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Psychologist
explains couples therapy model
(July 2005
Issue)
Couples therapy is a vastly underserved area in psychology, according
to Jim Donovan, Ph.D., an assistant clinical professor of psychology
at Harvard Medical School and staff psychologist at Harvard Vanguard
Medical Associates in Wellesley, Mass. And ironically, it's an area
in which mostly everyone has personal experience.
Nearly 30 years ago, when he first came to Harvard Vanguard to
do couples therapy, Donovan found that, while there was plenty of
research and there were long-term models to imitate, nothing would
fit within the short-term setting that the medical center needed.
In response, he developed a short-term model based on the existing
longer models.
Donovan, who also has a private practice in Chestnut Hill, recently
wrote a book about his work. "Short-term Object Relations Couples
Therapy: The Five-Step Model" is an explicit look at how the short-term
therapy is done. His plan, he says, is to help others who would
like to work in couples therapy but have nowhere to go for information
on just how. He spoke with New England Psychologist's Catherine
Robertson Souter about his book and how he hopes to expand the practice
of couples therapy.
Q: What inspired you to do this book?
A: I had edited an earlier book called "Short Term Couple Therapy"
that included chapters by some of the significant people in the
different areas of couples therapy. That led me to think, 'Why don't
I expand on my chapter and explain more?' People don't do enough
couples therapy - 40 percent of mental health referrals involve
a relationship problem. Couples problems are important mediating
variables in the treatment of depression and alcoholism and rehabilitation
from physical illness. Probably only 10 percent of the therapy that
is done is in couples work. So, there is a significant imbalance.
Q: Why?
A: I think it has to do with a number of factors; one being
that couples fight. Most couples come in because of one repetitive
fight. It's one fight but they have it hundreds of times. People
are very angry with each other and it's distressing to deal with
as a therapist. I think therapists often don't want to wade into
that kind of conflict and they may also be inhibited about prying
into someone else's marriage, almost as if it's their parents' marriage.
Couples therapy also calls for the therapist to be more active
because you have to stop the fight. It's not a heavyweight bout.
Another reason is that people don't teach couples therapy and there
are not very many good books.
Q: So where do you learn it?
A: You read some of books that are available, try to get some
supervision and then you start and just wade into it. You learn
as you do it.
Q: How has the book been received?
A: I've been very pleased with the feedback that I've received.
One colleague said, "I didn't know anything about couples therapy.
I read the book and now I get how you would do it." That made me
very happy. I tried to write the book that I would have wanted to
read when I was starting in the field, when it was hard to find
a book like this one.
Most books about psychotherapy don't tell you how to do psychotherapy.
Some represent struggles to prove that their approach is better
than others or is at least a good one. They are very interesting
but I don't think that essential theoretical debates are as valuable
here. Very few go into describing exactly what you do in the first
session, the second session, etc. My point is if you're going to
write a book, let's tell people how to do it.
This book is about one approach to couples therapy although I include
other points of view. A friend of mine says that every medical treatment
works for someone, so it is meaningless to try to prove that one
approach is better. So, if my colleagues have suggested a variant
approach to a problem I included that.
Q: How did you yourself get involved in couples therapy?
A: When I started out, it just seemed that there was a need
for it. I started without any background at Harvard Vanguard 32
years ago. Harvard Vanguard at that time was a very open, experimental
place and you could try different approaches. It was in the early
'70s and we were trying a lot of new things and some of them turned
out to be really valuable.
The therapy is based on object relations therapy. The essence of
object relations therapy is to understand what expectations we bring
to an intimate relationship and how it is influenced by earlier
relationships we have had. Object relations therapy has to do with
what kinds of relationships we form so it is very appropriate for
couples work
I am not the first to do object relations couples therapy. But
I am the first to do it in a short-term model. One of the exciting
contributions that Harvard Vanguard made is to adapt models that
are used in other places to short term work and my contribution
is in that same area.
Previously, the assumption was that it couldn't be applied in a
short-term practice but we tried it and found that it could. It
does work. That's not to say my approach is better just that you
can accomplish a lot by taking models and rearranging them and applying
them to short-term therapy.
Q: What needs to be changed to turn them into short-term models?
A: The two differences are you must be focused to do short-term
work. You must decide what you are going to concentrate on and dismiss
everything else. I found that couples therapy fits this criterion
very well because every couple comes in with their fight and if
you focus on the fight you'll be able to do the work effectively.
Every week, the job is to unravel their fight and keep it from destroying
their marriage.
Secondly, you need to be more active. You may find yourself doing
things that can be quite surprising. You find yourself interrupting
and making a lot of suggestions about what they might do. One of
the problems with couples therapy is that it can get away from you
and start the fight all over again. You need to get used to saying
"I don't mean to interrupt you," and then just interrupt the person
to bring it back to something that's more central. Sometimes people
are a bit appalled. You have to say, "I understand but I think its
more valuable to go in this direction." It's different than an open-ended
free association kind of therapy with a therapist who is kind of
quiet.
The nice thing about doing couples therapy is that people really
need the release. People come in because they are quite desperate
and they are very motivated. The level is high and you feel like
you are doing something important. Divorce is terribly upsetting
for people and if they have children, it's a nightmare.
Q: Are others doing it?
A: Some are. In my first book, all the practitioners that I
included have a well-worked-out, battle-tested, short-term approach.
They are not the same as mine but they are also very good. I do
more with delving into the past, the history of relationships.
Q: What recommendations do you have for other psychologists
who might be interested in the field?
A: Read a few of the books and then try it. Get some supervision
from experienced couples therapists if you can. The thing about
couples therapy is that, even without a lot of experience, you are
not going to do any harm. If you are careful and conscientious and
get supervision, you are not going to undermine the patients.
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