In this information-packed weekend, the Sexual Health Alliance presented us with an eye-opening conference on Coming Together: Techniques for Working with Relationships and Couples. Day 1 focused on blending couples and modern sex therapy, this seven-hour presentation was held by Sonya Jenson, SHA alumni and LMFT-certified Gottman Therapist. Jenson, a self-proclaimed romantic from “the moment she came out of the womb,” taught us how to look at couples as a system through the lens of the Gottman method, incorporating methodology with techniques she has learned through her own professional experience. On day two we were given an introduction to Integrative Behavioral Couple Therapy (IBCT) and the way it can be used in contemporary sex therapy, this was taught by Dr. Crystal Dehle, the IBCT provider, and recent SHA graduate, and Dr. Mariana Rosenthal, licensed clinical psychologist
DAY 1: BLENDING COUPLES AND MODERN SEX THERAPY
The lecture opened with Jenson’s explanation on learning how to structure an assessment with a couple. Jenson sticks to the following setup:
Initial session all together
Individual sessions for an hour with each person
A ‘feedback’ session altogether again
This first session with both partners involves solution-focused questions— ”if you got everything you needed out of therapy, what would be different about your relationship?” Asking these solution-focused questions acts as a way to get into their inner space, increasing the connection you built and rapport you establish. Solo sessions offer a chance to go more into personal family history, something that Jeson assesses through attachment lens. Here each person can discuss needs, boundaries, and what a healthy relationship looks like to them. This one-on-one session provides an opportunity to get an unfiltered view of the relationship, talk more about how committed they are feeling to the process, and their worries about it working/not working. Not only does this really build connection and feelings of safety, but allows them to really question what they are fighting for in the relationship. The feedback session takes on a different format, following that of The Sound Relationship House, another Gottman method that blends trauma therapy and EFT (emotionally focused therapy). Jenson took us through the levels in the sound house, explaining how each level is essential in building a secure relationship and learning conflict resolution and self-soothing skills.
In terms of building a treatment plan, Jenson explains the first step is diagnosis: “always make an informed diagnosis for both partners — you can’t treat something if you don’t know what it is,” this stage also involves working out what outside resources you need to get involved. Here Jenson stresses the importance of asking every partner when the last time they had a physical was to rule out any physical causes if they are facing issues with penetrative sex. Treatment plans also involve finding ways to emotionally regulate individually, and together— ”people need to express their emotions but it needs to be productive.” Emotional regulation also consists in creating a safe word to be called out in moments of conflict, and a plan of action of what will happen after this is called to come back and make a repair. In terms of conflict work, Jenson taught us about mastering of the conflict blueprint and the importance of practicing what it’s like to be an active listener—you need to hit every conflict with the idea that there are two ways to look at this. Compromise exercises are additionally crucial in handling conflict, couples can gain traction and make decisions about what something will look like moving forwards. For this to be effective, they need to identify their core needs, and needs so they can be more flexible enough—are they willing to explore more or talk more about it?
The session finished with Jenson going over her session structure and the way it works well for her and her clients. She additionally provided us with a “therapist toolkit,” emphasizing that we need to model what we are sharing. Protecting yourself as the therapist means taking care of your emotional needs and having set boundaries—set office hours where clients can contact you removes the stress of panicked clients calling you at all hours of the day. In terms of understanding, if your boundaries are being breached, Jenson quotes: “if something is causing resentment for you, it’s because there needs to be a boundary there.” The first day came to a close with an opportunity to ask Jenson questions directly and finished with many of us being enlightened on therapy assessments and being slightly less scared of tackling couples therapy.
DAY TWO: AN INTRODUCTION TO INTEGRATIVE BEHAVIORAL COUPLE THERAPY (ICBT) AND ITS USE IN CONTEMPORARY SEX THERAPY
Day two was split between Dr. Crystal Dehle and Dr. Marina Rosenthal—both prepared to give us information-packed presentations.
The day started with Dr. Crystal Dehle discussing ICBT with us, describing it to be a “principle-based, pragmatic, experiential, tailored, and evidence-based intervention for relational difficulties.” ICBT involves an assessment phase that generates a case formulation and a treatment phase that is guided by the formulation. The framework it follows is normalizing and de-pathologizing, valuing difference as a potential source of connection and strength. It further works towards de-pathologizing emotional vulnerabilities as understandable. Dr. Dehle explains that conflict is an inevitable component of intimate relationships and that ICBT works not on eliminating disagreements, but on managing conflicts in a way a connection can be maintained. ICBT is further useful in the way it lends itself to intersectionality by bringing identities into a relationship. By incorporating important roles of systemic, contextual, developmental, and environmental influences on individuals and relationships, it doesn't assume that problems in the relationship are solely on one partner, but rather encourages us to look at influences of external circumstances. As a theoretical framework, IBCT is readily compatible with sex therapy interventions, for example, they both value the importance of experiential learning that occurs in response to natural contingencies in the context and environment.
Dr. Dehle then went on to discuss what is a relationship, and how distress and dissatisfaction happen in intimate relationships. Relationship dissatisfaction is seen when a significant portion of interaction leads to negative emotional reactions and thoughts/appraisals, as well as an absence of positive emotional reactions and thoughts. Dr. Dehle takes a moment to reinforce that whilst all couples will deal with disagreements, it is not so much the presence of these conflicts which is the problem, but how well it is handled between the partners. Dr. Dehle further emphasizes how there is lots of individual variability in relationship dissatisfaction— ”people very in what is positive, negative, what they expect from relationships, and what they are comfortable experiencing or tolerating.” In an IBCT formulation of relationship distress, you should aim to capture what looks like separate problems/topics of conflict under a common umbrella, such as trust, investment in relationship, and relationship transitions. To capture these themes, Dr. Dehle introduces us to DEEP analysis:
Differences between partners that contribute to problem
Emotional sensitivities/reactions
External circumstances/stressors
Patterns of communication
Dr. Dehle went into great detail on all of these, explaining that whilst early on in the relationship we are more accommodating to our partner, as interdependence increases and lives are shared together more, they may find themselves being more directly affected by their partner's behavior. Their messiness may have been tolerable when you were living separately, but when you're living together—this can become more of a burden and result in conflict between one another. Dr. Dehle added to our knowledge by discussing the difference between protective and vulnerable emotions. During conflict, we may produce surfaces (protective) emotions such as anger and resentment, but behind them, there are hidden (vulnerable) emotions such as sadness, rejection, and guilt.
Carrying on from Dr. Dehle, Dr. Marina Rosenthal worked to expand our knowledge on ICBT, introducing us to the treatment that includes a balance of both acceptance-based interventions and direct change-focused interventions. Acceptance in ICBT means “embracing a partner’s flaws and releasing the desire for a partner to change.” Acceptance in itself is a form of change, Dr. Rosenthal gives the following example:
You change: “be more emotionally available to me.”
I change: “my partner is not someone who shares big emotions. I will connect with them in other ways
There are three ways ICBT teaches acceptance-based interventions: empathic joining, unified detachments, and tolerance. Empathic joining supports partners in sharing and receiving both positive and negative disclosures as a source of connection, encouraging us to focus on the pain rather than the behavior. Unified detachments encourage observing the typical sequence of patterns of their problematic interactions in a collaborative, mindful way—this is practiced through discussing typically distressed content (a thematic conflict) in a calm, somewhat detached manner. Dr. Rosenthal explained that in tolerance practice, it ultimately aims to reduce a partner's reactivity to unpleasant traits/behaviors. She made sure to emphasize that tolerance is NOT appropriate for abuse behaviors, and that if you don't want to tolerate certain behavior, you don’t have to—you can leave.
The session ended with Dr. Rosenthal going over deliberate change intervention strategies, explaining that this intervention is not always needed and that you need to have a clear formulation in mind before teaching this to your clients. Dr. Rosenthal and Dr. Crystal Dehle joined forces for the plethora of questions the SHA had prepared, englighting us on questions we had about cases we were dealing with. Both presenters did an sexceptional job condensing complex topics into their presentations, providing us with new knowledge and skills we can bring into our own practices.
By Stephanie McCartney