Transcript Initial Assessment Process

Treating Affair Couples:
An Integrative Approach
Kristina Coop Gordon
University of Tennessee
In collaboration with:
Donald H. Baucom
University of North Carolina
Douglas K. Snyder
Texas A&M University
Why Study Affairs?
Lifetime occurrence in oldest cohort: 37%
men; 19% women (Laumann et al., 1994)
40% of divorced men/44% of divorced
women report extramarital sexual contact
during marriage
2nd leading cause of divorce for women and
3rd leading cause for men (Janus & Janus,
1993)
Therapists report as 3rd most difficult issue to
treat (Whisman, Dixon, & Johnson, 1997)
What Is An Affair?
Physical non-monogamy: Occurs along a
continuum of physical involvement
Emotional non-monogamy: Characterized
by emotional intimacy, secrecy, or sexual
chemistry
Betrayal: Violation of relational standard
(implicit or explicit) regarding physical or
emotional exclusivity
Infidelity: A Trauma Perspective
Violation of important standards or
assumptions about the world or relationship
(safety, commitment, trust, well-being of the
individual) (Janoff-Bulman, 1992)
Post Traumatic Stress Disorder (PTSD)
– Recurrent, intrusive, and distressing
thoughts
– Avoidance of activities, places, or persons
associated with the trauma
– Increased arousal (disturbances in sleep
and concentration; hypervigilance)
Characteristics of Successful Process
Gaining a fuller and balanced
understanding of event
Not remaining preoccupied with the
traumatic events
Giving up the right to continuously
punish the person who has “wronged”
you
Deciding whether to maintain or
terminate the relationship
Overview of Stage I: Absorbing the Blow
A Thoughts
Assumptions about partner/self/relationship disrupted
Extreme, negative attributions
Perceptions of loss of control in the relationship
B Emotions
Strong, overwhelming emotions such as anger,
depression, and anxiety
May change daily or hourly
C Behaviors
Strong need to question partner about his/her behavior e.g., Why did he/she do it? What was he/she thinking?
Refuge -- or acts of revenge
Overview of Stage II: Giving Meaning
A Thoughts
Gain a deeper understanding of what contributed to the
affair and subsequent reactions
Explanations for the affair may change
B Emotions
Intensity decreases
Control increases
Affected by changing explanations of the affair and
response
C Behaviors
Retributions by injured partner diminish
Restitution by participating partner may continue
Vacillations between retreat vs. engagement
Overview of Stage III: Moving Forward
A Thoughts
More realistic perceptions of partner/self/relationship
More realistic expectations for the future
B Emotions
May experience compassion for partner and ability to
wish her/him well
Regain a sense of emotional safety which allows you to
give up some of the anger and anxiety
C Behaviors
Relinquish the right to punish partner further
Decision about future of the relationship
Enacting the actions needed to improve the
relationship or to terminate it
Preliminary Outcome Findings
How does this intervention impact:
– Symptoms of trauma and related
individual distress?
– Empathy and assumptions about one’s
partner?
– Relationship distress and commitment?
Study Method
Participants: Six married couples having had
sexual affair in past year; not ongoing
Excluded based on psychoticism, alcohol
abuse, borderline personality disorder,
antisocial personality disorder
Recruited based on television stories,
radio interviews, newspaper ads
PTSD Symptoms
20
18
16
14
12
IP
10
PP
8
6
4
2
0
Pre-Tx
Post-Tx
Beck Depression Inventory
16
14
12
10
8
IP
6
PP
4
2
0
Pre-Tx
Post-Tx
State - Anger
18
17
16
15
IP
PP
14
13
12
11
10
Pre-Tx
Mid 1
Mid 2
Post-Tx
Negative Assumptions About
Partner
18
16
14
12
10
IP
PP
8
6
4
2
0
Pre-Tx
Mid 1
Mid 2
Post-Tx
Empathy
40
38
36
34
32
IP
PP
30
28
26
24
22
20
Pre-Tx
Mid 1
Mid 2
Post-Tx
Global Forgiveness
5
4.5
4
3.5
3
IP
2.5
2
1.5
1
0.5
0
Pre-Tx
Mid 1
Mid 2
Post-Tx
Follow-Up
Global Distress (MSI-R)
70
68
66
64
IP
62
PP
60
58
56
Pre-Tx
Mid 1
Mid 2
Post-Tx Follow-Up
Global Commitment
94
92
90
88
86
IP
84
PP
82
80
78
76
74
Pre-Tx
Post-Tx
Treatment Success
Injured partners’ forgiveness levels increased
overall; their global marital distress and
symptoms of individual distress decreased.
Across the four treatment periods, injured
partners reported decreases in negative
assumptions about their partners, consistent
with predictions based on a forgiveness model.
Over time, injured partners reported less
withdrawal from their partners.
Initial Assessment Process
Interview both partners together
Interview each partner separately
– Injured partner
– Participating partner
Provide initial tentative formulation to
both partners together
Goals of the Initial Interview
Establish an atmosphere of safety
Establish an atmosphere of trust
Establish an atmosphere of competence
– Expertise regarding affairs and recovery
process
Prepare for subsequent sessions
Domains of the Initial Interview
Brief marital history
Current marital functioning
Individual functioning (screening only)
Immediate decisions and subjective
timeline
Crisis containment
Domains of the Initial Interview
Current marital functioning
Content and regulation of marital affect
Conflict engagement and level of containment
Intramarital boundaries
Extramarital boundaries
Domains of the Initial Interview
Immediate decisions and subjective
timeline
Whose decision to pursue couple therapy
Initial goals of couple therapy
– Containment of negative exchanges
– Evaluate potential for restoration
– Work toward reconciliation
Beliefs about recovery process
– How recoverable? How long? By what process?
Domains of the Initial Interview
Contain immediate crises
Verbal or physical aggression
Immediate decisions regarding
boundaries
Immediate self-care needs
Goals of Individual Interviews
Strengthen therapeutic alliances
Provide opportunity for self-disclosures
Obtain additional information:
– Individual and marital histories
– Current understanding of affair and
recovery
– Current individual functioning and needs
Individual crisis intervention and support
Domains of Individual Interviews
Understanding of affair and recovery process
Beliefs about why the affair occurred
Expectancies regarding a recurrence
Attributions regarding affair:
– Own behavior prior to and following disclosure
– Partner’s behavior prior to and following disclosure
Expectancies regarding potential for recovery
– Partners’ responsibilities in recovery process
Domains of Individual Interviews
Follow-up on individual functioning
Affect: Content, intensity, lability
Cognitions: Content, intensity,
consistency
Coping strategies:
– Intrapersonal
– Interpersonal
Additional attention to flashbacks
Individual crisis intervention and support
Goals of Follow-Up Interview
Provide tentative formulation based on:
Marital history: Attachment and conflict
Situational stressors
Individual histories:
– Potential vulnerabilities prior to the affair
– Individual challenges following disclosure of affair
– Resources for coping and recovering from affair
Summary of immediate challenges
Summary of overall strategy and next phase
Treatment Goals for Stage I
Re-establish some form of “equilibrium” for
the couple and individuals
– Minimize emotional upset and dysregulation
– Establish behavioral routines
Minimize additional damage to either
individual or the couple– “damage control”
– Minimize hurtful behaviors between the
partners
– Minimize either partner creating problems with
the outside world
Treatment Strategies for Stage I
Re-establishing equilibrium
Couple
– Set boundaries regarding 3rd person
– Decide on new behavioral patterns (e.g.,
who sleeps where)
– Discuss impact of affair
Individual
– Deal with flashback-type phenomena
– Use self-care strategies (e.g., exercise,
diet, prayer, minimizing sexuallytransmitted diseases)
Flashback Guidelines
Clarify whether emotional upset is due to
something currently upsetting or re-experiencing
feelings from past
Let your partner know what is happening (e.g.,
driving by the hotel triggered old feelings)
Let your partner know what you need at present
(e.g., being held; being left alone; talking about it)
Balance how much you talk with partner about
flashbacks with other ways to handle on your own
Treatment Strategies for Stage I
Minimizing additional damage
Between partners
– Problem-solve on issues such as physical
violence or saying hurtful things
– Discuss limits of what to discuss about
affair (e.g., details of sexual behavior)
Between couple and outside world
– Discuss limits of what to tell other people
Discussing Impact of the Affair
What assumptions have been violated about
who your partner is and what to expect from
your relationship?
What standards for your marriage (how
partners should behave) have been violated?
What does the affair mean about your
partner, the relationship, and you?
What emotions are you experiencing, and
what ideas go with those feelings?
Given these thoughts and feelings, what
behaviors have changed or have been
disrupted?
Brian and Angela – Summary
Brian 29, injured partner; Angela 26,
participating partner
Married 6 years; sons ages 3 and 1
Affair – two months’ duration.
Marital history and shared work history.
Individual histories:
– Angela: Adopted, mother died age 18
– Brian: Oldest of 3 siblings; college drop-out
Treatment Goals for Stage II
Identify factors that potentially contributed
to “vulnerability” or “risk” of affair
For injured partner: Restore predictability
and soften view of participating partner
For participating partner: Expand
explanatory context while promoting
responsibility for decision
Prepare groundwork for additional change
Treatment Strategies for Stage II
Present rationale
– Potential benefits and risks of doing this
Examine potential factors successively
– Relationship factors
– Stressors from outside the marriage
– Individual susceptibilities or contributions
Participating partner
Injured partner
Develop shared, comprehensive formulation
Rationale for Exploring Context
For injured partner
– Restores predictability
– Potentially “softens” view of participating partner
– Contributes to appropriate self-view
For participating partner
– Broadens explanations for hurtful behavior
– Contributes to appropriate self-view
For couple
– May facilitate collaborative efforts at addressing
marital and outside factors
Challenges to Stage II
Confusing “understanding” with “excusing”
Reactivity of injured partner
– Reluctance to examine marital or own factors
– Preoccupation with “why”
Reactivity of participating partner
– Reluctance to hurt injured partner further
– Intolerance for sustained distress
Differences in subjective time-lines
Preparing a Formulation
Emphasize multiple contributing factors
– Vulnerabilities or risks from multiple domains
– Both historical (developmental) and recent
Different factors at different stages of affair
Cite reductions in risk already achieved
Propose additional steps to be pursued
Treatment Goals for Stage III
Consolidating work done in Stage II
Discussing forgiveness and blocks to
forgiving or “moving on”
Deciding whether or not to continue the
relationship
Either making the necessary changes to
rebuild the relationship or working on an
amicable termination
Treatment Strategies for Stage III
Consolidating work from Stage II
Each partner writes a “narrative” of the affair
Discuss the narrative in session
Discuss how their understanding has changed
since they began treatment
Couple identifies what needs to change in the
relationship, based on what they have learned
Therapist summarizes and gives feedback
Treatment Strategies for Stage III
Discussing “forgiveness,” “letting go,”
or “moving on”
Assess/discuss couple’s beliefs about forgiveness
Discuss how forgiveness fits with work done in
previous sessions
Discuss whether they feel ready to move on and to
forgive and what that means to them
If not ready, discuss “blocks” to forgiveness
Address pro/cons of forgiving/not forgiving
Common Beliefs about Forgiveness
Forgiveness means reconciliation
Forgiveness means excusing the partner or saying
what happened does not matter
Forgiveness means forgetting or no longer feeling
any anger about what has happened
Forgiveness is weak or condoning what happened
Forgiveness must be granted immediately,
particularly if person has apologized
One should not/must not forgive one’s partner for
certain types of betrayals: affairs, violence, lies ...
Our Model of Forgiveness
Forgiveness is not:
– Excusing or forgetting the affair
– Reconciling
– An immediate or one-time event
Forgiveness is:
– A process
– An opportunity to gain in understanding about
your partner, your relationship, and yourself
– A release from being dominated by negative
thoughts, feelings, and behaviors
Treatment Strategies for Stage III
Deciding whether to continue relationship
Again discuss changes that would need to occur
for relationship to continue
Discuss evidence supporting their ability to make
the desired changes
Discuss partner’s motivation and willingness to
make the changes
Help them think through what they wish to do
Preparing a Formulation
Emphasize multiple contributing factors
– Vulnerabilities or risks from multiple domains
– Both historical (developmental) and recent
Different factors at different stages of affair
Cite reductions in risk already achieved
Propose additional steps to be pursued
Formulation for Brian and Angela
Relationship strengths
Basis of attraction, initial maintenance
Initial stressors and responses to these
Escalation of tensions, relationship
erosion
Additional contributing factors
Implications for reducing vulnerability
– Communication changes
– Balance of relational roles
Questions for Evaluating the Relationship
Is the affair isolated event or ongoing pattern?
Has participating partner been able to make
difficult changes in the past?
Has the injured partner been able to make similar
changes?
Has participating partner accepted appropriate
responsibility for actions?
Are both partners willing to make the necessary
changes? In themselves? In the relationship?
References
Baucom, D. H., Snyder, D. K., & Gordon, K. C. (in press). Treating
couples recovering from affairs. New York, NY: Guilford Press.
Snyder, D. K., Baucom, D. H., & Gordon, K. C. (2007). Getting past
the affair: A program to help you cope, heal, and move on – together
or apart. New York, NY: Guilford Press.
Gordon, K.C., Baucom. D.H., Snyder, D. K., & Dixon, L. J. (2008).
Treating affair couples. A. Gurman (Ed.), Clinical Handbook of
Couple Therapy (pp. 429-458). New York: Guilford Press.
Gordon, K. C., Baucom, D. H., & Snyder, D. K. (2004). An integrative
intervention for promoting recovery from extramarital affairs. Journal
of Marital and Family Therapy, 30, 213-231.
Allen, E. S., Atkins, D. C., Baucom, D. H., Snyder, D. K., Gordon, K.
C., & Glass, S. (2005). Intrapersonal, interpersonal, and contextual
factors in engaging in and responding to infidelity. Clinical
Psychology: Science and Practice, 12, 101-130.
Contact Information
Kristina Coop Gordon
University of Tennessee
[email protected]
Douglas Snyder
Texas A&M University
[email protected]
Donald H. Baucom
University of North Carolina at Chapel Hill
[email protected]