Chapter 1

Basic Observation

2
7 Fundamental Expressions of Emotion

1. Fear 5. Surprise
2. Sadness 6. Happiness
3. Disgust 7. Contempt
4. Anger

3
FEAR

4
SADNESS

5
DISGUST

6
ANGER

7
SURPRISE

8
CONTEMPT

9
HAPPINESS

10
 Example: AU4

brows down + together,

vertical furrow

11
Example: AU 1+4

brows together,
inner brow raise,
inverted “U”

12
Chapter 2
Tension in the Voice

13
Type 1: Speech Disturbances

Neutral (“Ah-Disturbance”)
o “Ah” “er” “um”
o Provide speaker with thinking time
o Keeping the floor

14
“Non-ah-disturbances” = tension
o Repetition mid-sentence
o Topic change mid-sentence
o Stuttering
o Omissions
o Incomplete sentence
o Slips
o Intruding incoherent sounds
15
Type 2: Fundamental Frequency Shift

Frequency shifts upward when people are tense

16
Chapter 3
The Words Themselves

• How people tell their stories

• What emotion do you get?

17
Chapter 4
Bids & Turning

18
Request for partner’s…
• Attention
• Interest
• Engagement
• Mirroring Affect
• Support

19
Types
• Silent Bid
• Comment
• Question
• Playful Bid
• Negative Bid

20
Turning Against Response
• Contempt
• Belligerence
• Domineering
• Criticism
• Defensiveness

21
FILM
Spain Without Interest (Before 9/11 Attack)

Bread With Interest

22
FILM
Greg and Jennie

23
Chapter 5
Assessment Overview

24
Assessment Session 1:
Couple’s Narrative
Build rapport, empathize

Oral History Interview

Conflict Discussion
Don’t Intervene
25
Chapter 6
Oral History Interview

26
Oral History
• Fondness & Admiration
• Negativity Toward Partner
• We-ness vs. Separateness
• Expansiveness vs. Withdrawal
• Chaos
• Glorifying the Struggle
• Disappointment / Disillusion 27
FILM
Oral History Interview Samples

28
Chapter 7
Evaluating Conflict Management

29
Conflict Discussion

• Sample of how they talk about problems

• Pulse oximeter - measure heart rate
• Videotape, do not intervene

30
Getting Conflict Avoiders To Conflict
• Gottman Perpetual Problems List – p. 12-91
• Agree to Disagree?
• Upcoming, potentially stressful event?

31
Observing Conflict
• The Four Horsemen
• Start-up (Gentle and Harsh)
• Repair (Effective and Ineffective) – Section 7.4.
• Accepting and Rejecting Influence
• Compromise
• Gridlock
32
Observing Symbolic Conflict
Section 7.3.

Transcript, page 7-4

33
Observing Symbolic Conflict

• 70% problems = Perpetual

• Gridlock = a deeper symbolic meaning

34
FILM

Initial Session – Michael & Trudi

35
Oral History Interview, p. 6-9
Chapter 8
Assessment Session #2: Individual Interviews
• Build Rapport
• Get to Know Each Partner
• No Secrets
• Perspective on Relationship

37
Build Rapport
Assess Commitment
Family of Origin
Physical Abuse
Unwanted Touch - Sexual Abuse
Substance Abuse
Prior Therapy
Affair
Unwanted Touch – Domestic Violence
38
FILM
Assessment Session #2 - Individual Sessions

39
Chapter 9
Core Assessment Questionnaires

40
• Locke-Wallace
• Weiss-Cerretto
• SRH Questionnaires (5-item Scale)
• Gottman 19 Areas Checklist
• Three “Detour” Scales
• Gottman Emotional Abuse Questionnaire (EAQ)
• Control, Fear, Suicide Potential, and Acts of Physical
Aggression
• SCL-90
• CAGE-AID and b-MAST
41
Scoring & Interpreting Questionnaires
Section 9.3.

Interpretation Guidelines, p. 9-60

Scoring Summary Sheet, p. 9-61

42
Chapter 10
Assessment Session #3: Feedback & Treatment Planning

Checklist for Relationship Assessment, p. 10-7

Sound Relationship House

43
Page 10-13

Section 10.3.

44
Gottman Treatment Plan, Section 10.5.
FILM
Masters & Disasters
• Love Maps
• Fondness and Admiration
• Turning Toward/Away
• The Perspective
• Regulation of Conflict
o Dialogue with Perpetual Problems
o Solvable Problems
• Honoring dreams
• Creating Shared Meaning 46
Feedback Session Benchmarks
Section 10.4., p. 10-12

47
ROLE PLAY DEMONSTRATION

Feedback Session
• Love Maps
• Fondness and Admiration
• Turning Toward/Away
• The Perspective
• Regulation of Conflict
o Dialogue with Perpetual Problems
o Solvable Problems
• Honoring dreams
• Creating Shared Meaning 48
GROUP ROLE PLAY PRACTICE

Feedback Session, p. 10-15

49
I Feel…
State what you feel w/ “I” statement. Example: I feel upset…
About What…
Describe the facts. Describe “it,” not your partner
I need…
Tell your partner what you need to make it better.
Be Polite
Give Appreciations
52
Introducing Steve and Crysta

53
Steve and Crysta’s Scoring Summary Sheet
p. 10-16

54
FILM

Family Dinner

55
Four Horsemen and Their Antidotes
p. 11-31

56
57
58
59
60
61
FILM

Four Horsemen Examples

62
Four Horsemen Benchmarks, p. 11-31
• Stop couple’s interaction when one partner exhibits a Four
Horsemen.
• Short explanation of why you stopped them.
• Explain antidote clearly and accurately.
• Briefly share relevant, accurate research findings when appropriate.
• Alternative way to express him- or herself using antidote.
• Re-direct couple to resume discussion.

63
Flooding - Self-Soothing
p. 11-37

Managing Diffuse Physiological Arousal (DPA)

64
Effective Break:

Immediate

20-25 minutes before re-uniting

Don’t ruminate

65
Flooding Benchmarks
Full description, p. 11-37

66
• Stop interaction. Identify flooding. Pulse check. Above
100bpm (80 if athletic).

• Explain flooding clearly, sensitively, using only a few words.

• Guide one or both partners through relaxation exercise

before continuing.

• Relaxation techniques may include breathing, muscle

tensing-relaxing, heaviness, warmth and/or imagery.

67
FILM

Flooding and Soothing

68
GROUP ROLE PLAY PRACTICE

Flooding and Soothing, p. 11-43

69
Gottman-Rapoport Intervention
Full description – p. 11-45

70
• Understanding Must Precede Persuasion and Problem-
Solving

• Assumption Of Similarity

71
Speaker:
Gentle Start-up

Positive Need

72
Listener:
Take Notes

Postpone agenda, listen with empathy

Validate

73
FILM

Gottman-Rapoport

74
GROUP ROLE PLAY PRACTICE
Gottman-Rapoport, p. 11-47

75
Dan Wile Intervention
Full description - p. 11-49

76
• Speak for each
• Kneel beside them, don’t stand over them, be at least eye
level
• Interrupt Attack – Defend
• Have client say it in his or her own words (transfers skill to
client)

77
FILM

Dan Wile Intervention

78
GROUP ROLE PLAY PRACTICE

Dan Wile Intervention, p. 11-51

79
Internal Working Model
Full description - p. 11-53

80
• Explore the client’s history that relates to resistance

• Find out how the meaning of that history affects their view
of the relationship.

• Wounding and healing? Survival mechanism that is now

related to resistance?

81
Examples:
• Fondness and admiration = manipulation
• Turning Towards = fears of abandonment
• Any conflict = danger, violence
• Dreams = foolish, or disappointed in major ways

82
FILM

Internal Working Model

83
Compromise
Full description - p. 11-55

84
• For either solvable or perpetual/gridlocked problem.

• Both partners must feel understood before compromise

(Gottman-Rapoport Intervention, Dream Within Conflict)

• Perpetual/gridlocked issues = reach a temporary or partial

compromise on part of the larger issue.

• Gridlocked during Compromise? Do a Dreams Within

Conflict before proceeding.

85
Compromise Benchmarks
Full description - p. 11-55

86
• Give compromise ovals handout to each partner

• Write down core need or dream in smaller circle

• Write down areas flexibility in larger circle

• Getting to “Yes”

87
FILM

Compromise

88
GROUP ROLE PLAY PRACTICE
Compromise, p. 11-59

89
Dreams Within Conflict
Full Description - p. 11-63

90
Sample Questions and Sample Dreams (p. 11-66):
o Dream Catcher (Listener)

o Dream Speaker

91
Dreams Within Conflict Goals:
o Postpone persuasion or problem-solving

o Deepen understanding of issue

92
• Speaker-Listener structure
• Speaker’s job, refer to Sample Dreams
• Listener’s job, refer to Sample Questions
• Coach one partner to ask the other partner questions from
the handout.
• For very difficult cases – ok for therapist to address
questions to Speaker. But try to keep it dyadic.
• Switch roles
93
FILM
Dreams Within Conflict

94
GROUP ROLE PLAY PRACTICE
Dreams Within Conflict, p. 11-67

95
Aftermath of a Fight or Regrettable Incident
Description begins on p. 11-69

Booklets available on
www.gottman.com

96
Step One – Feelings, p. 11-72
Step Two – Subjective Realities, p. 11-73
Step Three – Triggers, p. 11-74
Step Four – Taking Responsibility, p. 11-75
Step Five – Constructive Plan, p. 11-76

97
FILM

Aftermath of a Fight

Demonstrating Steps One, Two, and Four

(Step Three – Triggers, not shown)

98
GROUP ROLE PLAY PRACTICE
Aftermath of a Fight, p. 11-77

99
Overview: Friendship & Romance
• Integrate into treatment

• As important as conflict interventions

• Change how couple moves through time

• Change how couple sets priorities, engage, and connect

100
Sample of Friendship Interventions
• Love Map Exercise, p. 12-5

• Ask Open-Ended Questions, p 12-17

• Rituals of Connection, p. 11-81

• “GottSex” Seven Exercises

• Three skills for intimate conversation, p. 12-81

101
Gottman Card Decks in iTunes App Store

102
Sample of Turning Towards Interventions
• Behavior Exchange, p. 12-39
• Stress Reducing Conversation, p. 11-15
• ”Who Does What” – Negotiating Power, p. 12-47
• Aftermath of Failed Bids, p. 12-53
• Salsa Cards, p. 12-73

103
“I Appreciate…” Adjective Checklist
Full description – p. 11-11

104
FILM
Working on Fondness & Admiration: “I Appreciate…”
Exercise

105
Stress Reducing Conversation
Full description – p. 11-15

106
FILM

Stress Reducing Conversation

107
GROUP ROLE PLAY PRACTICE
Stress Reducing Conversation, p. 11-19

108
Build Rituals of Connection
Full description – p. 11-81

109
• Create meaning, traditions in the relationship

• The Intentional Family by William Doherty

• Formalized turning towards

• Informal rituals of connection

• Help with friendship and meaning

110
FILM
Build Rituals of Connection

111
Monogamy in Heterosexual Couples
• Social
• Reproductive
• Sexual

113
• 89% get married by age 49 (social monogamy)
• 96 to 98% genetic monogamy
• 10-15% women, 15-43% men sexually unfaithful
• Majority sexually monogamous

114
Advantages
• Live longer ≈ 10 years
• Stay physically healthier
• Recover from illnesses faster
• Become wealthier
• Children do much better (into their 50s)
• Brain comfort during fear

115
How Often Do Affairs Happen?
22 % men; 14% women

12/21/98 report in USA Today on national study by UCSF

116
10% last 1 day
10% last 1+ day but less than 1 month
50% last 1+ month but less than 1 year
30% last 2+ years
Few extramarital affairs last 4+ years

117
• 70% women, 54% men did not know about affair.
• 85% women who suspect cheating are right.
• 50% men who suspect cheating are right.

118
How Many Affairs Become Lasting Relationships?

• 3% men married affair partner (Jan Halper)

• Divorce rate 75%
• Major reason for the divorce? They don’t trust their partner.
(Frank Pittman)

119
Three “Metrics” Or Ways of Measuring In Any
Interaction.

• Trust
• Fairness
• Betrayal

Lack of Trust not same as Betrayal

120
Love has three phases

• PHASE 1: Falling in love - “Limerence”

• PHASE 2: Trust – Are you there for me?
• PHASE 3: Commitment – Loyalty VS. Betrayal

121
The Physiology of Falling In Love
DHEA (dehydro-epi-androsterone)
• natural amphetamine high
• readiness for sex
• mind is going fast

122
Pheromones
• sex scents
• smell
• attraction
• intoxication

123
Oxytocin
• touch
• cuddle hormone
• bonding
• reduces fear
• reduces good judgment

124
PEA (phenyl-ethyl-amine)
• spikes at ovulation
• regulates approach, romance
• love at first sight
• magnetic pull of limerence

125
Estrogen
• softness
• receptivity

126
Testosterone
• aggressive sexual desire
• lust
• seeking novel sex

127
Serotonin
• emotional sensitivity
• dampens irritability

128
Dopamine
• excitement
• pleasure
• risk taking
• anticipation of reward
• something wonderful is about to happen

129
Progesterone
• sedating
• calming
• needs to be inhibited

130
Prolactin
• reduces aggression
• increases nurturance

131
Vasopressin
• monogamy molecule
• aggressive possessiveness in males

132
133
Trust is Built by

• “Attunement;” Being There For One Another

• Repairing When Communication Gets Messed Up. Fully

“process” negative feelings/events

• Fairness

134
Will You Be There For Me?
Can I Talk To You?
Will You Listen and Empathize?

135
Six “Emotional Command” Systems (Panksepp)
1. Explorer (Seeking, adventure, learning together)
2. Sentry (Safety, reducing fear)
3. Nest Builder (Emotional closeness, give/receive care)
4. Jester (Fun, humor, surprise, play)
5. Commander-in-Chief (Power, dominance, fairness)
6. Sensualist (Sensuality, orgasm)
136
Trust is Built by

• “Attunement;” Being There For One Another

• Repairing When Communication Gets Messed Up. Fully

“process” negative feelings/events

• Fairness

137
When One Partner Turns Away

“NOT FULLY PROCESSED”

• Regrettable incident sits between partners, festers
• Feels like a stone in your shoe
• Rumination on unprocessed, unfinished negative affect
events. (ZEIGARNIK EFFECT)

138
When One Partner Turns Away

“FULLY PROCESSED”
• Repaired regrettable incidents
• Aftermath of a Fight or Regrettable Incident

139
Build Trust – “ATTUNE”

A = Awareness Of Partner’s Emotions

T = Turning Toward
T = Tolerance
U = Understanding
N = Non-defensive Responding
E = Empathy
140
Trust is Built by

• “Attunement;” Being There For One Another

• Repairing When Communication Gets Messed Up. Fully

“process” negative feelings/events

• Fairness

141
Fairness Metric
• Gottman & Murray mathematical modeling power equity
• Trust occurs more easily when there is equal power
between partners

142
Will you make a life-long commitment to me?
- OR -
Will you keep making negative comparisons between me and
real or imagined alternate partner?

143
THE GERM OF DISTRUST IS NOT THE SAME AS THE
GERM OF BETRAYAL
That’s why there are 3 phases of love instead of 2.

144
What begins the cascade toward betrayal?

NEGATIVE COMPARISONS

145
What is a NEGATIVE COMP? (Caryl Rusbult)
• UNFAVORABLY judging a behavior exchange
• Comparing it with real or imagined alternatives
• “I can do better with somebody else”

146
“GERM OF BETRAYAL”
• NEGATIVE COMP: “I CAN DO BETTER”
• Turning away from partner’s need

147
Shirley Glass, Not Just Friends

Took affairs out of the pulpit and into the clinical and social
psychology laboratory.

148
The 24-Step Gottman-Rusbult-Glass (GRG)
Cascade Toward Betrayal

149
1. Turning away or against
2. NEGATIVE COMPs with turning away/against
3. Not “there for me” (turning away 86%). Emotional
distance
4. More Flooding occurs w/ negative events.
5. Conflict absorbing state. Repair does not work.
6. Blow-ups. Avoids conflict. Suppresses negative affect.
150
7. Avoids self-disclosure. Secrets; deception
8. Bidding for attunement declines.
9. Invest less in relationship. Loneliness increases.
10. Less dependency on relationship to get needs met.
Confiding in others, not partner.
11. Less sacrificing. SUBSTITUTING (find what’s not there
elsewhere).

151
12. Maximizing partner’s negative traits. Defensiveness
begins.
13. Minimizing partner’s positive traits. Criticism begins.
Takes no responsibility for problems.
14. “Trashing” versus “cherishing”. Contempt begins.
Shared Meaning erodes.
15. Trashing partner to others. Story of Us goes negative.

152
16. Builds resentment. Sees partner as SELFISH.
Stonewalling starts.
17. More loneliness. Vulnerability to other relationships
starts.
18. Partner refusing sex becomes punishing. Low sexual
desire. Porn use may increase.

153
19. Less pro-relationship, more anti-relationship thoughts
20. Starts innocent new secret liaisons.
21. Reverses “walls & windows” (Shirley Glass). Fence
between self and partner
22. Keeping more and more secrets from partner. Deception
increases.

154
23. Actively turning toward others for needs. Seeking what’s
not in relationship.
24. Crossing boundaries. Real betrayal unfolds. Deception
becomes way of life. Risky.

155
ATONE-ATTUNE-ATTACH Therapy:
Healing From an Affair

156
ASSESSMENT
• Session 1: Couple’s narrative, Oral History, conflict sample,
Gottman Questionnaire package
• Session 2: Individual interviews. No secrets
• Session 3: Feedback

157
• Talk about PTSD
• Make sure affair is really over, or don’t do therapy
• May need individual sessions with betrayer about grief in
losing affair partner. Express empathy.
• Every level of SRH destroyed.
• Marriage #1 is over. Build Marriage #2
• Outline overall therapy to clients
158
PHASE 1: Atone
• Explain, explore hurt partner’s PTSD.
• Hurt partner asks any questions s/he wants about affair(s)
• Betrayer answers honestly
• Encourage betrayer to avoid sex-related questions; can
worsen PTSD
• Spend as much time as betrayed person needs
• Do NOT examine why affair happened in this phase
159
Listening To Hurt Partner’s Emotions
• Encourage to discuss affair in session at first
• “Voice dump” on therapist’s voicemail or in journal.
• Expressing negative emotions okay, but not Four
Horsemen

160
Explore Atonement Needs

• What kind of atonement does hurt partner need?

• What kind of transparency does hurt partner need?

161
Tools for Atone Phase

• Gottman-Rapoport Intervention
• Dealing With Flooding (diffuse physiological arousal)
• Antidotes for the 4 Horsemen
• Questions Regarding Affair (created by betrayed partner)
• Recognizing hurt partner’s PTSD reactions

162
Tools for Atone Phase

• Dan Wile Intervention

• Expressing needs card deck
• Giving appreciations card deck
• The stress reducing conversation
• Open-ended questions card deck

163
PHASE 2: Attune
• Build Marriage #2
• Open-Ended questions
• Expressing Needs
• Explore other Regrettable Incidents
• Process conflict differently
• Turn towards, rituals of connection, how to honor each
other
164
PHASE 3: Attach
• Intimate conversation w/ GottSex Kit.
• Hurt partner in charge of timing.
• Re-build new shared meaning system.

165
CASE PRESENTATION – ROSE & DAVID

166
• Substance misuse causes more deaths/disabilities per
year in U.S. than from any other cause
• About 17.4 million Americans have alcohol problems, 1/12
adults; 1/3 women
• Death rates for women 50-100% higher than men
• About 5 – 6 million Americans have drug problems
• > 50% all adults have family history

168
Impact of Addiction
• Alcoholic families as more troubled than nonalcoholic
families:
• boundaries, adaptability, cohesiveness, interactional
patterns, distribution of power
• Separation & divorce rates 4x higher than general
population

169
DSM-V
• “Addiction” now used in diagnosis
• Gambling disorder under behavioral addiction
• Craving added as category
• Early Remission: at least 3 months sobriety but less than
12 months
• Sustained Remission: at least 12 months
• Distinction btw abuse and dependency removed
• Substance Use Disorder
170
American Society of Addiction Medicine (ASAM)
• Primary, chronic disease of brain reward, motivation,
memory, and related circuitry
• Biopsychosocial-Spiritual Model
• Characterized by cycles of relapse and remission
o Durable recovery = 4-6 years of continuous sobriety.
o 15% will relapse
o 60% will remit some time for at least a year
171
American Society of Addiction Medicine (ASAM)
“Addiction is characterized by inability to consistently
abstain, impairment in behavioral control, craving, diminished
recognition of significant problems with one’s behaviors and
interpersonal relationships, and a dysfunctional emotional
response.”

172
Biopsychosocial-Spiritual Model of Addiction
• Addiction as a brain disorder
• Dopamine hypotheses
• Genetic predisposition
o 89 genes linked to substance dependence
• Environmental factors

173
174
 Precursor
= vesicle
= neurotransmitters
Synthesis
= receptor
Storage Degradation

Reuptake
Release

Synaptic
Cleft

175
176
177
178
 COCAINE
Accumbens
400

DA
300
DOPAC
HVA
% of Basal Release

200

100

0
0 1 2 3 4 5 hr
Time After Cocaine
179
 Accumbens
AMPHETAMINE
1100

1000

900

800
DA
700 DOPAC
% of Basal Release
600 HVA

500

400

300

200

100

0
0 1 2 3 4 5 hr

Time After Amphetamine

180
Dopamine D2 Receptors are Lower in Addiction
Cocaine DA D2 Receptor Availability

Control Addicted
181
Dopamine D2 Receptors are Lower in Addiction
Methamphetamine DA D2 Receptor Availability

Control Addicted
182
Dopamine D2 Receptors are Lower in Addiction
Alcohol DA D2 Receptor Availability

Control Addicted
183
Dopamine D2 Receptors are Lower in Addiction
Heroin DA D2 Receptor Availability

Control Addicted
184
Circuits Involved In Drug Abuse and Addiction

185
Implication:
Brain changes resulting from prolonged use of drugs can
compromise mental and motor functions

186
Edwards & Steinglass (1995). Family Therapy
Treatment Outcomes for Alcoholism.
• Involving family unequivocally effective in motivating
alcoholics into treatment
• Family therapy not proven effective in primary treatment
when follow-up is taken past one year

187
Humphreys, Moos, & Cohen, 1997. Long-Term
Recovery Study.
• Short-term interventions have little long-term impact

• At 8-year follow-up family relationship quality appears most

predictive

• AA participation in first 3 years increased likelihood of

remission at 8 years
188
Behavioral Couples Therapy (BCT)
• O’Farrell, McCrady, Epstein and Fals-Stewart
• Primary objectives
o Eliminate abusive drinking and drug abuse.
o Engage in the family’s support for the patient’s efforts to
change.
o Change couple and family interaction patterns in ways
conducive to long-term stable abstinence and a happier,
more stable relationship.
189
Advantages
• Short-term outcome studies: positive
• Fits well w/ 12-step, other self-help groups, medication
• Some specific strategies consistent w/ GMCT
o Increasing positivity
o expressing needs
o problem-solving (solvable)
o soft start 190
Limitations
• Abstinence as primary goal; co-addiction and relationship
recovery not addressed
• Not an affective-based therapy

191
Interpreting Risk
One drink =
• 12 oz. beer or cooler
• 8-9 oz. malt liquor
• 5 oz. table wine
• 3-4- oz. fortified wine (sherry or port)
• 2-3- oz. cordial, liqueur, or aperitif
• 1.5 oz. of spirits (80-proof spirits) 192
Moderate or Low Risk Drinking
Men (less than 65 years age):

• No more than 14 drinks/week

• No more than 4 drinks on a given day in a week

• or 5 drinks in any given day.

193
Moderate or Low Risk Drinking
Women (less than 65 years age):

• No more than 7 drinks/week

• No more than 3 drinks in any given day

194
Binge Drinking

Reaching blood alcohol level (BAL) 0.08g/dl in 2 hrs

• Men = 5 drinks

• Women = 4 drinks

195
Addiction Assessment
• Quantity and frequency
• When first tried substance
• Pattern of use
• Tolerance?
• Date of last use
• Date of longest abstinence from substance of choice
• Legal/financial/health problems? 196
Brief Michigan Alcoholism Screening Test (b-MAST)
• Consistent, quantifiable interview screening instrument
to detect alcoholism.
• Widely used as screening device for alcoholism and in
research; not final diagnostic tool
• Unaffected by age and “fake good” self-report measures
• Effective instrument in assessing problem drinking
severity. (Connor, Grier, Feeny, Young, 2007)
197
CAGE:
1. Have you ever tried to cut down on____?
2. Have you ever annoyed when someone has expressed
concern about your use?
3. Have you ever felt guilty about your use?
4. Have you ever had a morning eye opener? (Started the
day with the substance)

198
Feedback Session
• Always address substance concerns in feedback session
• Consider referrals for further assessment
• Couples work effective in moving alcoholics into treatment
• Discuss treatment goals w/in SRH framework, including
substance use as a possible gridlocked problem

199
SRH in Active Addiction
• Love Maps: Hidden lives
• Fondness System: Primary relationship w/ alcohol
• Turning Toward: Alcohol central organizing principle
• Negative Perspective: Often w/ shame & guilt
• Conflict System: Gridlocked, avoidance, denial
• Meaning: Rituals around drinking, alcoholic legacies
Couple Recovery Typology
• Type 1: Both partners in recovery, but in separate recovery
programs. (2nd order change)

• Type 2: Only one partner in recovery

• Type 3: Neither in recovery. (“Dry drunk”, “white knuckle

sobriety”)

201
Key Findings
• Recovery long-term dynamic process.
• Collapse of active alcoholism family system is a
prerequisite
• Destabilization continues after sobriety begins
• Families are traumatized
• Change occurs slowly and over time.
• Identification of Family Recovery Typology.
202
A Relational Approach to Addiction Recovery

Three level of recovery addressed concurrently:

1. Alcoholic’s recovery
2. Co-alcoholic’s recovery
3. Couple recovery: interdependency antidote to co-
dependency

203
Couple Recovery Development Approach

• Recovery is a relationship issue

• Intergenerational Reworking (internal working model)
• Interdependency (expressing needs)

204
General Treatment Philosophy and Strategies (p.
13-15)
• Friendship System
• Conflict System
• Meaning System
• Ongoing Recovery
o PTSD
o codependency (control) vs interdependency (support,
concern) 205
Post Traumatic Stress Disorder (PTSD)
Section 13.4.

206
Love Maps
• Cut off from emotions, self-awareness, needs, values
• May feel threatened by telling others needs, feelings
• May be vague with partners with what happened
• Guilt, shame from war
• Creates emotional distance

207
Fondness and Admiration
• Can’t take in positive regard
• Accepting fondness, admiration = “go ahead” for sex,
danger
• Expressing positive feelings makes PTSD partner
vulnerable to hurt, rejection
• Criticism becomes defense to create distance

208
Turning Towards / Away / Against
• Cut off from own needs
• Perceives turning towards as dangerous
• Turning Away / Against in more acute cases

209
Accepting Influence
• Accepts all influence (“doormat”) to avoid punishment,
abuse
• Hyper-controlling – remain in control
• Inappropriate trust

210
Managing Conflict
• No gentle start-up
• Criticism
• Good at repair – controlling partner’s anger
• Flooding
• Disassociation

211
Gridlocked Conflict
• Sex abuse history – sex is gridlocked issue
• Incest history – committed partners take place of “family”

212
Shared Meaning
• Values, meaning unknown to self
• Dreams, hopes opposite from experience of helplessness,
powerlessness
• Living without a sense of purpose

213
Treating
• Build trusting alliance
• Don’t force them to tell their story too soon
• Eventually having them tell story in any way they can
• Story is told to partner

214
PTSD Case Presentation

215
• 67% couples in couples’ therapy have had violent episode
(O’Leary)
• 1/3 have had a violent episode before commitment
• Some studies suggest 50% have had domestic violence
• Most are probably situational not characterological

217
“Battery is a form of abuse where the primary aggressor
employs violence ranging from pushing to relationship rape,
to homicide, to enhance the aggressor’s control over the
partner, leading the partner to modify their behaviors in daily
life. It is meant to instill fear and intimidation.”
- Ann Ganley (1989)

Couples therapy is inappropriate

218
Jacobson & Gottman Study

Situational Violence vs. Characterological Violence

219
Situational Violence
• Conflict escalated out of control.
• Minor injuries.
• Does not involve control or dominance.

220
• 80% situational, 20% characterological. (Jacobson-
Gottman)
• Police reports bear these 80/20 % estimates out.
• Characterological incidents get media attention, victims
show up in shelters.
• Couples therapy is against the law after DV incident in
most states.

221
• Women started altercation 71% of the time (Dutton, 1995)
• Men cause much more harm than women
• DV in same-sex couples
• Does not escalate to characterological domestic violence
• Does not involve control or dominance.
• No fear.
• Showed remorse, understood impact, internalize blame,
wants to change
• Violence is reciprocal - No clear perpetrator or victim.
Characterological Violence

• Asymmetrical with a clear perpetrator and victim.

• Controlling, dominating behavior, or belligerence.
• Little remorse, blames victim.
• Victim has no control over perpetrator or violence.
• Victim fears perpetrator.

224
Characterological Violence

• TWO TYPES: Pit Bulls or Cobras (Gottman & Jacobson)

• Cobras typically violent in all aspects of life.
• Pit Bulls typically violent to intimate partner only.
• Shelter victims mostly victims of either Pit Bulls or Cobras.

225
Pit Bulls

• Major fears of abandonment

• Extremely jealous
• Suspicious of partner becoming independent; keep
partner socially isolated
• Domineering
• Condescending and lecturing

226
Pit Bulls

• Lead with forehead

• Anger builds gradually when getting more belligerent and
contemptuous
• Pulse rate slowly increases w/ anger; high when they
strike

227
FILM

Pit bull

228
Cobras

• Violent in relationships outside the couple’s relationship

• Power and Control
• Uses fear and intimidation to get power and control
• Lead with chin
• Begins w/ high levels of belligerence; provocative,
domineering

229
Cobras

• Look threatening from beginning, not appear calm

• Heart rates would drop before they strike
• Charming, highly manipulative, seductive
• Can use weapons to threaten victims and often surprise
them
• No remorse

230
FILM

Cobra

231
Couples Therapy Contraindications

• Avoids responsibility for abuse

• Blames victim
• Minimizes the violence
• Severe injury

232
Other DV Information
• Husband to wife violence 3x higher in binge drinkers.
• SES more a factor than race.
• Prejudice and racism issues in early studies

233
History of Treatment For DV
• Julia Babcock’s meta-analysis.
• All male group interventions had no different success rates
than arrest alone.
• Yet these treatments are mandated by law in many states
in USA. Couples’ treatment is mostly illegal!

234
Couples Treatment for DV?

• Concern that couples’ treatment w/ characterological DV

holds victim responsible. Victim has no control over
violence.
• Most states mandate NO COUPLES’ TREATMENT FOR
DV (Babcock, Green, & Robie 2004)
• No distinction between situational and characterological
DV in most agencies.
235
Duluth Treatment Model
• Based on psycho-educational/feminist principles.
• Treatment aimed at men, teaching about role/rights of
women.
• Change men’s social values about women

236
Duluth Treatment Model
• Has NO effect on recidivism after a 5 year follow-up
• 1/3 to 1/2 of all batterers drop out after first session.
• Only 1/2 of those remaining after first session complete
full treatment.

237
Cognitive-Behavioral Groups

• Skills training, anger management, time outs, deep

breathing, etc.
• Don’t work over the long run.
• Don’t deal w/ emotions of perpetrators (shame, fear of
abandonment)

238
Stosny’s Compassion Groups
• Feelings were a focus of treatment
• No follow-up by research.

239
Stith, Rosen, & McCollum:
Group Couples Treatment for DV Study
• Solution-focused treatment
• Male recidivism rates 25% for experimental vs 67% for
control group.
• Couples’ group or just usual couples’ therapy equally
effective.

240
Emotional Abuse Considerations

• Characterological Emotional Abuse just as damaging to

victim over a long period of time.
• Sometimes move from physical to emotional abuse
• Physical abuse no longer necessary, victim already beaten
down.

241
Victim Safety Plan

• Develop safety plan

• Copies of any important papers, account numbers,
anything needed in order to disappear.
• Hide clothes, money, etc. for immediate escape if needed
• Establish a safe, unknown place to hide
• Go w/o warning to a safety shelter

242
Can We Screen Out Characterological DV?

• CTS2
• Intimate Justice Scale
• Fear of Partner (see Chapter 9, page 35)
• Social Control of Partner (see Chapter 9, page 35)

243
Our Theory About Situational DV

1. Lack of social skills in expressing needs and dealing w/

conflict
2. Flooding (DPA) plays a major role in escalation toward
physical violence.

244
Couples Together Against Violence (CTAV)

• Teach information and skills needed to succeed as a

couple and family
• Small group model; community (prevent attrition)
• Foster respect
• Counteract shame and disrespect expected from authority
figures by lower-income people.
• Give couples sense of pride in making it as family.
245
Couples Together Against Violence (CTAV)
• Conflict Management
o Flooding
o Four Horsemen
o Repair Checklist
• Increase Friendship
• Deepen Shared Meaning
246
Adapted CTAV for RRI study

• Focus more heavily on conflict management.

• Manage emotional flooding via physiological soothing.
• Develop rituals for withdrawing from escalating conflict.
• Mechanisms for ensuring safety.
• Useful for broader population of couples with children.

247
• Each module starts w/ 15-minute video that week’s topic.
• Videos help couples feel less alone with their struggles and
triumphs, and lead to self-disclosure.
• Group discussions weave couples together into supportive
communities.

248
• Topics included:
o preventing harmful fights
o avoiding domestic violence
o healing from infidelity
o building friendship and intimacy
o creating positive legacies for their children
• Information provided in straightforward, clear language.
• Followed by skill-building exercise to teach couples skills of
successful relationship.
249
• Before every exercise couples use
Emwave (HeartMath)
• Biofeedback device that helps
teach physiological self-soothing.
FILM

Collage Video

251
CTAV Content Areas And Modules

• Preserving Intimacy
• Managing Conflict
• Creating Shared Meaning
• Managing Stress
• Fathers, Marriage, and Parenting

252
CTAV Intimacy Core Modules

• Stay Close
• Have Close Conversations
• Express Needs
• Turn Toward, Not Away
• Magnify and Savor Positive Emotions
• Building a Culture of Respect and Appreciation
253
CTAV Intimacy Core Modules

• Build Passion and Good Sex

• Heal Old Wounds, including 1) Feeling Proud of Ourselves,
and 2) I am my Family’s Protector
• Prevent and Recover from Infidelity

254
CTAV Managing Conflict Core Modules

• Prevent Harmful Fights

• Compromise
• Self-Soothe, including Em-Wave Biofeedback Training
• Manage Anger (Your Own and Others’)
• Have Recovery Conversations After A Fight

255
CTAV Managing Conflict Core Modules

• Know When Endless Fights Turn Harmful

• Avoid And Heal Violence 1- Recognize when you are
Heating Up
• Avoid and Heal Violence 2 - Avoiding Domestic Violence is
Everyone’s Responsibility
• Edit Out Negativity and Accept Influence

256
CTAV Shared Meaning Core Modules

• Honor Your Partner’s Dreams

• Connect Emotionally – Create Rituals of Connection

257
RESULTS

• Males in treatment group more successful to physiologically

self soothe during conflict discussions.
• Males in control group showed significantly greater heart
rate reactivity over time.

258
RESULTS

• Treatment group - IPV reduced over time,

• Essential that couples stay in group for entire program.
• Couples who dropped out did not improve, did not change
on IPV.

259
Who Learned the Social Skills? Who Didn’t?

• Couples who learned skills were:

o MORE VIOLENT
o MORE UNHAPPILY MARRIED
o LOWER IN AFFECTION
o MORE HOSTILE based on scored videos of conflict
o Effects even stronger for men, which is very good.

260
RESULTS

Male Hostile
Behavior

261
RESULTS
Treatment couples:
o Higher relationship satisfaction
o Lower conflict than control couples.
o Effects lasted on 18-month follow-up.
o Significant improvements in Friendship and Shared
Meaning
o Greater parenting alliance
262