Adult Treatment Planner

Objectives and Interventions

• Attend and actively participate in conjoint sessions with the partner.
  • Facilitate conjoint sessions that focus on increasing the clients' communication and problem-solving skills.
• Complete psychological testing designed to assess and track marital satisfaction.
  • Administer a measure of marital satisfaction to assess areas of satisfaction and dissatisfaction and/or to track treatment progress (e.g., The Dyadic Adjustment Scale by Spainer or Marital Satisfaction Inventory - Revised by Synder).
• Identify the positive aspects of the relationship.
  • Assess the couple's positive behaviors that facilitate relationship building.
• Identify problems in the relationship including one's own role in the problems.
  • Assess current, ongoing problem behaviors in the relationship, including possible abuse/neglect, substance use, and those involving communication, conflict-resolution, problem-solving difficulties (if domestic violence is present, plan for safety and avoid early use of conjoint sessions; see "Physical Abuse" in The Couples Psychotherapy Treatment Planner by O'Leary, Heyman, and Jongsma).
  • Assign the couple a between sessions task recording in journals the positive and negative things about the significant other and the relationship (or assign "Positive and Negative Contributions to the Relationship: Mine and Yours" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma); ask the couple not to show their journal material to each other until the next session, when the material will be processed.
• Make a commitment to change specific behaviors that have been identified by self or the partner.
  • Process the list of positive and problematic features of each partner and the relationship; ask couple to agree to work on changes he/she needs to make to improve the relationship, generating a list of targeted changes (or assign "How Can We Meet Each Other's Needs" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma).
• Increase the frequency of the direct expression of honest, respectful, and positive feelings and thoughts within the relationship.
  • Assist the couple in identifying conflicts that can be addressed using communication, conflict-resolution, and/or problem-solving skills (see "Behavioral Marital Therapy" by Holzworth-Munroe and Jacobson in Handbook of Family Therapy by Gurman and Knickerson [Eds.]).
  • Use behavioral techniques (education, modeling, role-playing, corrective feedback, and positive reinforcement) to teach communication skills including assertive communication, offering positive feedback, active listening, making positive requests of others for behavior change, and giving negative feedback in an honest and respectful manner.
  • Assign the couple a homework exercise to use and record newly learned communication skills; process results in session, providing corrective feedback toward improvement.
• Learn and implement problem-solving and conflict resolution skills.
  • Assist the couple in identifying conflicts that can be addressed using communication, conflict-resolution, and/or problem-solving skills (see "Behavioral Marital Therapy" by Holzworth-Munroe and Jacobson in Handbook of Family Therapy by Gurman and Knickerson [Eds.]).
  • Use behavioral techniques (education, modeling, role-playing, corrective feedback, and positive reinforcement) to teach the couple problem-solving and conflict resolution skills including defining the problem constructively and specifically, brainstorming options, evaluating options, compromise, choosing options and implementing a plan, evaluating the results.
  • Assign the couple a homework exercise to use and record newly learned problem-solving and conflict resolution skills (or assign "Applying Problem-Solving to Interpersonal Conflict" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma); process results in session.
• Identify any patterns of destructive and/or abusive behavior in the relationship.
  • Assess current patterns of destructive and/or abusive behavior for each partner, including those that existed in each family of origin.
  • Ask each partner to make a list of escalating behaviors that occur prior to abusive behavior.
• Implement a "time out" signal that either partner may give to stop interaction that may escalate into abuse.
  • Assist the partners in identifying a clear verbal or behavioral signal to be used by either partner to terminate interaction immediately if either fears impending abuse.
  • Solicit a firm agreement from both partners that the "time out" signal will be responded to favorably without debate.
  • Assign implementation and recording the use of the "time out" signal and other conflict resolution skills in daily interaction (or assign "Alternatives to Destructive Anger" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma).
• Identify and replace unrealistic expectations for the relationship.
  • Identify irrational beliefs and unrealistic expectations regarding relationships and then assist the couple in adopting more realistic beliefs and expectations of each other and of the relationship.
• Increase flexibility of expectations, willingness to compromise, and acceptance of irreconcilable differences.
  • Teach both partners the key concepts of flexibility, compromise, sacrifice of wants, and acceptance of differences toward increased understanding, empathy, intimacy, and compassion for each other.
• Increase time spent in enjoyable contact with the partner.
  • Assist the client in identifying and planning rewarding social/recreational activities that can be shared with the partner (or assign "Identify and Schedule Pleasant Activities" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma).
• Initiate verbal and physical affection behaviors toward the partner.
  • Encourage increased use of verbal and physical affection, and address resistance surrounding initiating affectionate or sexual interactions with the partner.
• Participate in an evaluation to identify or rule out sexual dysfunction.
  • Gather from each partner a thorough sexual history to determine areas of strength and to identify areas of dysfunction (see Female Sexual Dysfunction and Male Sexual Dysfunction chapters in this Planner).
  • Refer the client to a specialist for a diagnostic evaluation of sexual dysfunction (e.g., rule-out of organic and psychogenic factors), with recommendation for appropriate treatment (e.g., medication, sex therapy, surgery).
• Commit to the establishment of healthy, mutually satisfying sexual attitudes and behavior that is not a reflection of destructive earlier experiences.
  • In a conjoint session identify sexual behavior, patterns, activities, and beliefs of each partner and the extended family (or assign "Factors Influencing Negative Sexual Attitudes" in Adult Psychotherapy Homework Planner, 2nd ed. by Jongsma).
  • Assist each partner in committing to attempt to develop healthy, mutually satisfying sexual beliefs, attitudes, and behavior that is independent of previous childhood, personal, or family training or experience.
• Acknowledge the connection between substance abuse and the conflicts present within the relationship.
  • Explore the role of substance abuse in precipitating conflict and/or abuse within the relationship.
• Chemically dependent partner agrees to pursue treatment and seek clean and sober living.
  • Solicit an agreement for substance abuse treatment for the chemically dependent partner (see Chemical Dependence chapter in this Planner).
• Identify the message, cause, and consequences of the partner's infidelity.
  • Assist the couple in identifying the message behind the infidelity (see "Five Degrees for Affairs" in Patterns of Infidelity and Their Treatment by Brown).
  • Assign the clients to read After the Affair (Abrahms-Spring) and then process key concepts gathered from the reading in conjoint sessions with the therapist.
• Verbalize acceptance of the loss of the relationship.
  • Explore and clarify feelings associated with loss of the relationship.
  • Refer the client to a support group or divorce seminar to assist in resolving the loss and in adjusting to the new life.
  • Assign the client to read How to Survive the Loss of a Love (Colgrove, Bloomfield, and McWilliams) or Surviving Separation and Divorce (Oberlin); process key concepts.
• Implement increased socialization activities to cope with loneliness.
  • Support the client in his/her adjustment to living alone and being single; encourage him/her in accepting some time in being alone and in making concrete plans for social contact.
  • Inform the client of opportunities within the community that assist him/her in building new social relationships.