TheroyApplicationPaper
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Apr 3, 2024
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Theory Application
Theory Application Paper
Introduction
Most couples attend couples therapy to prevent their problems from escalating into bigger
problems. Couples learn to develop better communication tools and find out how they can enjoy enriching relationship life without repeating harmful patterns. Abdul-Khabir, a thirty-seven-year-
old civil engineer, and Hadiza a thirty-six-year-old former nurse, have taken the next step into couples therapy for most of these reasons. The couple has been married for a decade now and has
lost the meaning of their love and why they formed a relationship in the first place. Through cognitive behavioral couples therapy (CBCT), Abdul-Khabir and Hadiza will work towards improving their communication, increasing rewarding relationship behaviors, and reevaluating harmful assumptions. Assumptions
Therapists must engage in mindfulness of their thoughts and feelings; memories; values and implicit assumptions or biases to have a better relation-intervention with couples (Lebow & Snyder, 2022). Therefore, making assumptions during an interview and treating them as facts can
harm the way a therapist intervenes with the couple. Several personal and professional assumptions were made about Abdul-Kahbir’s and Hadiza’s case using their presenting problems
which can demonstrate the reasoning behind why these two individuals are affected in their relationship.
There were a few assumptions that came up during the review of the vignette. The first professional assumption that was made during the initial session with Abdul-Kabir and Hadiza is their names seem to be Middle Eastern, therefore the therapist might believe that Hadiza might
be in a subservient position in the marriage and is not doing what the culture expects women to do, or if she is not meeting expectations in Abdul-Khabir’s eyes. The therapist must explore their
cultural beliefs and not treat the assumption as a fact since that topic was not brought up. Their behavior as a couple could be influenced by positive or negative cultural assumptions that may reinforce their dysfunctional patterns. The culture of every human defines a set of rules and behavioral expectations passed from generation to generation. Many times, failure to fulfill the expected behavior can lead people into conflict with their families and dysfunctional relationships. The second professional assumption is related to the possibility of depression within the relationship. Hadiza may be having difficulties transitioning into her new stay-at-home role and leaving her job. Displacing or abandoning a part of her identity can turn out to be an unpredictable turning point in her life. Along with the idea of having the primary responsibility for their children, she might be having feelings of irritability and depression which Abdul-Kabir is not taking into account.
After identifying the professional assumptions, there were also personal assumptions made throughout the initial assessment. Abdul-Kabir reveals more sentiments regarding the relationship since his eyes were full of tears as he talked about it. Such an assumption, in turn, might make one believe that by crying he cares for Hadiza more than she loves him, when in reality the tears mean something else entirely. Therefore, exploring with Abdul-Kabir his emotions would be crucial instead of making assumptions like this and thinking that one has more commitment than the other. A second personal assumption would be the couple struggling to be intimate due to the comment Abdul-Kabir brought up about Hadiza not going to bed with him. Focusing on this can
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result in assuming that sexual intimacy is the only problem around the presenting problem. Therefore, exploring this statement further during their conjoint session would be necessary to identify what is making Hadiza not go to bed with Abdul-Kabir. Assessment
Articulating an appropriate assessment will provide the couple with an understanding of the challenges Abdul-Kabir and Hadiza are experiencing. The assessment would be the starting point on which the introduction to CBCT interventions can be found useful to this couple and alleviate the relational distress they are experiencing (Fischer, et. al., 2016). The assessment sessions will range from 2-4 sessions lasting between one and a half to two hours each session. (Lebow & Snyder, 2022). Hopefully, there will be several sessions a week to speed this phase up,
therefore collaborating with the couple as to how their schedules are set up, would be ideal to accommodate what fits best for them, being that they have children and daily responsibilities. In this phase, the therapist will attempt to gather all the information needed to support this couple. Several techniques are used to collect information during the first assessment, such as individual interviews with each partner, self-report questionnaires, direct observations of the couple's communication, and combined interviews with the pair (Lebow & Snyder, 2022). To start comprehending the issues that this couple is currently facing and the reasons for their first emergence, more details are needed. The purpose of the following questions is to gain a deeper understanding of Abdul-Khabir and Hadiza as a couple and as an individual.
Because Hazida is exhibiting signs that point to depression it is crucial to rule this out by asking direct questions about her symptoms reported by her husband. Abdul-Khabir reported Hazida having isolative behaviors, and withdrawing from her family and friends, he reported she used to be energetic and full of life. Therefore, the following question is to further assess and
explore why she might be exhibiting these behaviors. The first question would be, “
Have you lost
pleasure in doing things you used to like to do before
? This question will allow the therapist to engage in conversation with Hadiza and explore any possibilities for mental health issues, particularly depression. If she responds yes, the therapist will identify what were those activities she lost pleasure in and ask for a timeline of when the symptoms began. The second question would explore why Hadiza decided to leave her job as a nurse and transition to stay at home. “
Hazida, I hear you were a nurse for many years, why did you decide to no longer work? Was it a personal choice or were there other reasons that might have influenced your decision?
This question will help me explore whether external parties influenced her decisions and explore cultural values and beliefs. It will also help me explore whether this transition and change disrupted her self-esteem and mood. The therapist should be able to explore the couple’s dynamics and what is expected from each one of them or how are duties distributed between both. “How are responsibilities distributed at home, do you Hadiza focus on all responsibilities at your home, like cooking, taking care of the kids, and cleaning, or does Abdul-Khabir help in any way
? Finding out how each person's tasks at home are divided up is essential. We are aware of their divergent views on the subject and their disagreement on who is ultimately responsible for providing for the children. Also, the therapist will determine if the routines have gotten in the way and they need to create new routines to alleviate any negative emotions. Another important factor the therapist needs to explore is their relationship history. It is helpful to examine the early stages of Abdul-Khabir and Hadiza's relationship to distinguish between core reasons for unhappiness, like personality differences, and secondary sources, like unfulfilled needs resulting from these differences. “
What attracted you to your partner
initially?”
This question will help the couple reflect on what led them to form a partnership in the beginning and change some negative emotions in the room. This question is resurfaced form Abdul-Khabir’s comment of him having a hard time remembering why he fell in love with Hadiza in the first place. This question also asks Hadiza to describe a happy experience from the past, which is beneficial for the therapist to see and hear since Hadiza expressed her feelings in a subdued manner during the first intake interview. Lastly, the next assessment questions focus on their current situation and assess their communication styles and patterns. “
I am wondering when there is no conflict, do you communicate and talk about things like your day at work or home?
This question is to explore how they communicate when arguments are not a primary concern. Observing the interaction of the couple during this assessment and the evaluation process is essential to see the body language
and expressions of both, as well as evaluate their listening skills as the other partner speaks (Lebow & Snyder, 2022). Case Conceptualization
Abdul-Khabir (37) works as a civil engineer and Hadiza (36), a former nurse presents to therapy as they are having some relational distress in their marriage of 10 years. They have two children aged, six and three. Abdul-Khabir initially stated how he has forgotten why he fell in love with Hadiza and is visibly emotional. He added that she has changed a lot and used to be energetic and no longer wants to do things they used to do before like going out with family and friends. He shared the lack of interest in spending time together as well as not wanting to share the same bed anymore. Their dynamics in the relationship have drastically changed as they argue
constantly. Hadiza shared her concerns and stated how her husband is “neurotic” and needs to
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learn to relax. She continues to add that if there are any slight changes he takes them as “big, earth-shattering problems.” Three main themes emerged from the data gathered from the assessments and individual interviews using the Cognitive Behavioral Couple Therapy (CBCT) paradigm. Different communication techniques, a lack of closeness, and the pattern of interaction when Abdul-Khabir
tries to persuade Hadiza to leave the house and engage with him, his family, or others surfaced as
themes.
Relationship issues may arise as a result of an individual's inability to control their emotions. Even when the partners do not suffer from emotions on their own, individual or cultural differences in how each person communicates emotions can create challenges for couples as well (Lebow & Snyder, 2022). In the first theme of communication styles, the therapist observed the different styles this couple shared. Abdul-Khabir was more sensitive and was crying as he shared their relationship struggles, while Hadiza was more confident and controlled. So, these different communication styles can affect them if they do not understand them on a daily basis. The second theme in this relationship was a lack of closeness. Abdul-Khabir shared how Hadiza does not go to their bed. He also doesn’t understand why Hadiza might not want to go out
anymore and just stay home. Their lack of closeness shows up as problems with intimacy that may make the current troubles worse. Their culture must also be considered because it may have an impact on their dynamics.
Lastly, another theme in this relationship is the lack of interaction. They do not seem to be doing things together without any extended family members. Possibly due to everyday stressors like work or being tired. For Hadiza it can be caring for her children daily and she no
longer has energy at the end of the day, so Abdul-Khabir sees the “drained” and “tired” part of his wife that presents with moods of irritable and isolative behaviors. Abdul-Khabir also may misinterpret her behaviors and maybe she just needs to relax a little since she holds more responsibility for the children. The couple's treatment plan will be developed using these three themes. concentrating on the couple's communication patterns. Early in the treatment, it's critical to support them in improving their communication skills so they can talk about the various problems in their relationship. The lack of closeness in Abdul-Khabir and Hadiza's relationship will be the next problem to be resolved as they improve their communication abilities. This will be accomplished
by reducing negative behavior. The goal will be to improve their communication skills to address the secondary stress issues (Fischer, et. al., 2016). Additionally, efforts will be made to enhance the constructive relationships within the partnership.
Behavioral Interventions
CBCT is an approach used to assist couples in relational distress and support in alleviating those struggles (Fischer, et. al., 2016). The goal of the couple is to communicate their emotions more effectively without any maladaptive assumptions of one another. They will learn to increase their sense of connectivity, accept their different communication styles, and have mutual emotional support and caring. There will be three interventions used to assist with reaching these goals. The therapist will start the couple with a skill-based behavioral intervention. Abdul-
Khabir and Hadiza will be asking how their days went and activity listening to one another, paying attention to their emotional tones, and caring genuinely about how their day went. Using the speaker-listener guidelines from CBCT, will allow them to appropriately share any thoughts
and feelings they had throughout the day and attentively listen to their partner (Lebow & Snyder,
2022). The second intervention for this couple would be engaging in doing one small and caring behavior for one another daily. They will be able to begin cultivating connections in their relationship as a result. It is advised that Abdul-Khabir and Hadiza establish their love language to maximize the effectiveness of this intervention and to better position themselves to participate in considerate actions that their spouse will value.
Lastly, the couple will try to choose an activity each week that they both will enjoy so they can have something joyful to discuss in sessions. This could be watching movies together, going out somewhere, getting takeout, playing games, etc. The purpose of this intervention is to reignite the love and happiness they once had. Some interventions that were not considered for this couple were focusing on physical touch because first, they need to work on emotional regulation, communication, and closeness to be able to go into engaging in this intervention. This intervention may be used at a later time or if
the couple identifies it as the current issue. The second intervention not considered was child care. Taking some cultural considerations into account, this might be something that they agreed on when Hadiza left her job. Therefore, focusing more on reinforcing their relationship as a couple is the goal and not co-parenting. Conclusion
Couples can change the negative patterns in their relationship with Cognitive Behavioral Couples Therapy (CBCT). This calls for Abdul-Khabir and Hadiza to concentrate on enhancing their communication and reducing unfavorable habits. They might be able to benefit for years to come if they work hard for four months.
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References
Fischer, M. S., Baucom, D. H., & Cohen, M. J. (2016). Cognitive-Behavioral Couple Therapies: Review of the Evidence for the Treatment of Relationship Distress, Psychopathology, and
Chronic Health Conditions. Family Process, 55(3), 423–442. https://doi-
org.umassglobal.idm.oclc.org/10.1111/famp.12227
Lebow, J. L., & Snyder, D. K. (2022). Clinical Handbook of Couple Therapy (Sixth). The Guilford Press