CC05 Workshop 08 - High Impact Couples Therapy: A Developmental Model to Start and Sustain Effective Treatment and Confrontation with Difficult Couples - Part I - Ellyn Bader, PhD

Description:

Difficult couples challenge therapists with their aggressive interactions, their demands for intimacy and their high levels of sensitivity to any confrontation. Dr. Bader will demonstrate how to start and sustain positive momentum with these high distress couples. Participants will discover how to create a context for change that uses four pillars to anchor all sessions. Participants will learn to make strong confrontations, take a firm leadership role and more smoothly interweave intra-psychic and systemic interventions. Video, role-play and clinical transcripts will all be used to demonstrate these principles.

Educational Objectives:

1. To identify the four Pillars of Relationship Change.
2. To name two ways to help each partner take responsibility for change.

*Sessions may be edited for content and to preserve confidentiality*

Outline

Workshop Overview

• Full-day session focused on starting and sustaining effective couples therapy.
• Personal case example illustrates common challenges: blame, hostility, lack of intimacy.
• Core therapy elements: strong start, structure, goals, shifting negative cycles, skill-building.

Common Couple Dynamics & Challenges

• Role-play highlights patterns of blame, hostility, poor listening.
• High-distress couples often:
  • Remain stuck in symbiosis
  • Escalate hostility quickly
  • Avoid vulnerability and responsibility
  • Lack trust and conflict resolution skills
• Cultural ideals of romance often fuel disappointment.

Starting Therapy & Setting the Stage

• Therapist sets expectations, contracts, and assigns self-assessment homework.
• Use of initial phone interview to clarify reasons for therapy and build rapport.
• Strategy for the first session: connect emotionally, set agenda, listen for patterns.

Breaking Destructive Cycles

• Identify repeating cycles: criticism/demanding vs. withdrawal/passive aggression.
• Teach autonomous change: partners act for growth, not reaction.
• Describe the cycle clearly and offer exit strategies.

Therapist’s Role & Defining Expectations

• Therapist helps set relationship vision and goals.
• Self-assessment exercise for therapists to clarify their approach.
• Guide couples toward better responses without violating values.

Setting a Vision & Goals

• Address both immediate issues and deeper intrapsychic conflicts.
• Identify missing relational skills and provide education.
• Help couples create a shared vision and individual goals.

Working with Ambivalence

• Support partners with differing goals (e.g., one wants divorce, one doesn’t).
• Clarify motivations and guide decision-making toward clarity.

Resolving Intrapsychic Conflicts

• Address conflicts like approach-approach, approach-avoid, avoidance-avoid.
• Help partners understand personal contributions to relationship issues.

Skill Development

• Teach apology, negotiation, and decision-making skills (e.g., 51-49% concept).
• Educate couples on relationship developmental stages.
• Use “Stepping Stones to Intimacy” handout to normalize experiences.

Handling Dangerous Situations

• Assess threats of harm, report if necessary, create safety plans.
• Prioritize creating a safe environment for therapy.

Closing Reflections

• Reiterate the therapist’s role in shaping process and outcomes.
• Focus on empathy, encouragement, and skill-building.
• Prepare therapists for complex, high-stakes situations in couples work.