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A Socio-Emotional Approach to Couple Therapy: Linking Social Context and Couple Interaction
CARMEN KNUDSON-MARTIN, PH.D. n DOUGLAS HUENERGARDT, PH.D. n All abstracts are available in Spanish and Mandarin Chinese on Wiley Online Library (http:// onlinelibrary.wiley.com/journal/10.1111/(ISSN)1545-5300). Please pass this information on to your international colleagues and students.

This paper introduces Socio-Emotional Relationship Therapy (SERT), an approach designed to intervene in socio-cultural processes that limit couples ability to develop mutually supportive relationships, especially within heterosexual relationships. SERT integrates recent advances in neurobiology and the social context of emotion with social constructionist assumptions regarding the uid and contextual nature of gender, culture, personal identities, and relationship patterns. It advances social constructionist practice through in-session experiential work focused on 4 conditions foundational to mutual supportFmutual inuence, shared vulnerability, shared relationship responsibility, and mutual attunement. In contrast to couple therapy models that mask power issues, therapist neutrality is not considered possible or desirable. Instead, therapists position themselves to counteract social inequalities. The paper illustrates how empathic engagement of a socio-culturally attuned therapist sets the stage for new socio-cultural experience as it is embodied neurologically and physically in the relationship and discusses therapy as societal intervention. Keywords: Couple Theory; Marital Therapy; Culture; Gender; Power; Emotion Fam Proc 49:369384, 2010

With couples you always have to go larger (Marianne Walters, 1990, personal communication). Therapy is always about becoming other than what we have been, rather than . . . becoming more true to who we are (John Winslade, 2009, p. 343).

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utually supportive intimate relationships have the potential to heal old wounds and promote health and resilience (Huenergardt & Knudson-Martin, 2009; Johnson, 2005; Jordan, 2009). Although what constitutes mutual support may vary
Counseling & Family Sciences, Loma Linda University, Loa Linda, CA.

Correspondence concerning this article should be addressed to Carmen Knudson-Martin, Counseling & Family Sciences, Loma Linda University, Griggs Hall, Loma Linda, CA 92350. E-mail: cknudsonmartin@llu.edu 369

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somewhat from relationship to relationship, the ideal is salient across cultural contexts (Moghadam, Knudson-Martin, & Mahoney, 2009). Current research suggests that mutual inuence and emotional engagement are particularly important (Atkinson, 2005; Gottman, Coan, Carrere, & Swanson, 1998; Johnson, 2003). However, gender imbalances in the giving and receiving of support in heterosexual relationships tend to be masked (Hare-Mustin, 1991; Knudson-Martin & Mahoney, 2009), and cultural examples of how to actually achieve mutuality are limited (Gerson, 2010). Although gender disparities make mutual inuence and engagement difcult, most approaches to couple therapy do not directly address them, perhaps because doing so requires conceptualizing emotion and relationship processses as part of the larger societal context. For the past several years we have been involved in a clinical project to clarify a practice model for addressing gender and power issues in couple therapy. SocioEmotional Relationship Therapy (SERT) is the outcome of this work. While most approaches to therapy require adaptations or add-ons in order to be culturally relevant and socially just (Aldarondo, 2007; Falicov, 2009; McGoldrick, 1998), we explicitly place a model of relationship equality at the center of therapy. Therapists respond differently to each partner, depending on their power positions in society and in the relationship. We believe that transforming gendered power is an important fulcrum around which other clinical change depends (e.g., Huenergardt & Knudson-Martin, 2009). Two other concepts help us begin with and maintain a cultural focus. The rst is the notion of socio-cultural attunement. Just as family therapists look at an individual and see a web of relationships, SERT therapists look at individuals and see socio-cultural persons. Our rst goal is to tune into each client such that we are able to resonate with that persons socio-cultural experience on an affective level. Our understanding of attunement is informed by Siegel (2007), who conceives of it as feeling felt. Attunement goes beyond understanding to opening oneself to anothers emotional experience. Our intentional focus on socio-cultural experience is consistent with Siegel, but expands the lens to explicitly bring forward the larger context. The second important concept from a socio-cultural perspective is the idea of discourse. Socio-cultural discourses are shared ways that members of a social community talk and think. They give contextual meaning to experience (Krolokke & Sorensen, 2006) and are an important link between an individual and the larger society. In any given situation cultural discourses suggest appropriate action and tell us what to feel. Thus, as clients tell us their personal stories, we listen for the socio-cultural discourses embedded within them. Identifying these frameworks helps us understand the sociocultural basis and emotional salience of issues and events. We use the term discourse to distinguish societal meaning from the personal. Focusing on discourse rather than individual traits, personality, or pathology helps maintain a socio-cultural perspective. The notion of discourse is also associated with a uid view of culture that makes cultural change both possible and inevitable. Because everyone draws upon multiple socio-cultural narratives, including implicit ones that have not been realized, alternative options are embedded in client stories (Carey, Walther, & Russell, 2009; Winslade, 2009). The idea of relationship equality is a common, unrealized sociocultural ideal. We have also been inuenced by recent work that suggests that emotional engagement is critical to clinical change (e.g., Fishbane, 2007; Fosha, 2009). SERT
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brings an emotional component to narrative and critical therapies. It builds relational connection between partners as a way of transforming socially constructed power disparities. SERT thus extends current thought in both social constructionism and socio-biology to offer an approach that uniquely works at their juncture. The purpose of this paper is to describe the conceptual framework guiding the SERT approach and demonstrate how therapists can address the intersection of societal and relational processes in couple therapy. The model of equality at the core of the therapy is applicable to diverse relationship forms and contexts; however, working from it is especially helpful in making visible implicit patriarchal discourse in heterosexual relationships. Although power processes in couple relationships involve the intersection of many bases of power, the illustrations in this paper highlight gendered power. Heterosexual power disparities limit the equal ow of mutual attention in relationships, but are frequently taken for granted or overlooked (Hare-Mustin, 1991; Knudson-Martin & Mahoney, 2009).

SOCIO-CULTURAL DISCOURSE FRAMES EXPERIENCE

Rather than focusing on the clients inner self, SERT therapists rst draw their attention outward, seeking to identify the societal discourses that provide the context for emotion. When Arthur and Bella1 came to us because his out-of-the-blue bouts of rage were distressing the relationship, we considered his emotional reactions as reections of his societal context, as social processes realized on the site of the personal (Gergen, 2009, p. 210). We look for markers of larger social context within the clients stories. The therapist draws on knowledge of institutional societal and cultural patterns such as gendered power structures and ideals for masculinity and femininity that touch all peoples lives in a particular society to some extent, and then explores the unique personal experience of the client around these. We focus especially on discourses that guide how people orient themselves to others (Silverstein, Bass, Tuttle, KnudsonMartin, & Huenergardt, 2006). We listen for and reect back messages about independence and connection, position and hierarchy, sources of personal worth and value, expectations about roles and decision-making, and the meaning of accommodating and attending to others. As Arthur described an incident in which he exploded at an airline ticket agent trying to help his family rearrange their ights, we listened for the social discourses he drew from to explain what happened. He spoke of the discomfort his family was feeling and his expectation that the trip he had planned for them would be good. Thinking of his words as reections of the larger context, we were interested in the role he saw for himself: It sounds like you felt responsible for how the trip turned out. Embedded in Arthurs story was an image of him in charge, the one who is supposed to make everything right. As we probed his experience, we sought to attune ourselves to his understanding of himself as a man whose identity and worth were demonstrated in his ability to enact cultural expectations of male competence and leadership: It was upsetting to let your family down in this way. You must have felt incompetent, like a failure.
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All client names and identifying information have been modied to protect anonymity.

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Emotion Flows from Social Identity

From a social constructionist perspective, identity is the way one recognizes self in relation to larger societal patterns of meaning (Gergen, 2009; Rusovick, 2009; Sarbin, 2001). It is a uid and on-going process in which people assemble personal identities out of storylines derived from a variety of larger discourses and put them together in idiosyncratic ways (Gee, 2005). Personal identity is thus inseparable from larger collective understandings (Blume, 2010). Feelings of personal worth and emotional expression ow from these identity constructions. The emotional salience of a situation or interpersonal event is intricately linked to whether or not ones identity is conrmed in the transaction (Sarbin, 2001). Arthur knew himself within cultural messages regarding his role as leader of the family and as the designated interface between them and the world. As a Filipino he was also sensitive to his position in North American society. His rage arose in the context of his inability to fulll his family role and the affront to his sense of competence this failure represented. By focusing on the socio-cultural context of Arthurs experience, we were able to attune to his overwhelmingFbut previously unspokenFsense of incompetence, which allowed him to feel supported and understood in the therapy. As social constructionists we also keep a consistent focus on what is taken-forgranted in partners descriptions of their day-to-day experience and what other possibilities are absent but implicit (Carey et al., 2009). For example, the idea that Arthur must competently represent the family superseded his desire for connection with Bella and other family members. Once he follows the line of ight (Winslade, 2009) directed by the competence discourse, his actions and responses align with it, and miss the mark when it comes to the other more relational options potentially present in his account. Community members, family, and intimate partners actively participate in the ongoing processes of identity creation (Blume, 2010). Family of origin experiences, trauma or abuse, and other important life history thus inform which socio-cultural discourses are meaningful and how they are assembled into personal identity narratives. For example, when we reected to Bella that it seems important to maintain your sense of self in this marriage, she described losing herself in her abusive rst marriage. She said that she discovered her self in the 4 years she was single. When we asked, how does Arthur recognize your independent self ? she responded that she was not certain her new self could be maintained in the marriage. We framed her identity dilemma as a socio-cultural one, a choice between old constructions of women as vulnerable and an evolving possibility of female independence within a mutually supportive intimate relationship: Given your experience that its not safe for women to be vulnerable in relationships with men, it must be hard to trust that a man could respect your independence.

Social Discourse Defines Personal Worth

One important consequence of societal gender processes is the disparate impact on how partners validate each others worth. When afrmation and validation is mutual, the relationship supports the well-being of each partner (Sirkin, 2010). When one partner is dominant, that partner becomes the focus in the relationship and the less powerful is made responsible to soothe his emotion and attend to his needs (Silverstein et al., 2006). Historical gender models imply that men have more value than
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women, and these inuence privilege and what is focused on within relationships. Empowering couples to create a context that validates the worth of each partner is an important ethical principle guiding SERT. For example, Sam called for an appointment to address his concerns regarding his wife Angelas drinking. Sam was successful in his work, and this validated his worth both in the larger Anglo-American culture and within the marriage. Angela gave him considerable credit for this and accepted the blame as the problem. In contrast, Angela felt that she was not important in the relationship, that she was expected to sacrice her personal interests for Sam and their young children. When drinking with friends (the only context in which she drank), she felt freed from these constraints and able to experience her personal vitality and cultural belonging with her Latina friends.

Multiple Cultural Discourses Create Options

Sam and Angela each drew upon multiple socio-cultural possibilities to dene themselves and their positions within the relationship. Sam believed that he should make accommodations to satisfy his partner, yet felt weak if he did. Angela was hurt that Sam did not attend to her needs, but ashamed to express anger because she was expected to be nurturing or understanding. Each available socio-cultural theme for masculinity and femininity carries with it different life consequences and perceptions of options (Winslade, 2009). If Sam follows relationship mutuality and attends to Angelas needs and accommodates them, she will feel more value as a person. But it is not as simple as picking this possibility or that. Larger forces constrain choices and tend to ossify institutional dominance patterns (Almeida, Dolan-Del Vecchio, & Parker, 2008; Winslade, 2009). Thus we look to see which discourse is given priority and which is ignored. In the case of Angela and Sam, the historical pattern assigning women responsibility for the relationship was primary. Angela was vulnerable to any judgment that she was not holding up her end in the relationship and was therefore willing to carry all the blame. They did not discuss Sams responsibility to the relationship. SERT therapists challenge this socio-cultural pattern by inviting Sam to share responsibility for the relationship. Because virtually every culture is in a process of transition, especially regarding what is expected of women and men, couple relationships reect socio-cultural contradictions and tensions (Falicov, 1995). As a Mexican-American woman, Angela is caught between cultural models of female sacrice and emerging cultural models of female entitlement. Sam is unsure if he can focus on Angela and still feel like a man. The question is not whether they will follow cultural models; it is which ones foster their mutual well-being and how they will enact them.

Power and Ethics in Socio-Cultural Process

Dominance processes are an important aspect of the relational interactions creating emotional bonds (Greenberg & Goldman, 2008). Angela does not have equal capacity to inuence creation of a relationship that supports her long-term well-being. She might be able to stop drinking and reduce the conict in the marriage, but as long as Sam holds little sense of responsibility for the relationship his needs are likely to take priority. The processes through which some possible discourses are silenced and others are supported are thus inherently ethical (McCarthy, 2001). Some promote mutual support; others hinder emotional engagement and mutual inuence. Clients
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and their therapists are faced with an on-going series of ethical choices regarding what is privileged and what other possibilities are not made visible. Therefore the SERT approach is not neutral. Therapists empower couples by intentionally and systematically framing our contribution to the clinical process to maximize the conditions that transform power positions and support shared relational responsibility (Lannamann, 1999; McNamee & Gergen, 1999). This ethical position also demands that therapy not replicate larger patterns of power in the dominant culture (e.g., Almeida et al., 2008). We want couples to experience new ways of relating and knowing each other in the here and now of therapy, both in the ways that therapists relate to each partner and in how partners relate to each other (Guilfoyle, 2009). Therapy must invite Sam to initiate relational options that enable the couple to experience shared power and Angelas personal worth. In so doing, the powerful person shifts to a more relational position involving openness to be affected by the other and reciprocal relationship responsibility (Fishbane, 2003; Lannamann, 1999). In contrast to narrative models that focus on language as the lever of change, we address the social construction of emotion and its experiential role in couple interaction.

EMOTION LINKS THE PERSONAL AND SOCIETAL

Emotions arise within a particular social context and engage the neural system (Porges, 2009; Sarbin, 2001). They are the interface between the individual and the outside world, making socio-cultural experience manifest at the physiological level (Trevarthen, 2009). Emotional resonance marks the link between self and larger contextual realities and makes possible communicating a shared relational experience. The brain is intuitively social, even before the linguistic (Trevarthen, 2009, p. 57). It is designed to evaluate prospects of action emotionally. Meaning is cocreated as we affectively situate ourselves in relation to the emotional communication of others and our sense of how we t (Tronick, 2009). Recognition of socio-emotional experienceFfor good or badFstimulates neural activation and growth (Siegel, 2010). Previous neural pathways become even more deeply ingrained, or if the experience is new, alternative neural connections begin to develop. In this way, socio-emotional experience becomes neurologically embodied. This suggests that therapy needs to access this socio-emotional system.

Therapy Activates Social Engagement System

When Damon and Ellie, both Anglo-American university students, sought therapy to help them deal with relational stress, we began by tuning into the emotion underlying the socio-cultural discourses in their account. Ellie described a situation in which Damon responded to a request from his aunt (with whom they were living) by simply getting up and leaving the room. To understand Damons experience we asked him to describe what dealing with his aunt was like for him. He attributed his response to his nature as a geek who did not have people skills. Within this popular socio-cultural image, geeks are smart but excused from relational responsibility. Damon explained his identity position matter-of-factly, with little sense of his impact upon others. But as we probed the emotion accompanying his experienceFFeeling like you have no people skills must make it hard to deal with
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othersFwe were able to attune not only with his feelings of helplessness and panic in the face of interpersonal conict, but also his pain and sadness regarding his relational disconnection. Emotions inform action of the self and are coupled with, but not caused by, autonomic nervous system responses (Trevarthen, 2009, p. 61). Damons emotional recognition of his self as not a people person was accompanied by emotion directing him to keep his distance from relational stress. As Damon began to access these feelings and make them interpersonally available, he became involved in what Porges (2009) calls the social engagement system. In this relational space social interaction involves concurrent visceral experiences and neuroanatomic communication that mutually impact neural regulation and physiologic states. According to Porges, this system is designed to reduce psychological distance and promote safety between people. The geek socio-cultural characterization did not facilitate Damons social engagement and left Ellie carrying the relational ball. To deal with the many stresses they faced she needed Damon to attune to her and others (Siegel, 2007). Having rst supported Damon by understanding his relational anxiety as a geek, we now invited him to focus on Ellie. We asked him what he thought it was like for her to be left to smooth things over with his aunt. In asking Damon to engage empathically with Ellie (rather than asking her to tell him) we directly confronted the societal message that geeks had no people skills and counteracted the power imbalance that left relational responsibility up to her. As Damon intentionally considered Ellies experience, we witnessed the ash of recognition between them as he experienced her sense of unfairness and abandonment. The experience of knowing and being known by the other is at the heart of intimate interaction (Weingarten, 1991, p. 295). This experience of shared meaning was new to Damon and Ellie. It involved shared emotional recognition as one neural system touched the other. This experience of emotional ttedness (Fosha, 2009, p. 179) is an important element in the change process. However, the on-going intersubjective experience of coconstructed affect cannot be based on unequal power positions (Hughes, 2009; Weingarten, 1991). Therapy must create the conditions that invite mutual support and safety.

CREATING CONDITIONS THAT INVITE MUTUAL SUPPORT

Considerable current socio-cultural conversation about couples implies or assumes an innate equality between partners that masks gender imbalances in power (Deetz & White, 1999; Mazanec & Duck, 1999). Couples speak of shared decisions, give and take, or being there for each other (Knudson-Martin & Mahoney, 1998). But what these mean in daily life are seldom well developed (Coontz, 2005; Gerson, 2010). Instead, an unintended gender legacy continues to shape heterosexual couple interaction such that women are more likely to orient toward relationship maintenance and men toward autonomy (Knudson-Martin & Mahoney, 2009; Silverstein et al., 2006). When this is the case, partners do not approach relational processes from equal positions (Lannamann, 1999; Mazanec & Duck, 1999). Changing the way partners orient to each other creates the potential to catalyze new relational possibilities (McNamee & Gergen, 1999; Silverstein et al., 2006). The question is how to begin (Mazanec & Duck, 1999). If partners are on unequal footing, how do we engage them in a process that supports mutuality?
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Interrupt the Flow of Power

In the socio-emotional approach therapists must recognize unequal relationship patterns and position their responses to interrupt the usual ow of power. Therapists must resist cultural messages that place relationship responsibility and vulnerability on women and, instead, encourage powerful male partners to initiate relational connection. Recall that Damon was asked to consider Ellies perspective as a way to engage him relationally. When Damon successfully empathized with her predicament, we asked Ellie what it was like to have Damon understand her. As she described her sense of relief that she was not alone, her demeanor visibly calmed. Since the goal was to shift the power dynamic, we asked Damon what it was like to be aware of his impact on her. In response he began describing new awareness of his responsibility toward Ellie. The key was inviting Damon to orient toward her and resisting the temptation to move too quickly to also direct Ellie to empathize back with him. This will of course eventually be important, but we rst wanted Damon to experience the effect of taking a relational orientation.

Orient PartnersToward Mutuality

While each couple will dene for themselves the particular ways mutuality is actualized, therapists and couples need guidelines that help position clients toward relationship. Our responses to Damon and Ellie were guided by attention to four conditions that help us orient partners to each other: mutual inuence, mutual vulnerability, mutual attunement, and shared relational responsibility. We tell couples that these constitute the circle of care. Mutual inuence In a mutual relationship inuence is reciprocal. The most relevant kind of inuence is validation of ones worth; that ones needs are important to the other (Greenberg & Goldman, 2008). Thus the ability to inuence ones partner to respond is a key element of supportive validation. It also means that mutually supportive partners are attentive, observant, and interested in the other. They are open to being changed by the other and willing to accommodate. If power is equal both partners are likely to use direct inuence strategies; when it is not, the less powerful person will use indirect strategies to inuence partner behavior (Steil, 1997). Inuence patterns can become automatic as one partner anticipates the needs of another. When mutual, this is validating for both partners; however, if one partner is oriented toward autonomy and the other is oriented to the relationship, an imbalance in inuence is the likely outcome. Although Damon did not seek to directly dominate Ellie and did not act or appear overtly powerful, his lack of relational focus had a great impact on Ellie and made it difcult for her to inuence him. Shared vulnerability Unequal power positions and stereotypic gender socialization can make the vulnerability inherent in intimacy difcult. The powerful person may fear appearing weak or letting his guard down. The less powerful person may hold back out of a need for self-protection and fear that her needs will not be acknowledged. It is important to
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address vulnerability issues in a way that builds connection rather than reinforcing distance and power positions (Scheinkman & Fishbane, 2004). The most powerful person must take the lead in moving toward a more vulnerable position. Partners with a history of abuse or other trauma may especially need a partner willing and able to create a safe place for experiencing vulnerability (Johnson, 2005). They need a nonjudgmental steady companion willing to be touched by what is brought forth (Weingarten, 2003, p. 197). When Damon expressed his vulnerability rather than retreating into separateness, Ellie felt less vulnerable and safer in the relationship. While this shift in the expression of vulnerability is a necessary step in creating mutual support, it often takes time before the person in the one-down positionFusually the female in heterosexual relationshipsFfeels safe to risk the reciprocal vulnerability inherent in increased connection. Shared relational responsibility Sustaining relational trust implies several kinds of responsibility. First is responsibility for the well-being of the partner, to honor their unique experience, act on their behalf, and to make it safe to be vulnerable. Second is to bring oneself fully into the relationship, to risk emotional engagement, including the risk to raise things that are troubling. Third is responsibility for the relationship itself, to direct ones energy toward relationship maintenance and creating an environment that builds the relational bond. Here fairness is not simply quid pro quo, that is, I do something for you and you do something for me. Rather it arises out of attunement to and concern for the relationship as a whole. As noted earlier, socio-cultural processes tend not to support mutual relational responsibility. We tell couples that it is our ethical position to work with them to create relationships that equally support both partners. We assist distant, powerful partners to experience accountability for their effect on their partners. This helps create a sense of relational justice (e.g., Boszormenyi-Nagy & Krasner, 1986; DolanDel Vecchio, 2008). Our decision to rst place relational responsibility on Damon was an ethical choice point based on this stance. Damons experience was common. When he began to tune into Ellies experience he felt an ethical responsibility toward actions that would promote her welfare. Mutual attunement Siegel (2007) reports that attunement only happens when people have the intention to experience the other. When we intentionally empathically resonate with another our limbic systems and bodily states change to match the other. Oxytocin, a hormone related to social bonding, is released. However, the more powerful person is typically less motivated to attune and make the accommodations that follow this intimate knowledge of the other. The SERT approach assumes that men as well as women can attune and facilitates relational processes that challenge gender stereotypes and empower each partner to empathically imagine the others experience such that they feel felt and are mutually changed by that resonance. In so doing, we are sensitive to the tendency of more relationally oriented persons to give up their interests when they attune to their partners. Thus, since Ellie appeared moved by Damon when he expressed his feelings of disconnection, we took care to encourage him to tune into her and consciously
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avoided following the taken-for-granted gender script that she should then take on additional responsibility for his emotional state. Experiencing mutual attunement at the neural level is a critical aspect of creating shared relational experience through which partners redene themselves and their relationships. Damon began to consciously revise his story of himself in a way that oriented him to Ellie and signicant others in their lives and encouraged him to intentionally develop his people skills. Ellie began to envision herself with a partner in dealing with their stresses. The couple was able to dene what shared relational responsibility and mutual inuence looked like for them and to start experiencing it embodied in their relationship. This focus on emotion as a core element of the social construction process is what distinguishes the SERT approach.

CASE PROGRESSION: JOELLEN AND MICHAEL

Like narrative therapy (White & Epston, 1990) and the cultural context model (Almeida et al., 2008), SERT therapists position themselves to help make the consequences of larger social discourse visible in intimate relationships and empower couples to create just, mutually supportive relationships. However, the source of empowerment in the socio-emotional approach is new relational experience that makes possible and embodies alternative discourse neurologically and physically. The progression through which this is accomplished is presented in Figure 1. The sequence is additive in that each new step must continue to incorporate elements of the previous steps. The case of JoEllen and Michael highlights key elements of the SERT process. This mixed race couple in their mid-30s sought therapy in their third year of marriage because JoEllen was distressed by Michaels obsession with the bodies of other women. Rather than focusing on this symptom, we primarily addressed his socio-cultural experience as a Black man and the inequality in vulnerability in their relationship.

Step 1: Create a Mutually Supportive Context

During the initial consent process we told JoEllen and Michael that we believe relationships need to mutually support each partner and that we expect both partners to take active responsibility for their relationship. They readily agreed. We introduced ideas of mutual inuence, mutual vulnerability, mutual attunement, and shared relational responsibility into the early conversation. For example, when JoEllen reported that she had been married before, we asked how equal that relationship had been. When she said that her former spouse regularly degraded and abused her, we asked Michael if he was aware that she was more vulnerable than he. Mindful of her limited socio-cultural power, we took special care to validate JoEllens concerns. Although we also needed to validate Michael, we intentionally engaged him from the outset in understanding and acknowledging that his actions affected her.

Step 2: Demonstrate Socio-Emotional Attunement

Before we could work further with the relationship, we needed to get each partners socio-cultural experience. Each needed to feel felt. We asked Michael, a successful businessman, what it was like being a Black man working in a White world. He poignantly described learning as a young man to shine it on, to smile and placate. He felt that to be successful he had to t someone elses image. As we listened to
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GOAL: CREATE NEW RELATIONAL EXPERIENCE THAT EQUALLY SUPPORTS EACH PARTNER 1. Create a mutually supportive context Introduce framework of mutual support into early therapeutic conversation, particularly as it relates to each partners hope for the outcome of therapy. Position therapist in relation to power differences between partners
(i.e., invite silenced voices into the conversation; avoid colluding with powerful partners entitlement to define the problem; ask questions that create awareness of equality issues)

2. Demonstrate socio-emotional attunement with each partner Identify relevant social contexts and emotionally salient discourses Therapist intentionally opens self to client experience Each partner feels understood as a cultural person and safe to engage 3. Collaboratively assess to create a new relational frame for addressing client issues Identify how socio-cultural discourses are demonstrated and reinforced within the relationship. Explore interactional power processes, gender markers and prescribed roles and identities
(See Relational Assessment Guide, Silverstein et al., 2006)

Reach agreement with clients regarding specific relational changes that the therapy will address.

4. Make the social context real with personal consequences Taken for granted assumptions are made visible, discussed, and questioned Name power issues Experience the reality and implications of power differences Collaboratively craft on-going experimentation directed toward balancing power differences between sessions 5. Envision new relational possibilities Explore unscripted egalitarian ideals Operationalize what equality/mutuality means to the couple Explore application of personal definitions in day-to-day circumstances 6. Deepen relational experience Facilitate ability of the couple to genuinely engage with difficult issues Facilitate mutual experience of connection around areas of vulnerability Foster accountability that overcomes gender stereotypes Promote shared responsibility for relationship maintenance and each partners wellbeing 7. Maintain new, egalitarian relational model Solidify new relational experience and maintain it as future issues arise Integrate newly constructed socio-emotional discourse into social networks and be prepared to consciously confront institutionalized discourse patterns

FIGURE 1. Socio-emotional relationship therapy case progression

understand, tears rolled down his face and he said he did not realize how deeply this had affected him. This began to shift the balance of vulnerability between Michael and JoEllen.

Step 3: Assess to Create a New Relational Frame

Assessment was collaborative. It involved identifying how socio-cultural discourses were demonstrated and reinforced in the relationship and how power processes played
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out between the partners. We asked Michael how he thought cultural messages to keep his distance affected his relationship with JoEllen. He said that he acted the same way with her. Despite JoEllens history of abuse, both said that she readily engaged with him, creating a typically gendered power imbalance. We discussed this imbalance. All agreed that the goal of therapy was to help Michael to become more present in the relationship and that this would stretch JoEllen as well.

Step 4: Make Social Context Real with Personal Consequences

The next sessions focused on recognizing and naming power processes as the couple engaged with each other. For example, when Michael smiled and said Yes, OK to a concern raised by JoEllen, we asked her what his response was like for her. She said it felt dismissive. Exploration of this experience in the here and now helped to make real the way Michaels socio-cultural-based pattern of relating left JoEllen feeling not valued, even though he was friendly on the surface.

Step 5: Envision New Relational Possibilities

We discussed what mutual engagement would look like for them. The couple began to develop an image of mutual connection that they used to evaluate their progress. For example, when we asked about their interaction over the week, Michael said that they had felt mutual connection for a while and then he noticed himself distancing. JoEllen added that she had felt really valued because he took initiative in making conversation.

Step 6: Deepen Relational Experience

In the seventh session we noticed that JoEllen seemed less guarded. She reported that although she still needed time to trust that the changes were real, she felt safer. At this point we began to engage the couple in more difcult conversations about topics they had been avoiding or which made them vulnerable. A key turning point was when Michael was able to share his fears that she would reject him. They were able to speak directly about how his focus on womens bodies had affected each of them. (He had stopped the behavior after only a few sessions.)

Step 7: Maintain New, Egalitarian Relational Model

Final sessions focused on solidifying their new relational experience. Michael reported that he was speaking up to men at work about how he was learning to be more relational. The behind-the-mirror therapy team came inside a session to share their own experiences dealing with socio-cultural messages for women, men, and intimacy. The couple made plans for what they would do when new issues came up. After a months break, they returned for a 12th session to review how their mutuality was progressing. We discussed how Michael could nd support for his new relational understanding of masculinity among the men in his community and how they were better able to engage with JoEllens family. As JoEllen and Michael continue to deepen and solidify their shared new experience, their core biology is changed and they help build alternative socio-cultural images for men and women. Therapy is thus a site of social, as well as personal, transformation.
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THERAPYAS SOCIAL INTERVENTION

Conceptualizing therapy as social intervention challenges several taken-for-granted ideas about clinical practice. Firstly, therapists need to expand their lens outward, to look at an individual and see enactments of socio-cultural discourse. This is counter to the individualistic models perpetuated by Western culture and also stretches family therapists to look rst beyond the family. This challenge to individualism can initially be very difcult and abstract. Recognizing the bridge between socio-cultural discourse and emotion helps make the contextual real and accessible. Secondly, the SERT approach is organized around a model of relationship that overtly focuses on mutual support. Although the elements of mutuality are not new to couple therapy, working explicitly from a model of equality challenges implicit power differences, especially taken-for-granted gender differences that tend to be overlooked when partners are each addressed in the same way, as though they are equal (as in much relational focused therapy). SERT therapists provide in-session leadership that interrupts socio-cultural-based inequality. We believe that neutrality in a notneutral world reinforces existing power differences and limits what is possible (Knudson-Martin, 1997). Therapists take responsibility for leading a clinical process that makes alternatives visible to couples and facilitates the relational conditions that promote mutuality. Each couple determines how this will look in their relationship. Our ethical position regarding support for each partner is consistent with the virtually universal norm of reciprocity in human relationships. Third, the socio-emotional approach rests on the notion that all persons benet from and are capable of relational connection. This challenges dominant stereotypes about women and men, and clinical success frequently rests on the ability to effectively engage powerful men and help them experience new ways to address their needs and be available to their partners. Managing the tension between making it safe for them to participate, yet not validating them at the expense of their partners is one of the key skills in working with power inequities. Socio-emotional attunement to their experience must be followed with a challenge to their dominant position and an invitation to tune into their partners. Finally, societal ideas regarding equality are usually grounded in notions of individual rights. But what is needed are partnerships based on equal commitment and responsibility for maintaining the relationship. This can be a huge challenge to the powerful socio-cultural identity constructions that women and men are confronted with nearly all the time. Mutual relational engagement is the method through which couples resist these inuences and begin to transform social injustices. Working at the nexus of social discourse and emotion, SERT therapists see and unravel these power inequities supported in our culture.

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