagement , marriage , transition to parenthood , children , ups and downs , hard times and changes over time in the relationship . This interview provides data concerning the friendship , conflict and meaning systems in the relationship . Events of the week and conflict interaction discussions works from the premise that it is critical to understanding how conflict occurs in the couple relationship through direct observation of their interaction . In this component two , conversations ( events of the week conversation and a conflict conversation ) are set up and recorded . Physiological information is also rate and oxygen uptake . The clinician does not intervene but observes the interaction looking for key relationship patterns and conflict indicators such as the ability to empathise , use of the four horseman , repair attempts , pattern , emotional distance , acceptance of influence , humour , affection , gentle , and validation . At the completion of the observation , each partner is asked to review the recording and use a distress rating dial to rate how positive or negative they were feeling during the conversations . Online relationship check up ( This clinical tool consists of 480 questions about friendship , intimacy , management of emotions and conflict and insight into shared values and goals . There are additional questions about parenting , housework , finances , trust , and individual areas of concern . The questionnaire is completely confidential , fully compliant and a detailed report is sent only to the clinician . It is essential the is completed before the individual sessions are conducted to ensure information concerning and to therapy are revealed In October 2020 , the Institute released their Connect website and accompanying APP . It includes a new enhanced relationship check up and a range of resources for the couple called The Relationship Builder which includes educational resources , couple activities and video demonstrations . Individual sessions Following the initial session , the clinician conducts an individual session with each partner . This session is used to build trust with each individual and learn more about each partner perspective , family of origin , history , possible , hopes , expectations , and commitment to the relationship . The individual

155 session provides a discreet opportunity to explore potential contra indicators such as domestic violence and ongoing affairs . Feedback session This session provides the opportunity to share your formulation with the couple from the information collected in the , the initial conjoint and individual sessions . The feedback session is structured using the Sound Relationship House with the clinician explaining each level of the house to the couple whilst giving feedback on their strengths and areas requiring development in each area . It is through these conversations that treatment goals are discussed and agreed upon . Second phase therapeutic interventions typically begins with the negativity in a couple conflict and ways to increase positivity during conflict moving towards building positivity during conflict and building positive affect during conflict , bridging emotional , and creating shared meaning in the relationship . It is useful to view the therapeutic intervention in two ways . Some interventions are Set Up interventions . These are structures used to assist the couple in moving into a more dialogue on an issue . interventions such as the intervention and Dreams Within Conflict intervention are key examples of set up interventions ( defined later in this chapter ) The other form of interventions is step in interventions which occur whilst the couple are in dialogue , aimed at either reducing escalation or promoting a deeper understanding perspectives . Four horseman intervention and flooding intervention are key examples of step in interventions ( defined later in this chapter ) Many other interventions are used regularly within however , only the four mentioned above will be detailed in this chapter . The following is a detailed description interventions commonly used to couple conflict . Set up interventions intervention is a structured conversation where each partner takes a turn in being the speaker and the listener , providing the opportunity for each other positions , feelings and positive needs to be heard , understood , and validated . was a mathematician and social psychologist who worked extensively in international conflict ( 2016 ) John has used some of assumptions in this intervention . An important assumption of this intervention is the concept of two valid subjective realities , not just one that both positions are valid , that there is no absolute right and wrong , simply each person has a different perceptive on the same issue . This allows the couple to focus not on facts but on perceptions . This intervention is about slowing down a conversation , reducing physiological arousal levels and ensuring the listener is able to reflect understanding and validate at least part of their partner perspective . In this intervention is suspended until both partners understand each other perspective and each other positive needs on the issue are fully understood . The speaker , with the assistance of the clinician , speaks directly to their partner using gentle up such as an , expressing emotions and avoiding blame and criticism , exploring their perspective with the articulation ofa positive need on this issue . The listener is encouraged to take brief notes about what the speaker is saying , assisting in promoting listening and reducing the tendency to form in their mind that interrupt listening capacity . Once the speaker is finished , the listener reflects back and validates what the speaker said , including the speaker affect . The intervention enables the couple to gain a deeper understanding and appreciation of each other perspective and an opportunity to feel more understood and validated by one another thereby creating a corrective emotional experience that enables flexibility and possible compromise on the topic of conversation .

156 Dreams within conflict This intervention is specifically designed for couples to explore gridlock conflict on perpetual issues in their relationship . Couples have issues that they continually fight about without resolution , from serious conflicts ( should we have children or not , to small issues such as how one should fold the towels ) Over time these conflicts can become stuck , gridlocked , where neither feels heard , understood , or validated . Indeed , perpetual gridlock conflict can create a feeling of vilification , distance , and emotional disconnection . Gridlock is an indication that the dreams embedded in the issue are not being understood or honoured . Dreams are defined as hopes , aspirations , and wishes that are part of one identity , personality , and give purpose and meaning to one life . The purpose of this intervention is to move gridlock to dialogue not to solve the problem but for the couple to engage in constructive ongoing conversation without escalation or vilification . The structure of the intervention again includes a speaker and a listener role , where the listener role is to create a climate of safety , allowing the speaker to talk deeply about the meaning for them of the issue , exploring their underlying values , dreams , and fears on the topic . To assist the speaker in deepening the conversation , the listener asks a series of questions like an interview such as What are your core beliefs , ethics and values that are part of your position on this issue ?

is there a story behind this for you , or does this relate to your background or childhood story in some way ?

Tell me why this is so important to you . What feeling do you have about this issue ?

What would be your ideal dream here ?

is there a deeper purpose or goal in this for you ?

What do you need ?

is there a fear or disaster scenario in not having this dream honoured ?

To move out of gridlock , both need to feel understood and that the deep purpose and dream that exists in their position on the issues is validated and honoured . Acknowledging and respecting each person deepest , most personal hopes and dreams is the key to a strong and connected relationship . Four horsemen John research identified four highly destructive interaction patterns that he named the four horsemen of the relationship apocalypse . These are criticism , defensiveness , contempt , and stonewalling . Consistent use of the four horsemen moves relationship interactions onto a battleground where the conversation quickly ceases being about the initial issue raised and moves to every complaint , they have about how they feel their partner is treating them . Criticism and contempt are personalised attacks on the partner personality , communicating that something fundamental is not okay with them . Contempt can be condescending , speaking down at their partner , communicating that they think they are better than was able to predict with 94 accuracy those relationships that will end in separation and divorce based on existing contempt in conflict conversations . Using a gentler beginning when raising a complaint , with the speaker talking more about what they feel and what they need rather than negatively describing their partner allows the issue to be understood by their partner , providing a real opportunity for that person concerns to be heard . Defensiveness and stonewalling are behaviours that redirect the complaint or criticism away , where feedback is received , and the person does not allow themselves to be influenced by the other . Interestingly , when someone is stonewalling , they are experiencing stress and shutting down to stop or avoid the conflict from getting worse . Unfortunately ,

157 the opposite is true defensiveness and stonewalling tend to escalate negative interactions . The capacity of a couple to accept some responsibility for their partner concerns and to self soothe when feeling stressed and wanting to shut down , assists in reducing the cascade into negative interactions and the escalation of conflict . When a couple in therapy uses the four horsemen , the clinician intervenes by stopping the interaction , identifies the horsemen that was used and explains the antidote for the client to use . The clinician then assists the client in using the antidote . The goal is for the couple to experience a different type of conversation , one that does feel like a personal attack or a rejection of their perspective and that does not build negativity . Horseman antidote Criticism Use a gentle start up . Defensiveness Take responsibility . Contempt Describe your feelings and needs do describe your partner . Stonewalling Do physiological . Flooding John noticed in his research that when a couple conflict escalated , it was not only their words , tone and volume that escalated , it was also their heart rates and the amount of stress hormones being secreted . This is called flooding or diffuse physiological arousal . The research findings were compelling the more aroused couples were in conflict , the faster their hearts beat , the faster their blood flows , the more they sweat , the more stress hormones they release , the more their relationships deteriorated in the next three years . What we know is that it is the escalation of the conflict that builds negativity , and it is this of negativity that predicts relationship demise . Flooding in conflict increases negativity in a relationship . The term flooding refers to a flood of stress hormones ( such as adrenalin and cortisol ) to the nervous system that generates what is commonly known as the fight or flight response . What happens in your body when flooded ?

A cascade of physiological events takes place in the brain and the autonomic nervous system . Individuals are not in control ofthis cascade . Heart rate increases to 100 beats per minute or above . Blood is drawn in from the periphery and into the trunk to minimise haemorrhage . The frontal lobe of the brain is deactivated , and the amygdala is activated . Blood flow is redirected to vascular beds necessary for fighting or fleeing . services like digestion are shut down . Glycogen in the liver is converted to glucose . Blood volume is increased through the system there are considerable increases in myocardial contractility . Blood pressure increases . Breath becomes faster and shallower . What happens in interaction with a partner when flooded ?

When people are physiologically flooded , they have trouble processing incoming information , meaning their capacity to listen and understand their partner is significantly impeded .

158 In flooding , people can not remember what they like about their partner , and it is hard for them to either give or receive affection . People do not want to be touched , and in many cases , it is even impossible to be polite and gentle with their partner . Tunnel vision occurs , and perception becomes distorted so that everything seems dangerous , the partner becomes the enemy , everything said by one partner seems like an attack . Alternative solutions and creative problem solving becomes difficult , and people can move into what we call repeat yourself syndrome where they repeat the same point over and over again with increasing tone and volume in a misguided belief their partner will somehow see the merits of the argument and without equivocation , totally agree with everything being said , Of course , this does not occur . includes over 50 couple interventions that therapists can use with couples to not only assist them in better managing conflict but also to deepen friendship and intimacy , create shared meaning , and strengthen trust and commitment in their relationship . Outcome studies and individual case study follow up ( derived from authors private practice outcome data ) routinely indicate that couples who complete a course of experience ongoing improvements in relationship satisfaction , conflict management and relationship commitment for years afterwards ( et , 2013 ) EMOTIONALLY FOCUSED THERAPY WITH COUPLES ( is a experiential , systemic and therapy , focused on couple interaction in the present moment , facilitating awareness of emotion within the couple interaction to promote positive interaction changes in the here and now . The clinician observes the dynamics between clients in the therapy setting , ties this behaviour to the dynamics in their home lives , and helps direct new conversations and interactions based on more honest feelings . To accomplish this , the clinician encourages the couple to explore their current issues and assists in the discovery of deeper feelings and emotions that exist . The couple may access deeper past feelings and vulnerabilities that are blocked by the more immediate emotions displayed in their current relationship . They may learn to express these emotions in a way that will help one another connect , rather than disconnect and distance one another . The therapeutic goal is for the couple to learn new ways to listen and stay attuned to the others emotions and discover more productive ways to respond to emotional situations . identifies three stages in the therapeutic process , and within the three stages , there are nine steps of the therapeutic process . The first stage is to the couple negative cycle of interaction and to assist the couple in gaining insight and understanding of the deeper processes of each others interactions in their relationship . The clinician assists the couple to see and understand what is underlying the current negative interactions in their relationship . The couple begin to see more substantive emotions and needs that exist with the negative interaction patterns that are commonly masked through the escalation of negativity and the distancing and pursuer patterns . The next stage is to restructure interactions , where the clinician assists the couple to engage in dialogue about their fears in the relationship in a way that can be heard by the other and thereby increase , not decrease , connection . Couples learn to turn toward each other and express their needs and hopes in a way that creates openness and responsiveness . Consolidation is the third stage of I , where the clinician assists the couple see how they got into negative patterns and points out how they were able to change those patterns and how they can continue these types of conversations in the future .

159 Limits of therapy identifies three fundamental limits to therapy The clinician does not decide ifthe couple should end or continue the relationship the decision is only for the couple . information in the individual sessions is confidential unless it seems crucial for the therapy to move forwards . The clinician will advise that partner to disclose relevant information with their spouse . The clinician can not change the relationship , only the couple can . The couple is responsible for their relationship between therapeutic sessions . for The critical question with is can the clinician create safety in therapy ?

Two major considerations for making this decision are the following ongoing domestic violence competing attachments ( ongoing affairs or serious addiction ) Stage Assessment and ( includes the first four of the nine steps ) Assessment is carried out in the first stage of the therapy with the clinician using conjoint and individual sessions to create a therapeutic alliance , formulate couple issues and concerns , and gain individual and relationship histories . individual assessment sessions are completed after one or two initial couple sessions . These sessions aim to develop rapport with the couples and to understand their perspective on the relationship , negative interaction patterns and attachment issues . Further , the individual session covers the following areas commitment or ambivalence to the relationship previous attachment trauma previous relationships childhood and family background affairs domestic violence mental health issues drug and alcohol use medical conditions chronic pain sexual difficulties . The individual session provides a discreet opportunity to explore possible contra indicators such as domestic violence and ongoing affairs . Throughout the first phase of counselling , the clinician relies on the use of such as empathic listening , mirroring , or reflecting , individual stories and perspectives . importantly , the clinician tracks and articulates the negative interaction pattern and reflects back the problem cycles . These processes assist the client in becoming more aware of their emotions and how their emotions can affect themselves and others . it helps the client become more confident in the changes that are occurring .

160 Step the relational issues The clinician assists the couple to identify the presenting issues within the relationship and assess the effects on the relationship . Step the negative interaction pattern in which the conflict is expressed The clinician and couple explore the interaction pattern at the heart of the problem . This occurs through identifying positions of withdrawal and pursuit within the interaction and tracking the steps in the reactive cycle . Tracking the negative interaction cycle is identifying how the couple interacts in relation to each feelings , thinking and behaviour , and how attachment needs are met or not . Step Access unacknowledged emotions underlying the interactional position Through discussion , the clinician assists the couple to explore each partner feelings in relation to the conflict cycle , with a focus on emotions that had not previously been the underlying and often hidden attachment fears that perpetuate the negative interaction cycle . Step Reframe the problem in terms of the negative interaction cycle The clinician begins to reframe the issues of the relationship away from deficits in either individual into seeing the problem within the negative interaction cycle . assists in the of conflict and help the couple move towards validating each other different perspectives on the same issue . This step is to help the client view the problem from their partner point of view , helping each partner to understand the emotions and needs . Stage is complete when the couple gains awareness that the core issue in the relationship is the negative interaction loop creating their distress , hurt and pain . This negative , cycle is nicknamed the demon dialogue in Hold me tight ( Johnson , 2008 ) At the end of stage , the couple is able to take ownership of their part in the negative interaction cycle and understand what draws them back into it . They recognise how each other attachment fears are triggered and how this continues the negative cycle . Stage ( includes the steps five through to seven ) In Stage , the clinician facilitates deepening the expression of primary attachment emotions to generate new pathways of connection and interaction , rebuilding secure and safe attachment bonds . Each partner expresses their deeper unmet attachment needs that have been hidden in the negative interaction pattern . Each partner takes a risk , to allow vulnerability , to turn towards each other and ask that these previously hidden attachment needs be met . These acts are intentionally structured interventions known as . The clinician uses a range of and techniques such as the legitimacy of the person emotion empathic and commenting on emerging emotions , noticing verbal and expressions of the client heightening of the emotion of the client whilst emphasising and a stronger connection for the client with that emotion . Heightening enhances vulnerable emotions that can lead to a high arousal state that moves the client towards a greater understanding of themselves and others . The use of metaphor or imagery assists heightening . empathic clinician works on the edge ofa client experience to move the client forward in experience such that new meaning can emerge . Often these conjectures address the attachment fears related to others . restructuring clinician offers a new suggestion for the couple , which in turn builds on a

161 new emotional experience that seeks a different response to one partner . This challenges the couple old relationship interaction patterns and creates the possibility of something new . tracking the clinician names the steps in the negative interaction pattern between the couple from the material they bring into the session . The clinician , step by step , talks through the feelings , thoughts , and behaviour of the couple in interaction , touching on deeper emotions and attachment fears and needs . clinician draws out the attachment needs through the negative interaction of the withdrawer and pursuer . clinician sets up small for the couple to express primary emotions to one another ( Can you turn to your partner and tell them how lonely you are feeling right now ?

enable the client to contact and engage with difficult emotions , the following acronym is useful . Repeat the key words and phrases repeated several times . Image images capture and hold emotion in a way that abstract words can not . Simple keep words and phrases simple and concise . Slow a slow pace enables emotions to unfold this process . Soft a soft voice soothes and encourages deeper experiencing and . Client words the clinician uses the client words and phrases in a collaborative and validating way . These skills and techniques ensure the therapist is attuned to the couple allowing the couple to feel heard , understood , and safe . Step Promote the identification of disowned needs The clinician assists the couple to express and understand each other needs , wants and desires . This step places significant emphasis on the importance of understanding the other needs and wants fully through dialogue , and once achieved , to move towards meeting those expressed needs and wants . Step Promote partner acceptance The clinician encourages each partner to accept the other emotional experience and acknowledge their changing experiences . Step Facilitate expression of needs and wants to restructure the interaction based on the new understandings and create bonding events The clinician will guide each partner in learning how to interact more positively . A bonding exercise may accompany this step to help the couple promote a healthy new connection . The couple can risk the direct expression of their needs and wants to one another and have the capacity to create a new positive interaction that is responsive to unmet attachment needs . Stage Consolidation and integration ( includes steps eight and nine ) Stage involves consolidating the learning and experience of the I therapeutic experience by integrating and consolidating the changes made during therapy and creating a plan for continued success outside of therapy . The clinician uses encouragement and support and aftercare teaching to promote relapse prevention .

162 Step New solutions The clinician supports the couple to collaborate in solving pragmatic problems . Now that differences are no longer triggers of attachment threats , and new solutions are more readily forthcoming . With the new , more positive foundation in place , solving these problems become much easier than it seemed in step one . Step . Consolidation In consolidation , the couple will take new skills and interaction patterns into their lives to continue developing effective ways to interact and new , more adaptive behaviours . As with all humanistic therapies , the task of building and maintaining an alliance with each partner remains critical thought the three stages and nine steps of the I process . The other two key tasks are reprocessing emotional experience and restructuring new interactions between partners creating corrective emotional experiences for the couple , reconfiguring their interaction patterns from negative escalated interactions to conscious attuned interactions that build connection and attachment . Case study Intervention Treatment and Assessment phase Charlie and Blair were assessed using standard protocols . They attended an initial conjoint session where a relationship history was taken , presenting issues identified and they engaged in two conversations ( an event ofthe week conversation and a conflict conversation ) during which their physiological arousal was monitored using pulse . They each attended an individual session where an individual clinical history was taken , and they used the Love Lab rating dial to assess their level of distress while watching back the two conversations mentioned above . They both completed the online Relationship Check Up Questionnaire . From this data , the therapist prepared a case formulation , treatment plan and feedback report for the couple . A conjoint session in which feedback and related to the assessment data was provided and the following treatment goals were collaboratively established manage eradicate the four horsemen learn conflict management for meaning , reflection , repairing develop strategies and skills for deepening friendship and intimacy create a system of rituals of connection and shared meaning . Brief and Blair presented with high levels of negative sentiment override driven by lack of emotional and physical intimacy , familial and financial stress , Within this , perceptions of workload fairness have resulted in hurtful and bitter arguments . The assessment indicates that while both partners experience diffuse physiological arousal ( Charlie tends to become louder and more aggressive while Blair becomes overwhelmed , shuts down and attempts to withdraw which in turn escalates Charlie more a common negative interaction pattern . Charlie grew up in an intact household as the oldest of two children , Charlie father was a military officer who , despite being frequently absent , was the primary disciplinarian and used yelling , physical intimidation , and corporal punishment ( smacks , holding , dragging ) to manage misbehaviour . Charlie describes him as scary but fair . Charlie reported a mostly happy childhood free from except for witnessing his beloved family dog being fatally hit by a car at the age of 12 . Charlie denied any bullying or problems at school and graduated to a university to study law , After graduation , Charlie obtained a position with a large law firm and has steadily advanced with that

163 company over the last eight years until taking recent parental leave . Charlie has some concerns that decision may have an impact on future advancement but feels it was the right thing to do at the time . Blair is three years older than Charlie and grew up as the middle child in a family of five . Blair parents separated and subsequently divorced while Blair was in primary school , Blair continued to live with two younger siblings in the home with their mother , visiting their father and older siblings on alternate weekends . Blair describes this time as confusing , unstable and unsettling . Blair mother remarried within three years of the separation , and Blair reports her new partner was aloof and dismissing . Blair reports feeling different and always on the outer at school and identifies as being a loner , Blair was academic and did well in school , gaining entry to a medical degree and now works as a medical researcher and academic . Blair and Charlie met at university when Blair was 24 years old , and Charlie was 21 . Neither report any significant prior romantic relationships . Therapeutic phase Consistent with Blair and Charlie were scheduled for four consultations to assist them in learning skills to better manage conflict and to process and repair old hurts . Each consultation began with the question what would be useful to talk about in session ?

They were also reminded that they had agreed for the therapist to interrupt their conversation if or use of the four horsemen occurred . Blair and Charlie agreed the initial topic they wanted to discuss was My thoughts on workload distribution in our relationship . The therapist introduced and explained the Intervention . Blair chose to be the speaker first . During this conversation , Blair used two ofthe four horsemen ( criticism and contempt ) a few times . The therapist intervened each time and assisted Blair to restate using the appropriate antidote . This allowed Charlie to stay in listening mode for the most part . However , Charlie did become flooded ( 102 ) once , and the therapist led both partners through a breathing exercise which allowed them to and continue their conversation . Charlie was able to accurately reflect back position and to both validate and empathise with feelings of hurt , disrespect and loneliness , Charlie then took the speaker role , and the process was repeated . Charlie demonstrated some distress while disclosing shame and fear in not being able to manage in the parenting role as well as Blair had . The therapist assisted Charlie to draw a link between these feelings and his experiences in his childhood ( internal working model intervention ) that have led to behaviours that included being short , harsh , and demanding . Blair demonstrated deep empathy and disclosed it all makes so much more sense now . The couple were assisted to engage in a compromise intervention to establish some processes to better support each other in the parenting role . Both partners were gentle and affectionate with each other at the end of the session . The following session , Charlie and Blair reported that they had experienced great benefit from their previous session and had been feeling closer and more of a team . They decided they wanted to work on deepening their understanding of each other emotional needs . The therapist introduced the dreams within conflict intervention and framed the discussion as What I need to feel loved and supported in our relationship . Blair and Charlie took turns to respond to their partner questions on this topic . With the assistance of the therapist , Blair learnt that Charlie has carried a story from childhood about perfectionism and that when Blair gives appreciation and praise this helps Charlie to feel valued and worthwhile even when things are perfect . Charlie learnt that Blair has always felt unacceptable , different , and alone and that messages of approval and acceptance help Blair feel connected and wanted . In treatment session three , Charlie and Blair identified that they both still had hurt feelings relating to a very escalated argument they had had three years earlier . The therapist introduced the aftermath of a fight intervention and assisted them to reprocess the fight , empathise with each other , apologise for their own part in the fight and create a constructive plan to assist each other in better managing , in future , the emotional triggers that had led to this fight . During the subsequent six sessions attended over the following 14 weeks Charlie and Blair worked on issues related to increasing their friendship and intimacy through and dreams within conflict conversations around topics such as my thoughts on how we can have more fun in our relationship what a close , connected , intimate relationship means to me and what I need to feel ready of sex . They also engaged in activities such as the I appreciate intervention , love map cards , open ended question cards , salsa cards , and rituals of connection cards .

164 Charlie and Blair reported they were feeling more connected , experiencing less conflict , and when conflict arose , they were able to manage it by using a conversation . They reported using this process , and the skills they had learnt during couple therapy sessions had resulted in a complete reduction of the use of the four horsemen and physiological flooding . and relapse prevention stage Charlie and Blair attended five follow up consultations over the next six months during which they were introduced to interventions such as stress reducing conversation , the state of the union conversation , and expressing needs cards . They consistently reported their relationship was feeling more satisfying and happier . Twelve months post their initial presentation Charlie and Blair again completed the Relationship Check Up questionnaire which demonstrated marked decrease in their initial challenging areas related to conflict management , emotional disengagement , and loneliness in the relationship along with a marked increase in satisfaction , commitment , emotional connection , romance and quality and frequency of sex . A second Relationship Check Up Questionnaire was administered nine months later , which indicated the positive trend on all measures had continued . At this time Charlie and Blair were advised their case would be closed and that they were welcome to recontact should they need to in the future . Charlie and Blair complete course of treatment , including relapse prevention , consisted of a total of 24 hours of contact with their therapist and three administrations of the online Relationship Check Up Questionnaire . CONCLUSION Couples therapy requires a thorough assessment , formulation , and treatment plan due to the complexity of individual needs and couple interaction . The therapist needs a deep understanding of relationship theory , a , framework and therapeutic process to competently manage the emotional and frequently escalated issues that couples present with , and a well thought out and executed follow up and relapse prevention plan . Pre and post assessment is highly recommended as part of this process . Engaging in specific couple therapy training in an approach such as for couples provides therapists with the specialised knowledge , framework , interventions , and skills to ensure their couple clients are provided with best practice treatment and outcomes . RECOMMENDED RESOURCES Information for training in Method Couples Therapy can be found at Professional Training Workshops including certified Method Couples Therapy The Institute , upcoming events Information for training in for couples can be found at EFT Training Certification Overview Helpful YouTube channels The Institute

165 Great reading has published over 200 journal articles and authored or over 40 books , below are a few of his most recent books . A list articles , some with dynamic links , can be found on webpage . 2018 ) Eight dates Essential a lifetime oflove . Workman Publishing Company . 2018 ) The science therapy . Norton and Company . Silver , 2013 ) What makes love last how to build trust and avoid betrayal . Simon and . and Silver , 2015 ) The seven making marriage work . Random House . Goldman , 2008 ) couples therapy The dynamics of Emotion , Love and Power . American Psychological Association . Johnson , 2008 ) Hold me tight . Little and Brown Company . Johnson , 2013 ) Love Sense . Little , Brown Spark . Johnson , 201 ) Attachment theory in practice . Press . Learning activities For more information about , watch these four short YouTube videos Making relationships Making relationships Making relationships Making relationships A brief demonstration of I in action . A brief summary of I GLOSSARY OF TERMS acceptance of influence ( method couples therapy ) your partner opinion into account , and being open to using their contribution to make shared decisions theory of human behaviour describing a family system where each family member has an assigned role with the expectation to respond to each other per their assigned role . The family is considered an emotional unit by applying systems thinking processes to describe the unit complex interactions . The aim is to maintain patterns of behaviour within a system that can be beneficial or dysfunctional to its members . conjoint from a couple are seen together in a therapy session by one clinician contempt ( method couples therapy ) the third horseman of the apocalypse . Contempt is communicating to your partner an attitude of superiority , that you look down at them , implying your partner is inferior , less than or worthless . Contempt is used to create a position of moral superiority . consolidation and integration ( emotionally focused therapy with ) task of where the couple continue to reorganise their cycle of interaction by finding new solutions to their relationship problems and sharing their changed emotional experiences . With the clinician providing feedback to the couple on their accomplishments . method couples therapy and emotionally focused therapy with ) the limits of not proceeding with therapy for a couple , citing the possible risk of harm that it may cause to either client within the couple . For both approaches , therapy is when there is an ongoing affair or the presence of domestic violence within the relationship .

166 criticism ( method couples therapy ) the first horsemen of the apocalypse . Criticism is an attack on your partner character , focusing on your partner defects rather than the actual issue or complaint . clinician facilitates a reduction in harmful interactions between the couple through identifying patterns of interactions , emotions , behaviour , and unmet attachment needs , creating emotional safety for the clients defensiveness ( method couples therapy ) the second horsemen of the apocalypse and is an automatic batting away of their partner issue or complaint . Often defensiveness is a response to criticism . Defensiveness is a lack of taking responsibility and accountability for one own actions including an inability to listen and validate your partner perspective . demon dialogue ( emotionally focused therapy with ) and negative patterns of conflict communication that prevent safe communication by the confusion of emotional signals , preventing safe connection between partners . Johnson describes three demon dialogues as being find the bad guy AKA mutual attack , the protest polka AKA demand and withdraw , and flight and freeze AKA tension and avoidance . disowned needs ( emotionally focused therapy with ) clinician helps the couple to understand the needs and wants of each individual . Then how to convey these needs . The premise is to be able to meet your partner needs , firstly you must understand them . differentiation of self ( theory ) ability to be socially connected to others while remaining independent in one emotional functioning diffuse physiological arousal ( method couples therapy ) internal alarm system that sets off a chain reaction from the brain to the body in response to a threat ( perceived or real ) alerting danger . Priming the body for the fight or flight response heart rate increases , blood flow to the gut and kidneys slows down and stress hormones such as cortisol , adrenalin , and are released . Another term for is flooding . negativity ( method couples therapy ) use of positive emotions to facilitate the body return to homeostasis caused by the physiological arousal of negative emotions dreams within conflict intervention ( method couples therapy ) intervention is specifically designed for couples to explore gridlock conflict on perpetual issues in their relationship . The purpose of this intervention is to move gridlock to dialogue not to solve the problem but for the couple to engage in constructive ongoing conversation without escalation or vilification . emotional ' theory ) by high levels of anxiety in self and within the relationship , describes the pattern of extreme emotional distancing to address unresolved attachment needs emotional symptom of an unhealthy relationship dynamic that obstructs the development of intimacy emotional fusion ( theory ) formation of intense relationships where individual choice is to maintain harmony within the relationship ( emotionally focused therapy with ) clinician nurtures a new interaction experience , with the couple experiencing each other as being available and responsive . Designed to reduce relationship distress and enable change by highlighting and heightening brief snippets of attachment related relationship dynamics . family projection process ( theory ) process of parents transferring their emotional problems to their children . Describes the primary way parents transfer their emotional problems to their children . flooding Intervention ( method couples therapy ) used to reduce physiological arousal with one or both partner in couple therapy . The intervention including identifying when one or both partners are flooded , moving them into a relaxation exercise until their heart rates have reduced from above 100 beats a minute to nearer to rest . Once this is completed the therapist encourages the couple to in the dyadic conversation . four horsemen of the apocalypse ( method couples therapy ) metaphor to describe the counterproductive communication and behaviours that can predict relationship failure if left unchanged . These being criticism , defensiveness , contempt , and stonewalling . Each horseman corrodes away at the level of trust and commitment within the relationship . four horseman intervention ( method couples therapy ) used to stop the four

167 horsemen through the identification of their use and rephrasing the conservation using each associated antidote . To foster healthy , productive communication habits . gentle ( method couples therapy ) in resolving relationship conflicts that protect both people from feeling either attacked or defensive . A gentle start up is the antidote to the horseman of criticism and involves a partner saying what they feel about a situation and what they need rather than describing negative attributes of their partner . intervention ( method couples therapy ) intervention is a structured conversation where each partner takes a turn in being the speaker and the listener , providing the opportunity for each others positions , feelings and positive needs to be heard , understood , and validated gridlock conflict ( method couples therapy ) have issues that they continually fight about without resolution , from serious conflicts ( should we have children or not , to small issues such as how one should fold the towels ) Over time these conflicts can become stuck , gridlocked , where neither feels heard , understood , or validated . Indeed , perpetual gridlock conflict can create a feeling , distance , and emotional disconnection . transmission process ( theory ) family level of functioning is influenced by the instability or functioning of previous generations negative cycle of interaction ( emotionally focused therapy with ) the repeating interaction between each partners surface emotions and negative behaviours , thoughts , and feelings that cause relationship distress . Driving the cycle is the attempts at intimacy or closeness within the relationship . perpetual issues ( method couples therapy ) research identified that 69 of conflict in a relationship was perpetual in nature , meaning that most conflict is not solvable and is based on individually held values , family backgrounds , experiences , and personality primary attachment emotion ( emotionally focused therapy with ) primary emotions drive the negative interaction cycle between a couple . Emotional attachment is rebuilt through honest emotional expression . pattern ( method couples therapy and emotionally focused therapy with ) relationship pattern that describes attempts to relieve relationship anxiety and stress . Through attempts of turning towards ( pursue ) or turning away ( distance ) from their partner . repair attempts ( method couples therapy ) preventative statement or action that escalation between partners . A repair attempt strategy is unique to each couple , designed to amend rather than fix what is broken . shared meaning system ( method couples therapy ) the attic level of the sound relationship house that consist of rituals , goals , roles , and values . That encompasses the legacy of a relationship to reflect a life together that is full of meaning . It is the creation of culture , beliefs , and stories that form the shared meaning . sibling positions ( theory ) who grow up in the same sibling position , having the same functional characteristics of personality societal emotional process ( theory ) how the emotional system influences behaviour on a societal level , promoting both progressive and regressive periods in a society set up intervention ( method couples therapy ) interventions are structures used to assist the couple in moving into more dialogue on an issue or past regrettable incident . Examples include the intervention and the dreams within conflict intervention . step in interventions ( method couples therapy ) interventions occur whilst the couple are in a set up intervention , aimed at either reducing escalation or promoting a deeper understanding of different perspectives stonewalling ( method couples therapy ) fourth horseman of the apocalypse is stonewalling and is a form of defensiveness . Stonewalling is when one shuts down interaction and stops responding to their partner . Internally the person stonewalling is experiencing heightened levels of stress and physiological arousal . the sound relationship house ( method couples therapy ) the relationship theory for

168 relationships . It is divided into three interrelated components , conflict , and meaning systems . The sound relationship house has floors and walls of trust and commitment . systems theory ( family systems ) philosophy that focuses on the interdependence of individuals within a group to understand and improve relationships triangles or triangulation ( theory ) recruitment of a third person into a conflict between two people to reduce relationship tension . REFERENCE LIST Australian Bureau of Statistics . 2021 ) Marriage and divorce , Australia . abs . Australian Bureau of Statistics . 2016 ) Australia today . The way we live now . abs , Ryan , 2013 ) A component analysis of a brief couples workshop One year results . journal of Family Therapy , 35 Baker , 2015 ) family systems couple coaching . In , Snyder ( Clinical handbook therapy ( The Press . 1978 ) Family therapy in clinical . Brown , 1999 ) family systems theory and practice illustration and critique . Australian and New of Family Therapy , 20 ( Carter , Walters , 1988 ) The invisible web , gender patterns in family relationships . 1994 ) Step families in the United States A reconsideration . Annual Review of Sociology , 20 , 1995 ) Integrative behavioral couple therapy . In , Clinical handbook therapy ( Press . 1997 ) The scientific case for marriage and couples education in health care paper . University of Minnesota . 2016 ) Level clinical training , method couples therapy . The Institute . A . 2015 ) The theory and practice of couple therapy . In , Snyder , Clinical handbook therapy ( Press . Moore , Wilson , Dyer , Judge , 2006 ) Couple commitment and relationship enhancement A guidebook for life partners . Academic Press . Leopold , 2019 ) Divorce and diverging poverty rates A and Family , 82 ( 1998 ) When men batter women . Simon . 1979 ) Marital therapy Strategies based on social learning and behavior exchange principles . 2004 ) The practice of marital therapy Creating connection ( 1988 ) interpreted psychoanalysis , feminism , therapy . Basic Books . 2017 ) The Harvard Gazette . Nichols , 1987 ) The the system . Rodgers , Gray , 2011 ) Parental divorce and adult family , social and psychological outcomes The contribution of childhood family adversity . Department of Families , Housing , Community Services and Indigenous Affairs Social Policy Research Paper No 42 Australian Government .

169 , 1988 ) The new . Science and Behavior Books . Stuart , 1969 ) Operant interpersonal treatment for marital discord . journal of Consulting and Clinical Psychology , 33 , Weiss , 1975 ) Marital separation . Basic Books . AUTHOR INFORMATION Trish is a Clinical Psychologist , Clinical Director of the Heads Psychology Clinic in Heads , Australia , and the Senior Partner of Relationship Institute . She is also the first Australian practitioner to become a Senior Certified Method Couples Therapist , Master Trainer , and Consultant for the Institute . Trish has travelled to North America several times in the past ten years to be trained directly by and Julie . Trish is certified to present all three levels of the Method training sequence , as well as the Art Science of Love couple workshop . Trish frequently presents Method trainings for throughout Australia , New Zealand , Asia , and the USA . Trish has also undertaken training in Emotionally Focused Therapy for Couples having completed an , and all Core Skills training offered by the International Centre for Excellence in Emotionally Focused Therapy and integrates this into her work with couples . Because training and experience in couples therapy and clinical mental health disorders especially Post Traumatic Stress Disorder and Mood Disorders , Trish has been involved in the development and delivery of a number of couple programs and clinical treatment programs for the Department of Veteran Affairs , The Australian Defence Force and Open Arms ( Formerly known as Australian Veterans and Veteran Families Counselling Service ) Trish is also trained in Cognitive Process Therapy ( Schema Therapy Cognitive Behavioural Therapy ( Acceptance and Commitment Therapy ( ACT ) Motivational Interviewing Trish has been in private practice on the Gold Coast in , Australia since 1997 and provides a range of services to members of the general public including couples therapy , intensive marathon couples therapy , couple workshops and is an active educator and speaker to many community and professional organisations . Trish has recently a book called 365 Simple Ideas to Improve Your her business . This book provides a unique daily guide for couples and contains a daily tip and a task designed to help them make positive change in their relationship . To learn more about Trish , listen to this We All Wear it Differently podcast where Trish is interviewed about into and through Psychology and Couple Therapy . john has , since completing his Bachelor of Social Work in 1988 and later a Masters in Gestalt Therapy , had an extensive history in direct service delivery with couples , families , and young people . John was the first Social Worker in Australia to become a Certified Therapist , Master Trainer , and Consultant . This means thatjohn has completed all levels of training and mentoring available through the Institute in Seattle , USA and can now provide training to other therapists in this modality as well as provide couples with couple workshop experiences . He is one of only 26 therapists in the world to hold this standing . John is a certified presenter for all levels of therapist training and the Art and Science of Love Couples Workshop . He has completed his Certificate IV in Workplace Training and Assessment and has delivered a broad range of training both accredited and .

170 John is trained to provide therapy to individuals , couples , and groups in a range of therapeutic approaches including marital therapy Emotionally focussed therapy for couples Cognitive Processing Therapy Motivational Interviewing Gestalt Therapy Cognitive Behavioural Therapy Over the last 20 years , john has provided a range of group programs to Australian veterans and their families in areas such as trauma , stress disorder , depression , anxiety , and resilience . He has provided training to therapists and human service organisations in Australia , New Zealand , Hong Kong , Malaysia , the USA . Please reference this chapter as , 2023 ) Relationship Difficulties . In , Machin du ( Common Client Issues in Counselling An Australian Perspective . University of Southern .