Department of Psychology, The City College of New York, New York, NY.
Fam Process. 2019 Sep;58(3):569-594. doi: 10.1111/famp.12474. Epub 2019 Jul 23.
This article presents an integrative approach to the special challenges of therapy with couples on the brink of dissolution or divorce-who often describe this therapy as their "last chance." In some, one partner is considering ending the relationship, and in others, both partners are considering ending it. Often, these couples have had prior dissatisfying experiences in couple therapy. Four types of last chance couples are described: high-conflict couples; couples in which partners have differing goals for their lives or different timelines for reaching shared goals; couples in which one or both partners have acted in a manner that violates the values, expectations, emotional comfort, or safety of the other; and couples in which there has been a gradual loss of intimacy. The Therapeutic Palette, a multiperspectival, theoretically eclectic integrative approach, is enlisted as a general framework for selecting and sequencing use of particular theories and their associated practices, based on the three "primary colors" of couple therapy: time frame/focus, level of directiveness, and change entry point. An additional complementary framework, the creative relational movement approach, is proposed to provide an integrative frame encompassing both language-based and action-based practices, suggesting that meaning is held and expressed as much through interaction or "relational motion" as it is through language. Principles of change are described. Due to the couple's level of crisis and desire for immediate evidence of possible improvement, priority is given to action-based interventions in early stages of therapy, by engaging couples in "experiments in possibility." Typical action approaches are described. An extended vignette follows.
本文提出了一种综合方法,以应对处于解体或离婚边缘的夫妇治疗的特殊挑战——他们通常将这种治疗称为“最后的机会”。在某些情况下,一方伴侣正在考虑结束这段关系,而在其他情况下,双方伴侣都在考虑结束这段关系。这些夫妇通常在夫妻治疗中都有过不满意的经历。本文描述了四种“最后的机会”夫妇:高冲突夫妇;伴侣对生活有不同目标或对实现共同目标有不同时间表的夫妇;一方或双方伴侣的行为违反了另一方的价值观、期望、情感舒适或安全的夫妇;以及亲密关系逐渐丧失的夫妇。“治疗调色板”(Therapeutic Palette)作为一种多视角、理论上折衷的综合方法,被征用来作为选择和顺序使用特定理论及其相关实践的一般框架,基于夫妻治疗的三个“主要颜色”:时间框架/焦点、直接指导程度和变化切入点。本文提出了一个额外的互补框架——创造性关系运动方法(creative relational movement approach),以提供一个综合框架,涵盖基于语言和基于行动的实践,表明意义通过互动或“关系运动”与语言一样被持有和表达。本文还描述了改变的原则。由于夫妇的危机程度和对可能改善的即时证据的渴望,在治疗的早期阶段优先考虑基于行动的干预措施,通过让夫妇参与“可能性实验”。本文还描述了典型的行动方法。之后是一个扩展的案例。