Assignment 3

Assignment 3: Critique of Seminar Papers.
Kirti Joshi

Introduction
The following is an analysis offering insight into Systemic and Psychodynamic theory and practice. The material discussed offers different perspectives in working with couple clients in the counselling environment and is based on my personal interpretation and understanding of the articles. The readings are; 1. Facilitating Relational Empowerment by Mona DeKEVON FISHBANE which talks primarily about power struggles in relationships and supporting clients to promote ‘relational empowerment’. 2. Structural Family Therapy by Arlene Vetere which focuses on working with clients’ sub systems by joining them in their enactment to work through their distress. 3. Attachment Styles, Rules Regarding Sex, and Couple Satisfaction: A Study of Gay Male Couples by Oscar Modesto Ramirez and Jac Brown which I feel focuses of the chosen style of relationships within the gay culture.

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Facilitating Relational Empowerment in Couple Therapy. MONA DeKOVEN FISHBANE.
1. 1.2, 6.3, 6.5
The article by Fishbane, 2011 is concise, providing a clear model of couple functioning containing the 3 modes of interaction as shown below (fig1). Working on the basic principle of moving a couple from a reactive mode of ‘Power Over’ position where couples develop critical behaviour towards each other; blaming, disregard, humiliation including the possibilities of domestic violence and abuse. The underpinning of a reliable framework such as the BACP Guidelines for Good Practice provide a sound ethical foundation in working with couples; I adhere to these Values, Principles and Personal Moral Qualities (BACP, 2017). Relate’s policies and procedures on safeguarding and accessing supervision ensure I support my clients safely and accurately. A ‘Power To’ position enables clients to become aware of their own choices and achieve self-regulation… Furthermore, establishing a ‘power with’ position enables couples to achieve relational empowerment. This model informs a therapeutic approach by practitioners in reorganising the power structure within couples. In conjunction with this model, one could consider the ‘Core Conflictual Relationship Theme’ (CCRT) as a way of understanding the meaning underlying clients stories…research has supported the notion of transference.’ (Luborsky and Crits-Cristoph, cited in Howard, 2010, pg4). Luborksy and Crits-Cristoph found evidence suggesting that in the stories our clients tell us, the core conflict that they are struggling with are revealed. Client autonomy is vital so that clients can develop deeper senses of empathy, working on creating a ‘blame free zone’ and externalising blame in their relationship. This empowers them as it allows for ownership of their own process of self-regulation (White, cited in Fishbane, 2011, pg16).
2. 6.3
It can be argued that the model lacks consideration towards the effects of external sub-systems (cultural and social expectations) which can affect power dynamics within couple sub-systems (Diffused Subsystem Boundaries). Vetere, 2001, pg134 and pg137. Dominant cultures like in the USA promote male privileges and female accommodation, raising concerns in how effective facilitating empowerment in couple therapy is, where the female has to accept the relationship for what it brings in terms of male dominance, hierarchy, competition and individualism even in cultures/ societies of egalitarian principles (Jordan, Knudson-Martin ; Mahony, cited in Fishbane 2011, pg2).

3. 1.2, 6.2, 6.3. 6.5
This paper focuses on what happens to clients when their inner self is threatened and their needs are not being heard/ met (Hatfield, Cacciopo, ; Rapson, cited in Fishbane, 2011, pg4). Dangers of this result in the amygdala of the limbic system scanning for danger beneath awareness (LE DOUX, cited in Fishbane, 2011, pg4), creating ‘dances of disempowerment and disconnection’ (Fishbane, 2011, pg1-2). Counselling couples in their cycles of habitual behaviour can promote reactivity in ‘Power over’ struggles because of a lack of awareness of unconscious needs further compromised by external factors. Inability to regulate one’s own emotions leads to friction in one’s ability to hear, understand and respect a spouse/ family member’s points of view. This cycle prevents relational empowerment like the subsystems organised by hierarchy regulating power within and between sub systems (Vetere, 2001, pg. 134). Ethical issues should be addressed in clinical supervision (BACP, Relate policies). The practice helpline is a good point of reference, especially if a supervisor cannot be reached.

4. 1.2, 6.3, 6.5
The reading provides clarity in what my clients and myself experience and for me to consider a more proactive awareness of my position within the therapeutic environment (Fishbane, 2011, pg18).
In practice I pay more attention to power aspects through self-reflexivity with respect to creating a safe therapeutic alliance and environment, (BACP, Relate policies and procedures and supervision). Working as a therapist from a ‘Power With’ position allows me to feel my clients and join them in their limbic experience, similar to ‘enactment’ (Vetere, 2001, pg134) of joining clients in their story telling. For me, in order to enter a client’s world without feeling overwhelmed, self-regulation and attunement is essential.
To work with a couple in addressing their ‘power over’ struggles, identifying individual behaviours in their ‘dances of disempowerment’ in relational work is key for relational empowerment to be achieved. This is a very scientific approach relying on neuroscience, suggesting we are wired to connect (Fishbane, 2011) and that unhappy relationships create chronic stress especially for women (Kiecolt-Glaser ; Newton, cited in Fishbane 2011, pg5). This would suggest that men do not experience emotions as deeply as women and the emotional regulation in the ‘Power to’ for men may be more challenging, hence the frustration and dysregulation viewed as a partner’s lack of empathy will resort to continuation and possible escalation of ‘Power Over’ struggles making this model a challenge to work with and consultation in supervision may be necessary for safeguarding concerns.

5. 6.3
The proposal of a model/ framework to visually represent the ‘power over’, ‘power to’ and power with’ behaviours within couple/ family relationships (Fishbane, 2011, pg8). This model is based on a scale/ gradient (fig 1.2) allowing clients to plot the list of behaviours below onto the scale to identify with how they currently function and relate to each other. Providing clients with the ability to;
1. See how they are functioning individually and relationally, to think about their unhelpful behaviour/choices to understand the benefit of self-regulation and autonomy.
2. To make informed choices enabling them to relate positively and reach a level of Relational Empowerment.
From this reflection they can then focus on desired relational outcomes. They can do this by reformatting the scale and plotting behaviours in terms of least/ most desired outcomes they want in the relationship. This creates model flexibility through interchangeable variables as a couple works through their Power struggles. (fig 1.3).

Structural Family Therapy. Arlene Vetere.
6. 6.2, 6.5
I support Vetere’s central creative thesis of Structural Family Therapy (STF) explaining that STF is based on the changing perceptions/ assumptions of relational therapies. Vetere goes on to highlight that ‘…distress can be understood not only in the context of relationships within which it arises and is maintained, but also in seeing the potential for relationships to be the cause of distress.’ (Vetere, 2001, pg133). One must consider attachment styles, past experiences and the unconscious material an individual has not dealt with. Distress as a result is not necessarily caused by the relationship but an individual’s inability to self-regulate themselves on past experiences and their attachment styles. For me, the approach is limited focusing on family systems and functioning in the ‘here and now’. Structural family therapy is not usually conducted on its own, it is often part of an integrated care package where therapists will encompass a number of approaches. It also suggests that Family therapy is not always the treatment of choice when confronted with human distress (Vetere, 2001, pg134).
I have a better understanding of how the family is seen as a psychosocial system embedded within wider social systems and how it functions through transactional patterns. These transactions establish patterns of how, when and with whom to relate underpinning the family system. They operate in sub systems and the boundaries within the subsystems are said to be the rules defining who participates and how. The aims of therapy are similar to the ‘Power Over’ in that it aims to alter unhelpful modes of communication and behaviours that are abusive and neglectful on the basis of individuals ability to alleviate symptomatic distress promoting a position similar to ‘Power To’ position, (Fishbane, 2011, pg8). Developing a good therapeutic relationship is said to be the vehicle for change. I will implement techniques to include ‘enactment’ which is central to the model of change (Simon, cited by Vetere, 2001, pg134). I will encourage clients to think about new ways of responding to each other in the safety of the therapeutic environment (Vetere, 2000, pg134).

7. 1.2, 6.2, 6.5
Research on this model has shown that a power skew within a couple’s relationship was seen as a result of widespread distress and general problems within the family. A high risk of physical violence from men to their women partners has been identified. Consideration to the added responsibility when working with issues of safety and abuses of power within family relationships due to widespread distress and general problems is important. Research on this model has shown me that supervision is vital to ensure ethical and safe practice. I will access supervision, Case Supervision Groups as well as further training to make use of my under-utilised skills.
8. 6.2, 6.5
Joining my clients would be to go in a direction that the family needs, despite my own beliefs about family norms and best family fit, whereby the family can enact their drama and show possible alternatives (Minuchin, Lee & Simon cited by Vetere, 2001, pg135). This model works on the therapist developing a system ‘family plus therapist’. To apply techniques of Mirroring and Joining I must understand my position within the therapeutic environment. Providing useful feedback to families of the effects of their interactions with one another raises greater awareness. With this model the therapist has to have excellent self-reflexive skills. The model is more for family counselling than couple therapy.

Attachment Styles, Rules Regarding Sex, and Couple Satisfaction: A Study of Gay Males. Oscar Modesto Ramirez and Jac Brown.
9. 6.2, 6.5
For me it feels gay couples find it difficult to be fully available in an intimate relationship but there does not seem to be enough research on attachments. As Bowlby (1985: 39) FROM BLOCK 4 COURSE HANDOUTS, suggested, during the course of healthy development, attachment behaviour leads to the development of affectional bonds or attachments between parent, child followed by adult, adult. This shows working with attachments enables clients to reflect on their power dynamics (Fishbane, 2011, pg8) in order to explore helpful ways of relating.
There is a lack of research and evidence supporting the causal effects of Hypothesis 3 in which ‘Older gay male couples will be more likely to have open relationships than younger gay male couples’ (Ramirez and Brown, 2010, pg3), this is likely due to small/ limited age gaps (approximately 5 years) between both groups, resulting in data that lacked significant variation between both groups. See statistics Ramirez and Brown, 2010, pg5. If the data had greater variation, potential variations in patterns could have been identified. The potential of the research bottle necks the causal effects to include cultural/societal changes, acceptance of the gay culture and legalisation of gay marriages.
It could be argued that gay couples in open relationships with explicit rules last longer due to ‘detouring’ as a result of possible insecure attachment styles. (Vetere, 2001, pg134). Insecurities could arise from being rejected, abandoned and losing a sense of belonging due to ‘coming out’ as gay. As a result, the individual could develop ‘fearful avoidance’ attachments preventing them from having monogamist closed loving relationships, both sexually and emotionally.’ (Howe, 2011, pg187).

10. 1.2, 6.2, 6.5
I developed a deeper understanding of gay culture in terms of their relationships and levels of satisfaction. I learned that closed relationships are the norm for 50% of the couples. The data is consistent with other data where similar percentages of open relationships exist with gay male couples (Brown ; Trevethan, in press; Mao, Van de Ven, Prestige, ete al., 2002, cited in Ramirez and Brown, 2010, pg9) Gay relationships with explicit rules were said to be the most satisfying and that gay couples can separate emotional and sexual fidelity whereas most heterosexual couple’s fidelity covers all aspects of a relationship. Closed relationship gay couples may see fidelity as a heterosexual couple would. I understand the open sexual nature being the norm in some gay relationships. In therapy I would systemically explore with gay couples whether their relationship is open or closed including rules in which these relationships operate. In individual sessions look at current relationship rules, meaning of rules, who made them, are they happy with them, ensuring there is no Domestic Violence or Abuse and making a possible referral on consultation with a supervisor. In couple sessions, look at rules/ shifting rules including the reasons for this, whether the couple is happy with the way their relationship operates and their individual commitment to the style of relationship. Age difference and when partners have come ‘out’ as gay men, also requires exploring without imposing my heterosexual discourse around fidelity. I would enquire about the nature of intimacy between the couple and whether having partners outside of their relationship affects their interaction and trust of each other (Ramirez and Brown, 2010, pg9).
11. 6.2
A better sample of candidates based on; a wider age range, differing cultural diversity and looking at attachments in more detail to provide stronger evidence to support hypothesis 2 would have beneficial in this study. Studies could be practiced in different countries to consider social and cultural implications of the external environment and the effect it has on gay couple subsystems. There were loopholes in the way the study was advertised and would have potentially drawn in gay couples experiencing relationship difficulty, creating biased/ unreliable results.

CONCLUSION
The readings in this analysis have offered new information and techniques which will improve my effectiveness in practice including; therapeutic alliances, different ways of working with my clients being flexible and incorporating theories and models in an integrated, systemic manner. The readings highlighted cultural and neurological systems in which we as human beings operate and the challenges we face in changing these due to expectations and our own attachment styles and positions in our intrapersonal and interpersonal relationships.

References
FISHBANE, M. (2011). Facilitating Relational Empowerment in Couple Therapy. Family Process, 50(3), pp.1,2,4,5,8,16,18.
Howard, S. (2010). Skills in PYSCHODYNAMiC Counselling & Psychotherapy. 1st ed. London, 55 City Road: SAGE Publications Ltd, p.4.
Howe, D. (2011). Attachment across the lifecourse. Basingstoke: Palgrave Macmillan, p.187.
Ramirez, O. and Brown, J. (2010). Attachment Style, Rules Regarding Sex, and Couple Satisfaction: A Study of Gay Male Couples. Australian and New Zealand Journal of Family Therapy (ANZJFT), 31(2), pp.3,5,9.
Vetere, A. (2001). Structural Family Therapy. Child Psychology and Psychiatry Review, 6(03), pp.133,134,135,137.
BLOCK 3 Handouts; Bowlby, Attachment and Couple Therapy.
Weblinks
Bacp.co.uk. (2018). Ethical Framework. online Available at: https://www.bacp.co.uk/events-and-resources/ethics-and-standards/ethical-framework-for-the-counselling-professions/ Accessed 18 Apr. 2018.

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