Rob Fisher, MFT license # MFT 22886      

   "Psychotherapy is the gentle unfolding of the soul" - Jon Lonsbury

 

Experiential Psychotherapy With Couples –

A Guide for the Creative Pragmatist

 

By

 

Rob Fisher, MA, MFT

 

 

 

Publisherd by Zeig, Tucker, Theisen (2002)

Note:
This article includes key excerpts from the book, Experiential Psychotherapy with Couples – A Guide for the Creative Pragmatist by Rob Fisher
[1]. The exceprts are designed to provide the underlying rationale for experiential psychotherapy and practical information on how to intervene in somatic and experiential ways that gently go to the heart of a couple’s difficulties.  The article is designed to be immediately applicable to actual practice and to provide new ideas and approaches that can make couples therapy deeper, briefer and more satisfying to all involved. 

You may purchase the book by contacting Rob Fisher, MFT at wildtemple@aol.com

 

The Rationale for An Experiential Approach

“Think about it for a moment.  Which would be more satisfying: discussing the chocolate cake you ate sometime during the last week, or sinking your teeth into a piece of rich, moist, chocolate cake with swirls of butter cream frosting?  Which would be more interesting and impactful: discussing the last time you had sex, or actually engaging in sexual activity with someone you love?  Which would be more likely to change your life: watching National Geographic on television or taking a trip around the world?

 

There is obviously a world of difference between reporting about an experience and having one. There is also a significant difference between polite conversation and psychotherapy, yet much of contemporary therapy relies on the former, while neglecting the power and aliveness of direct experience.  By taking therapy from the realm of second hand reports about events that have occurred in the lives of your clients to the realm of actual experience, you will increase your therapeutic power and depth exponentially.  This book1 will show you how to move from the practice of couple’s psychotherapy in vitro to couples therapy in vivo.

 

Here is an example of an experiential intervention based on an assessment of present time material in a session:

 

Annie walked briskly into my office, followed reluctantly by her husband Jack.  While he and I listened, she spoke quickly, outlining their many problems in quite some detail.  Her pace was unrelenting.  Her sentences had neither commas nor periods.   After 20 minutes of her all out assault, she took a breath. I suspected this would be my only chance.  I was struck not so much by the content of her soliloquy, but by her internal state which accompanied it, and the system between them that allowed her to talk in this fashion and him to listen in a burdened and overwhelmed state.  She was desperately trying to get herself heard while driving away any possibility of this occurring.  He was trying to preserve some sense of himself in a way that incited her to escalate her verbal barrage.

 

I said to her, “You feel really fast inside, huh?”  She paused for a second, surprised that someone else was actually paying attention. “Yes”, she said simply.  “Lets try something”, I continued.  “I’ll write something on a piece of paper and ask Jack to say this to you while you notice what happens inside - feelings, memories, thoughts, images, impulses, memories, or nothing at all.   Would that be O.K.?”  “Yes”, she said.   I wrote something down and instructed Jack to say it to her when she indicated she was ready.  Finally she looked up at Jack and he said, “Annie, I hear you and I see you.”  She wept.  No more words. Finally she said, “I have been waiting our whole relationship for you to say that.”  Right now this may seem magical, but it is a simple intervention based on the principles and interventions you will assimilate from the following pages.

 

Understanding the causes of a problem is useful information, but few people have been released from the constraints of their personalities through interpretation alone. How many of us have heard a client say, “Well, it must be because my mother was intrusive”, or “I think that is because my brother always got all the attention”?  Interesting insights, no doubt, yet no change.  There is a limit to the efficacy of the analytic process.   It relies on our cognitive function (often a defense in itself) and neglects the wealth of information available through the other, more lively categories of experience. Psychotherapy that is organized around conversation simply misses the point.  We did not develop psychological and emotional problems by engaging in polite conversation.  We developed our character with all its strengths and limitations as the result of impactful experiences.

 

This is not a new idea.  When Freud began analyzing transference, he was exploring an experiential event that was taking place in the therapy room between patient and therapist.  Family therapists such as Virginia Satir built family sculptures to help clients bring into consciousness their relational dynamics in a visceral fashion.  Minuchin would ask couples to reenact in his office a dispute that happened during the week, so that he would be better able to intervene effectively in live material.  There have been masters of tracking clients’ experience such as Ericksen, therapists who focused on the energetic flow in the body such as Reich and Lowen and those who worshipped at the altar of current awareness like Perls.  All of these, and others, have contributed to the development of experiential work in individual, couples and family therapy.  Using their work as building blocks, this book will try to responsibly ground, broaden and deepen the possibilities for working experientially with couples.

 

Couples psychotherapy is an ideal environment to implement experiential interventions because actual interactions are taking place in your office. Your clients can, in vivo, explore the ways they are internally and externally organized around each other.  In the safety of your office they can begin to experiment with new ways of relating to each other affectively, cognitively and behaviorally, not just by reporting and discussing, but also by face-to-face, real-life implementation.  They can eat the chocolate cake and see the temples of Burma first hand.

 

“Eating chocolate cake is of course very well and good,” you say, yet you are reminded that you might get fat!  Having sex can be very rewarding and intense you muse, but be careful because you do not want to end up with AIDS!  And traveling around the world can change your whole perspective on life, yet you know how uncomfortable those inexpensive hotels are in Burma! 

 

So we sit in our conformable chairs, one step removed.  We have developed a sanitized, (if not devitalized) psychotherapy where we can hear about our clients’ experiences second hand, apply our (not inconsequential) analytic abilities to their problems, and keep it all nicely at arms length.  This book is as much about principles and techniques as it is about the state of being of the therapist.  While strategically applying experiential methods can be dramatic and can stir the boiling cauldron of the psyche, these approaches are mechanical without the investment of the process with the actual humanness of the therapist.  Your internal state of being and your willingness to participate in your clients’ experiential world are critical factors in the implementation of what you are about to read.  Technique without contact becomes mechanical and dry. 

 

Do not be deluded into thinking that you are being neutral with your clients.  They track you like a hawk - consciously or unconsciously.  They notice the small changes in inflection, how you sit forward when they become emotional, your bored analytical tone when they talk about their week, the ring on you finger, the slump of your posture, your interest in their sex lives, the softness of your handshake, the pace of your words, your inclination to fix their problems, the rigidity with which you keep your face from showing emotion, etc.  Madison Avenue has been aware of the power of these non-verbal signals for a long time.  Sales of Cutty’s Whisky increased 60% in 1961 when a picture of a nude woman was embedded in an ice cube in their advertisement.  This image was supposedly “unobservable to the naked eye”.  The good news is that your ability to notice what is happening is much greater than you may think. 

 

Working experientially with couples is not for the faint of heart.  It demands that you be engaged with all of your humanity, not just your mental or analytic facility.  It asks you to come out from behind the protection of your cloak of authority and proceed, hand in hand with your client into an adventure - the actual unfolding of the self.  I invite you to join me in this journey, not to the far reaches of the external world, but to the wonder and beauty of the internal world of experience.   Bon appetit, use condoms, sign your traveler’s checks prior to leaving the bank. And always remember to take your humanity with you into your sessions!”

 

If you subscribe to the premise that working with live experience is more productive than normal conversation, the creative challenge then becomes, how to design and effectively use experiential interventions.  The following section describes a number of such interventions.

 

 

Experiments

 

“One of the cornerstones of this method is the deliberate evocation of experiences while the client is in a state of mindfulness. Once a theme is evident, the therapist can design an experiment that the couple or one of the partners can undertake to study more deeply each individual's internal organization or their organization as a couple. Conducting therapeutic experiments in mindfulness is one way to gather information about the couple's internal worlds, to explore how the two worlds intersect, and to deepen each individual's experience of himself or herself toward core organizing material.

       An experiment is an experience intentionally set up by the therapist with the permission of the client(s) to evoke, study, and deepen the felt sense of organizing material. The purpose of an experiment is to bring into greater consciousness how a person is organized around a particular issue or conflict involving their partner. Experiments are always conducted in mindfulness and are oriented toward present experience. They involve and invite tremendous creativity on the part of the therapist. Almost anything presented to a client in a mindful state could be called an experiment. It is most useful, however, to propose experiments that either help clients elucidate their present organization, or provide an opportunity to expand beyond the limitations internally imposed on the self or the couple.

       For example, Leslie was angry at Richard because he ``never did anything for her.'' I questioned whether she, in fact, asked him for the things she wanted. She replied, ``No, he should just pay attention to me and then he'd know.'' I thought it would be a good idea to study with this couple how they were organized around their respective needs. I placed a 3 x 5 card between them. ``This is the TV remote control,'' I said. ``Both of your favorite TV shows are on tonight. You guys decide who gets to watch his or her show.'' She instantly gave up. We were able to explore in vivo what she said to herself inside that allowed her to do this: ``I can wait. My needs aren't really so important. My role as a wife is to make him happy. Fuck him!'' was the approximate sequence. This was an experiment designed to study the present organization of the couple around giving and taking in the relationship. We could have explored his side of this as well, but he indicated that he would be relieved if she spoke up more for herself and so became less resentful. He also admitted that he could become a bit self-absorbed and was willing to work on this. So we proceeded to construct another experiment in which she tried something different. I knew she had once trained to be on a debating team. We called forth the debater in her and had her practice standing up for her needs. I told her a story about a child who readily stood up for his desires to watch his television program (my son!). I asked her again to be mindful, as she tried on this new role, for what might come up internally either to support or to oppose her new way of being. She held on to the 3 x 5 card tightly this time. This gave us more of an opportunity to explore the forces counter to her asking for what she needed, and for her to have a real life experience of standing up for herself while also being supported by her husband. We checked in with him, and it was evident that he liked her spirit, even though in the short run it would appear to make life a bit harder for him, and would require more compromise on his part.

       Experiments take both the client and the therapist into the unknown. They are exercises that involve your ability to conceptualize thematic material and design appropriate and edifying experiences around those themes. They require the therapist not to be an authority on the inside worlds of clients, but to be an expert on leading them deeply into their own experience.

       As always, experiments should only be undertaken once safety and the therapeutic container are well established. This can take minutes to weeks, depending on the couple. Verbal experiments, supporting defenses, and other forms of deepening already described are all forms of experiments. Anything conducted in mindfulness that helps a client deepen his or her felt sense of his or her own organization can be classified as an experiment. Numerous forms of experiments will be described below.

 

HOW TO SET UP EXPERIMENTS

After attending to safety, the therapist should propose the experiment to the couple or individual and make sure that permission to carry it out and cooperation are obtained. You might say, ``Let's try this ...,'' or ``I have something in mind that might help us explore this further. How about ...'' or ``Would you like to find out more about how that's put together?'' Explain what you have in mind, ask the client or clients to become mindful, and then engage in the experiment itself. You might say, ``Study what happens when ...,'' or ``Notice what goes on inside when ...'' Make sure to proceed slowly and to allow the client to luxuriate in every phase of the experience. Remember to track the client's internal experience from the moment you propose the experiment, and also what they say both verbally and nonverbally about it. A compliant client will say that it is all right to proceed even if it is not. Therefore, it is up to you to notice any hesitation or reluctance in the person's voice or body movements, tension, and so on, and not to proceed until these are explored. The exploration of the reluctance may well be more important than the original experiment you had in mind. If, after exploring the reluctance, the partners are still hesitant to proceed, do not continue to push your agenda, however creative and brilliant it may be. Always adjust to their interest and willingness.

       Often a client will perform the experiment internally as soon as you propose it. This is a way of testing the waters internally before doing it externally. Track and contact what comes up for each person, even if he or she starts the experiment before you are ready. Once the experiment is in progress, continue to track carefully and to obtain verbal reports about what is happening. Contact the client's ongoing experience and apply other accessing techniques, such as the Three Step, to help deepen and unfold the experience further.

       If clients are not interested in an experiment, or you engage in one that does not spontaneously deepen, feel free to abandon it. It is all right to admit that you may not be on the right track. You can say, ``So that does not seem to go anywhere. Let's try something else.'' Feel free to use information from the client to refine an experiment by asking what might work better for that person. You are not required to come up with experiments all by yourself, with the client participating in a passive, disempowered role. Generating experiments conjointly helps equalize the power imbalance that often exists between a client and a therapist and engages the client as a real participant in the therapy. Experiments that fail often have one of the following characteristics: (1) they have been set up without first establishing safety, (2) the therapist proceeds too quickly, (3) the client's interest is not sufficiently engaged, (4) the client is not in a state of mindfulness, or (5) one or both partners are characterologically predisposed to resist whatever you propose, or to stay away from their inner experiences. Check to see which of these conditions exists and take steps to correct it.

       Once the experiment is introduced, permission is granted, and mindfulness is established, the experiment can be undertaken. The therapist then tracks the experiences that are evoked by the experiment, and the clients report what happens inside. Whatever comes up as a result of the experiment is then material for further deepening, even if it appears to be unrelated to the original experiment. As in all deepening, find ways to immerse the client in the felt sense of experience and continue to study particular aspects of it as it unfolds.

 

TYPES OF EXPERIMENTS

Anything can be used as an experiment as long as it is nonviolent, performed in mindfulness, focuses on present experience, and the therapist tracks the ongoing results and obtains a report from the clients afterward. Experiments can be derived from anything you track, such as gestures, pace, inflection, beliefs, methods of self protection, posture, feelings, and tensions. Here are some examples of what is possible. This list is not exhaustive. The possibilities are limited only by your own creativity and imagination (and appropriate boundaries, of course). Feel free to borrow from other disciplines such as art, dance, drama, sand tray, and rituals, as well as other theoretical orientations.

 

Mindfulness

       One of the easiest and most profound tools of experiential work is slowing a couple down enough so that they can sense underneath the blaming the unconscious ways in which each person is organized around the other's upset. This is accomplished by asking the couple to repeat a tiny segment of an interactional sequence in mindfulness and to study and report their experience. Mindfulness involves carefully and non-judgmentally studying one’s internal moment-to-moment experience. It means welcoming whatever comes and noticing the subtleties of ones feelings, thoughts, beliefs, memories, images, changes in physiology, breathing and muscle tension that occur at any given moment.  Mindfulness is oriented completely towards the present.  Here is an example of using mindfulness to explore a couple’ dynamics. Peter complains that Sally is always involved with someone or something else. As he talks, she looks around the room and he becomes increasingly upset as he talks. I might ask them both to close their eyes and go inside. When they are ready, Peter can open his eyes and watch in mindfulness as Sally opens her eyes and looks around the room. Because this is performed in mindfulness and in a homeopathic dose, he will probably be able to notice feelings and beliefs that were previously unconscious. In an ordinary quarrel, he would be going so fast that he would not be able to sense the real nature of the injury that her looking around triggers inside him. In fact, he would tend to act out, desperately trying to make the feeling go away by blaming Sally. This takes the attention off him and gives him some sense of validity by proving that she is wrong. In mindfulness, he can begin to turn his attention toward his inner world and therapy can begin. Sally, too, can study the impulse to look around. To accomplish this, she can be asked to look around and be inwardly mindful of the feelings, memories, images, and so on, that arise as she does this. She can also restrain herself from doing it, not as a behavioral prescription, but as an opportunity to study the internal effect of the restraint.



[1]Fisher, Rob, Experiential Psychotherapy With Couples – a Guide for the Creative Pragmatist, Phoenix, Zeig/Tucker/Theisen, 2002. Permission for inclusion of these excerpts has been granted by the publisher.

 

                                         Mindfulness in Couples Therapy

Mindfulness is a state in which the individual or couple can observe events internal to their psyches (or relationship) without judgment or preference. It is a state in which people can take a step back from their experiences and just notice them without having to change them. For instance, a man may notice that his chest begins to collapse inward when he thinks of his demanding and irrational boss. A couple may have the presence of mind to remark, ``Here we are again, you are pursuing me and I am resisting.'' If you really pay attention to your inside world, you can notice a constant stream of experience from thoughts to feelings, memories, impulses, beliefs, sensations, changes in muscle tension and relaxation, images, memories, and the like. The parade of internal experience is almost constant.

       Mindfulness is tracking turned inward. In mindfulness, a person or couple can notice not only the content of dialogue, but all the other internal and external events that accompany the words. In ordinary consciousness, for example, a couple might have a fight about how sexually unavailable she is. He may call her a variety of names in the hope that if she were to agree how pathological she was, she would reform. Of course, in reality, after being called names, she would probably withdraw further from him and feel increased pressure to perform, thereby continuing the cycle. By adding mindfulness to the interaction, the therapist simply might say, ``George, you're pretty mad about this, huh? Why don't you take a moment just to notice all of what is going on inside as you call her a frigid bitch? Notice the kind of anger, the sensations in your body, what you come to believe about yourself and your wife, and anything else you might observe.'' George may now begin to notice how he is worried that he is not a good lover, or feels unattractive in front of his wife. He may secretly be thinking that she is having an affair. This information was not available previously in ``fighting'' consciousness. Clearly, this is the opposite of blaming. Indeed, mindfulness, if you can evoke it, is the antidote to that dreaded couples disease. It is the observing ego at work, and is marked by its nonjudgmentalness about what is being observed. It is a state of curiosity and nonpreference. It focuses on present experience.

       Mindfulness describes the internal worlds of therapists as well. Therapists need to be mindful of all of the external signs of the internal experiences of their clients (``tracking''), as well as of their own internal flow of countertransference experiences. Therapists, in mindfulness, are registering all the verbal and nonverbal cues that the partners are expressing.

       Mindfulness sends the message to your clients that their internal and present experiences are important in the session, that therapy is an environment in which they can explore without judgment. It tells them that here is a place in which they can be both deeply in their experience as well as observers of it. Mindfulness is a gentle holding environment wherein one can welcome and celebrate one's experience.

 

Exercise

       Take a moment to turn your attention inward to a place where you can begin to notice the complexity of your internal world, the sensations, thoughts, feelings, impulses, memories, and images that flow through your awareness. It is like a living internal motion picture changing from moment to moment. Ask an intimate partner or a friend to reach out very slowly toward your heart. Give a signal when you are ready. Ask the person to take at least one minute to traverse the distance between his or her body and yours, stopping occasionally in order for you to notice more closely the subtleties of your experience. Notice the anticipation. Is it a friendly or an unfriendly hand? Do you shrink back, or are you open to it? Track carefully what happens in your body as you and your friend do this together. Does your experience change when the person actually makes physical contact? Ask yourself what your friend's hand seems to be saying to your body. What is your body saying to the hand? What memories or images come up as you sit with his or her hand touching you? What feelings? Which beliefs? Take some time to report all of this to your friend.[1]

 

 

PURPOSE OF EVOKING MINDFULNESS

Considerably more material is available in mindfulness than in states of ordinary conversational consciousness. The longer one stays in a mindful state, the more information becomes available. Our entrancement with the environment generally requires a great deal of our attention, and internal experience takes a back seat in our lives to a fast-paced and relentlessly goal-driven culture. If you are in a city at night, you can hear the rumble of cars, the swish of buses, the sound of your neighbor's TV set, but can you notice the change in breathing the specific moment that your lover drops off to sleep? Mindfulness brings you back to yourself and allows you to be in contact with the more subtle dimensions of your internal world. Conversational consciousness cannot easily access these realms.

 

 

HOW TO EVOKE MINDFULNESS

To invoke mindfulness, ask your clients if it would be all right to try something different in order to get clearer on the issue at hand, to deepen their understanding of their dynamics. Let's say that you have a blamer and a defender in a circular pattern. You can ask them to reenact what they were just doing, except to do it slowly enough that they can notice all the internal experiences that go along with the outward behavior. You might say, ``Take a moment to close your eyes (it is very hard to fight with your eyes closed). Allow your attention to go inward, and when you are ready, I would like you (the blamer) to repeat one sentence of what you just said and to notice what your internal world is like as you say it.'' To the defender you might say, ``As he says this to you, notice what occurs inside, the feelings, sensations, memories, images, beliefs, self-talk, impulses that come up in response to him just before you begin to defend yourself. Take your time in doing this.'' This adds mindfulness to their interactions, and they will be able to notice more of the inner workings of their feelings and beliefs while talking in a more vulnerable and less defended context.

       The therapist should slow down and deepen her or his voice, thereby signaling the clients that this is a time for them to change states to self-study rather than blame. Clients will often follow if a therapist slows down their pace. The therapist is not asking them to change their interaction at this point, but to study it more deeply.

 

Examples of Use with Couples

       Bonnie and Scott had terrible fights in which he would accuse her of not hearing him, and she would become angry because he was ``simply disrespectful'' toward her. One of these conflicts started in my office. After observing for a few minutes, I asked them to take a moment, close their eyes, and go inside. I asked if it would be O.K. to have Scott voice one sentence of his complaint and for Bonnie to track inside exactly what occurred. I asked them to do this in slow motion (so to speak) so that they could find out more about what was happening underneath. Bonnie gave Scott a signal, and he said, ``I can't stand it when you get defensive.'' I suggested she take her time so that she could really find out how that got under her skin. After a few moments, she said, ``I can't stand disappointing him.'' Again I suggested that she stay with this sense of how intolerable it was to let him down and notice if there was anything familiar about the feeling. ``Yes,'' she said. It reminded her of how her parents had never punished her; they just told her how disappointed in her they were. This had been quite effective in manipulating her behavior. Rather than experience the pain of disappointing one more intimate person, she would react angrily. By exploring the interaction in mindfulness, she was able to become aware of a dynamic that occurred too quickly to notice in ordinary consciousness. This became an entry way that eventually allowed her to begin to differentiate her husband from her parents, and to begin to tolerate his feelings of disappointment without having to fend them off with anger.

         If you watch a videotape in slow motion, you will notice much more than you do watching it at regular speed. Mindfulness is very much like slow motion — with the camera turned inward on your psyche.



[1]       Exercise originally developed by Ron Kurtz.


Rob M. Fisher, MFT is the author of Experiential Psychotherapy with Couples - a Guide for the Creative Pragmatist - (Zieg/Tucker/Theisen, 2002).  Copies may be purchased for $44.95 by contacting
wildtemple@aol.com.


The excerpts above are from this book and are reprinted with the permission of the publisher.



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