Natalie Winicov

Clinical Practice with Couples- final assignment

CM, a 27-year-old Asian male, and AC, a 27-year-old white female, have sought couples

counseling in the walk-in clinic and reported having recent difficulties in living together and that

AC had recently went to live with her mother. The couple has been in a relationship for 6 years

and have lived together for almost 3 years. AC and CM met in their first year of college and

began dating in their 3 year; both have a bachelor’s degree and are employed full-time with equal

financial contributions to the household. There is no evidence of alcohol or drug misuse and

both clients report to be in good physical health.

CM stated that he grew up in Long Island with a single mother, who had immigrated to

the United States from China shortly before CM was born. He lived with his two older sisters

and mother, and recalls that he considered his mother’s “boyfriend” to be a father-figure from an

early age. CM’s mother is not fluent in English and primarily speaks Mandarin, which he is not

fluent in, thus they seldom speak and according to CM, had a very distant relationship as he was

growing up. He mentioned significant conflicts between his immediate family (mother and

sisters) and the children of his mother’s boyfriend, and that the conflict had escalated to physical

violence at points. While he denies suffering any physical abuse, he witnessed his mother being

emotionally abused by her boyfriend and throughout college, often received worried calls from

his sisters about their mother’s physical safety.

AC grew up in Brooklyn with a mother, father and older sister. Her parents emigrated

from Poland before AC’s birth and remain married. She reports no significant familial conflicts

and indicates that her family is “very traditional”- her mother was a full-time homemaker and her
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father earned money for the family. She currently works in human resources and enjoys

spending time with her co-workers outside of work.

When asked about the state of their relationship, AC and CM stated that they have a

“good relationship with some bumps in the road”. Upon further exploration, CM reported that

following the suicide of a close friend during his last year in college, he and his partner had a

serious argument that escalated to physical violence. While he did not specify the subject of the

argument, according to both clients, CM bit AC and proceeded to punch through a glass door,

call the police, and get arrested for assault. He spent one night in jail and was released under the

stipulation that he attend 6 weeks of counseling, which he claims he found somewhat helpful.

AC has been to a college therapist for one session and has no other treatment history. Both

partners individually reported that there have been no other incidents of physical violence over

the course of their relationship.

AC feels that CM is “too controlling”, saying that “there’s just a feeling of ‘who does

more’ and there being a points system and some things that he does feel worth more to him but if

you add up all we do and all our strengths I feel like we’re more equal than he thinks.” To this,

CM responded: “well, if she does a favor for me then I’ll do something nice for her, it’s like

quid-pro-quid. But she doesn’t like the fact that I treat our relationship like a business or try to

apply an algorithm”. AC also feels that CM fails to recognize her efforts in both their

relationship and the maintenance of their home. She also acknowledged a stark disparity in their

communication styles. Both clients agreed that CM is easily angered and expresses his emotions

in an overt manner, while AC tends to conceal strong emotions and withdrawal during

disagreements. AC describes her partner’s escalation as: “He gets loud. He yells. He shuts down

but in a different way than I do. I shut down by not engaging and he shuts down by forgetting
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that there’s a person in front of him like he thinks the world is against him and in the beginning I

just couldn’t understand it before and always thought ‘where did we go wrong” after fights. We

just don’t have communication tools for those times.”

Meanwhile, CM conveys frustration with AC’s last-minute tendencies and “laid-back”

approach to their schedule. He has created a Google calendar for him and his partner, and has set

the expectation that AC always keep her calendar up-to-date. He provided an example of their

most recent fight, explaining that he became frustrated when she had gone to a work happy hour

but had not noted this in the calendar. When asked what his concern was in this moment, he

responded that “I was just annoyed because I thought we would clean up around the apartment

that night and then it ruined my plans.” Both he and AC have stated that he highly values his

time and is most often irritated when he feels that his time is being wasted.

Looking into other areas of contention between the two, CM expressed concern that AC

does not share her emotions and “shuts down” when he attempts to communicate with her.

Irritated, he said “you can’t just walk away. I’m angry and need to talk”. AC agreed, stating “I

don’t live in the moment with that anger because I’m not comfortable with that anger so I try to

disengage by any means necessary…I would be mean, I would be petty and nasty and rude and

things about me that I don’t like. I would lash out and get hurtful and I don’t want to do that.”

Importantly, this couple exhibits enormous strengths and a clear motivation to work

through their issues and eventually, build a family. For example, they went through a period of

experimentation with communication strategies during arguments. Attempted techniques

included journaling, a “talking stick”, hugging during moments of escalation, or taking turns

“being the bigger person”. To this point, CM states “these techniques will only hold us for so

long, especially if it gets really heated.”

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Based on the psychosocial assessment and several information-gathering sessions, the

intervention plan was formulated. However, the intervention stage was largely a process of trial-

and-error before finding strategies that worked for both partners. Self-efficacy was a primary

treatment goal for both individuals. A central theme in the assessment sessions was both clients’

doubts in their ability to successfully navigate arguments or alter their communication pattern of

CM becoming angry and AC withdrawing. Bandura’s theory of self-efficacy suggests that a

person’s confidence in whether or not they are capable of performing specific behaviors plays a

strong role in the outcome. In order words, self-efficacy is one’s confidence in their abilities,

which applies to the domain of relationship performance i.e. effective communication, providing

support and love, and regulating emotions. This concept is critical in how one approaches

situations, and in the case of AC and CM, how each individual manages disagreements. Several

studies demonstrate the importance of self-efficacy in relationship satisfaction and happiness

(Mohammadi, Arjomandnia, & Razini, 2016; Mashal pour fard et. al, 2016), indicating that if

CM or AC believe that they can effectively deal with the circumstances, they will expect to

overcome the problem, display persistence and resilience, and operate with higher personal

performance. As part of the intervention stage, this couple found it helpful to begin providing

each other with positive feedback on their skills during arguments during our sessions. As CM

began to take time to step back and breathe before approaching a disagreement, AC began to

reinforce this by staying in the room during the conversation and later, commending CM for his

regulation.

Given that structure and use of monitoring is important to CM, the couple decided to

incorporate this into their individualized intervention plan. They developed a Google doc where

they tracked “posi-tallies”- they would mark down all of the kind and positive words that they
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had said to one another in an attempt to decrease the cynicism between them. “It’s a way to

show our appreciation for each other. There are small things that I didn’t realize that she took

notice in but then she would mark it down on our sheet and I knew that she actually took notice

in my compliments or that I fluffed the pillows or something.” However, AC explained that this

became yet another source of stress, because CM would get upset when she inevitably fell

behind on updating the sheet.

A second theory that is heavily implicated in AC and CM’s case is Bowbly’s attachment

theory, which emphasizes an individual’s physically and emotional bond to another person to

achieve a sense of security and stability (Collins & Read, 1990). Further, the theory applies to

social and personality development. These facets are certainly relevant in the context of couples

counseling, as the intimate partner becomes the primary attachment figure in adulthood and serve

as the primary source for assurance, dependability and warmth. Emotionally-focused couples

therapists seek to strength connections between couples and assist the couple in achieving secure

attachment by the end of treatment. In practice, this entails that a client will “listen to their

emotions, speak their needs clearly and reach for their partner in a way that helps that partner

tune in and respond” (Johnson & Whiffen, 2006). Particularly in the case of CM, there is a

history of inconsistent love from his mother and due to language barriers, difficulty in openly

communicating needs. Research indicates that secure attachments between a mother and child

can assist an individual in later relationships to express their needs, regulate emotions and accept

or offer comfort (Mohammadi, Arjomandnia, & Razini, 2016). This may, in part, bring clarity to

CM’s reluctance to communicate his emotional needs to his partner and take the risk of

appearing vulnerable for the sake of a deeper understanding between the two of them. Couples

therapists who are informed by attachment-theory attempt to create secure attachment between
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partners through recognizing and reducing negative cycles of attacking or withdrawing, and

attempt to reshape relational patterns into responsiveness and sense of security (Johnson & Sims,

2001). Guided by this theory and approach, the second intervention strategy involved creating a

“change event”, as described by Johnson & Whiffen (2006). A change event includes a process

of “softening”, which Johnson & Whiffen (2006) explain as when “a newly vulnerable spouse

reaches out to a now accessible and engaged partner and asks for his or her attachment needs to

be met”. This requires several steps, with the first one being a reenactment of an interaction that

the couples labels as “negative”. CM and AC chose to reenact a fight that had occurred a week

prior. The couple had been walking past the NYU campus, and AC had suggested that they stop

to eat. CM became agitated, feeling that they did not have time to “sit around and eat” because

he wanted to go to the movies. He began to raise his voice and complain about her pace and her

disregard for his time, and in response, AC walked away. They walked to the movies in silence,

sat through the movie angrily, and when CM brought up the fight at home, AC went into their

bedroom and shut the door.

In the reenactment stage, the moment that CM responded to AC’s request to stop and eat,

I stopped him and asked him what he was feeling in his body (Heyman, 2001). He described a

sense of anxiety and urgency, feeling that his time was being wasted. Unexpectedly, he brought

up an environmental trigger that his girlfriend had been unaware of: his friend had committed

suicide at NYU, near where they were walking at the time of the fight. Because of CM’s

difficulty in expressing his emotional needs to his partner, this cue and its activation of CM’s

sadness, guilt, anger, and anxiety, manifested as rage that was incongruent with the situation. A

goal of this activity was to shift CM from a reactive stance to a reflective one, or a state in which

he can take a moment to formulate a thoughtful and honest message (Scheinkman & Fishbane,
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2004; Bowen, 1978; Lerner, 1989). I encouraged CM to translate his anger into needs by

disclosing his true experience and he did, in fact, articulate his emotions in a concise and calm

manner during the activity. As a result, AC provided an empathic response in lieu of retreating.

This reenactment served as a “second chance” for the couple to experience a healthy conflict and

allowed CM to “experiment” with being vulnerable and asking for his attachment needs to be

met in a safe space. In this experiment, he gathered evidence that this strategy would result in

increased feelings of emotional security.

Following this, I asked the couple to start the reenactment from the beginning again, this

time with CM acting exactly as he had in the actual scenario. In response, as AC began to walk

away, I asked her what she was feeling in that moment. She responded that she felt scared, and

that this feeling was located in her stomach. The fear was centered on what would happen if she

did not walk away, which goes back to her previous statement: “I would be mean, I would be

petty and nasty and rude and things about me that I don’t like. I would lash out and get hurtful

and I don’t want to do that.” This concern is consistent with feminist theory-based literature that

highlights women’s fear that assertiveness equates to being aggressiveness and being

“unfeminine” (Scheinkman & Fishbane, 2004). I challenged AC to stay in the moment with her

partner and respond as honestly as possible. Contrary to her expectations, she was able to

respond in both an honest and respectful manner, explaining that it felt frustrating to always be

kept on a schedule, and that she thought it would be nice to spend time with her partner before

the movie. This put the situation in perspective for her partner, who responded with increased

warmth. The situation relates to the aforementioned theory of self-efficacy; AC felt a sense of

accomplishment and improved confidence in her ability to respond to conflict in an appropriate

manner that she did not consider to be “mean” “petty” or “nasty”.

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References

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Johnson, S. & Sims, A. (2001). Attachment Theory: A Map for Couples Therapy. Handbook of
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Johnson, S. M., & Whiffen, V. E. (2006). Attachment processes in couple and family therapy.
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