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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).
All client names and identifying information have been modied to protect anonymity.
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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.
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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.
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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.
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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
Fam. Proc., Vol. 49, September, 2010
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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.
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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
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.
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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.
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