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F A L L
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Welcome to the
Gottman Connections Newsletter I S S U E
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In this Issue:
Hello Certified Gottman Clinicians!
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Breakthrough Research An article from Dr. John Gottman
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The Application of Gottman Theory to Collaborative Practice Michael Basta, L.C.S.W.
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Case Study #2 Working with a Couple when One Partner has Depression of PTSD
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Therapist Self-Care: An article from Peg Davies, MS, LMFT
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Why Should Therapists Use Social Media? A message from Michael Fulwiler, TGI Staff
Batia Gottman, Director, Professional Development
We’re excited to bring you this Fall 2012 second edition of the Gottman Connections Newsletter! First things first – there is cutting edge research for you to review. Let me call your attention to an article on page 2 by Dr. John Gottman titled “Announcing Breakthrough Research in the Treatment of Characterological Domestic Violence using Gottman Interventions.” In addition to TGI’s mission of providing the best training possible in the Gottman Method, the Professional Development Department’s goal is to support our therapists in pursuing their own professional goals as we seek to disseminate the method worldwide. To that end, we’ve tried to think creatively and provide you with articles on a variety of topics to stimulate your reflection about your own career. Check out “The Application of Gottman Theory to Collaborative Practice” by Michael Basta. He and his partner Marcia Gomez, both Certified Gottman Therapists, were invited by the Collaborative Council of the Redwood Empire to provide training on how the Gottman Method might be applied to this 20-year-old alternative to legal dispute resolution in the area of family law. Have you noticed that personal coaches are beginning to encroach on the couples’ therapy market these days? We certainly have. So here’s a thought for you: How about using their business model, and “coaching”
And much more…
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groups of people using the Gottman Method and teleconferencing? Take a look at this website, which demonstrates just such a model. Their teleconferences for support groups yield an hourly fee of close to $700 for the group leader. While we’re not advocating that you follow any particular model, we’re presenting some creative applications that might monetize your mental health expertise. Mike McNulty, Ph.D., LCSW provided this issue’s case study, which emphasizes the additional co-morbidities of depression and PTSD. Please read it and join our clinician’s Forum to confidentially discuss this case with your colleagues. These days it’s unwise to overlook the Internet as a serious marketing tool. If you haven’t sought to brand yourself on the Internet yet, you may be interested in the article “Why Should Therapists Use Social Media?” by Michael Fulwiler, TGI’s Director of Social Media Marketing. Michael makes a solid case for an Internet presence for your practice and yourself. In Psychotherapy Finances, the article “Facebook Ads Offer Targeted Alternative to Other Web Marketing” discusses the advantage of using targeted Facebook ads to drive people directly to your therapy website. The return on investment can be truly amazing. In the future, we’ll continue to feature web marketing as a means not only to increase your client numbers, but to create passive and residual income to free you from the business formula of hours worked = income. Courtesy of Bob Navarra, download a free PDF of Chapter 25, “Gottman Method Couple Therapy: From Theory to Practice,” by Robert J. Navarra and John Mordechai Gottman from the book “Case Studies in Couples Therapy: Theory Based Approaches,” made available to Bob by Routledge here. Rene Goldin, Psy. D., has written a thought provoking piece on using the Gottman Method to work with Hassidic couples who are in arranged marriages. These couples have only met for one hour when betrothed, and then spend their engagement in complete separation. How might the Sound Relationship House apply to them? Reba Connell, LCSW, who specializes in treating LGBTQI clients (lesbian, gay, bisexual, transgender, queer and intersex) presents a tongue in cheek treatment of fostering a couple’s bond in “Everything that was not David: Sculpting Emotional Connection in Gottman Method Couples Therapy.” Finally, CGT Peg Davies, MS, LMFT, discusses mindfulness techniques you employ when you feel yourself carried away emotionally during couples’ therapy in “Therapist Self-Care: Staying Grounded During Moments of Intensity.” TGI’s best and most vital resource is YOU, the clinician on the front lines, dedicated to using the Gottman Method in your mission to restore and repair relationships and families. My greatest pleasure is serving your needs and in turn hearing your energy and excitement as you are empowered by this eminently workable and scientifically grounded method. If you have an idea for an article you’d like to submit, please contact me, Batia Gottman, at bgottman@gottman.com. Or call me at 206-607-8716. We hope you enjoy this issue, and we wish you a joyful and productive autumn!
- BATIA
- Batia 2
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Breakthrough Research in the Treatment of Characterological Domestic Violence Using Gottman Interventions John Gottman, Ph.D This column of the Newsletter announces a recent breakthrough scientific achievement in the treatment of characterological batterers. The breakthrough was achieved and experiment conducted by Dr. Julia Babcock, Associate Professor of psychology at the University of Houston, and former graduate student of John Gottman and the late Neil Jacobson. The new intervention was designed by John Gottman using audiotapes that teach batterers how do “edit out negativity,” and “accept influence.” Both skills were shown to be two of the essential skills lacking in characterologically abusive men in Jacobson and Gottman’s earlier basic research (see Jacobson & Gottman’s book When men batter women). Researchers now agree that there are two different kinds of domestic violence, called “situational” and “characterological.” In situational domestic violence, both people play a role in the violence, and take some measure of responsibility for the violence. There is no clear victim or perpetrator in situational domestic violence. Violence that is situational results from arguments that get out of control. In characterological domestic violence, however, there is a clear victim and a clear perpetrator. Characterological perpetrators externalize blame and often expressed the attitude that the woman’s words were just as violent as their physical violence, and justified their violence. Sequence analysis of reports of arguments in the Jacobson & Gottman study showed that there was nothing that the wife did in characterological domestic violence to either start or end the violence. Estimates currently suggest that between 60 and 80 percent of all domestic violence is situational, and only 20 to 40 percent is characterological domestic violence. Recent anecdotal reports from military chaplains suggest that they are now seeing many cases of characterological domestic violence in which the female soldier is the perpetrator. Jacobson and Gottman’s book described two kinds of characterological domestically violent men, who they named the “pit bull” and the “cobra.” Most subsequent classifications of characterological domestic violence have confirmed that general breakdown of characterological domestic violence. The pit-bull was described as threatened by the woman’s attempts at independence, possibly motivated by a fear of abandonment, so violence was used to control the woman and socially isolate her. The pit-bull’s violence was confined to the wife. The pit-bull’s physiological arousal increased over baseline, becoming higher and higher as the conflict discussion progressed. The major behavioral pattern of the pit-bull perpetrator was domineering behavior and escalating blaming, criticism and contempt. The cobra was described as threatened by the woman’s attempts at trying to influence her husband even by making reasonable demands, possibly motivated by a fear of accepting influence, so violence was used to control the woman so she would stop trying to influence her husband. The cobra’s violence was not confined to the wife. The cobra’s physiological arousal decreased over baseline, staying low as the
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conflict discussion progressed. The major behavioral pattern of the pit-bull perpetrator was belligerence, threat, as well as escalating blaming, criticism and contempt. Babcock’s basic research to replicate this work supported some of Jacobson and Gottman’s findings, but not others. The pit-bull/cobra classification is still controversial. As further support for the situational/characterological distinction, Jacobson and Gottman also followed a group of situationally domestic violent couples for 9 years, and not one couple became characterologically violent, so it appears that situational domestic violence is stable, if left untreated. The two kinds of violence showed no overlap in their study. Babcock showed in a now famous meta-analysis paper that to date there are NO successful same-sex group treatments for any kind of male batterer that are more successful than just one arrest. In that review of the research studies on the efficacy of batterers’ intervention programs, Babcock found the results disappointing. There was a very small change when a perpetrator completed a batterers intervention program and only a 5 percent reduction rate in repeat offenses. “There is definitely a need to improve batterers’ intervention programs, since research suggests that they’re largely ineffective, but frequently prescribed by courts as a remedy for convicted IPV perpetrators,” said Babcock. Babcock’s research focuses on male batterers because men are the perpetrators in about 85 percent of the abuse cases, and women are 10 times more likely to be murdered by an intimate than are men. Despite the inadequacy of these male-only group treatments, in 31 states in the Union couples treatment for domestic violence is illegal. This is true despite the fact that the ONLY successful treatments for situational domestic violence are couples treatments. One landmark study using solution-focused therapy was conducted by Sandra Stith. Her couples’ intervention is described in a recent book on a couples’ treatment for domestic violence. She screens out characterological perpetrators. A very recent second highly successful intervention for treating situational domestic violence was done in a randomized clinical trial in the Gottman Relationship Research Institute (RRI) laboratory. That intervention was designed by both Drs. John and Julie Gottman. That study also employed a more quantitative questionnaire method for screening out characterological perpetrators designed by John Gottman at the RRI. Stith’s intervention totally avoids discussing emotion, dealing with physiological arousal, or teaching social skills for managing conflict, while the Gottmans’ intervention is emotion-focused, teaches social skills for dealing with conflict and intimacy, and uses the Heart Math’s emwave biofeedback device for down-regulating physiological arousal. Surprisingly, both interventions appear to be effective in eliminating situational domestic violence and are effective at long-term follow up. The acceptance of a couples’ treatment for situational domestic
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violence will take some time because the field has become highly political. Advocates against a couples’ treatment argue that all domestic violence is the fault of men, and a couples’ treatment blames the innocent female victim. That argument makes sense only for characterological domestic violence, which form of domestic violence appears to dominate most women’s shelters.
1) a time out; 2) a request to edit out the negative, where he makes the same points in a more neutral fashion; or, 3) a request to accept influence, where he listens to the female’s ideas, trusts that the partner may be right and validates her idea even if his idea is different. The male batterer was taught these communication skills then asked to use them in the second half of the argument.
However, nothing to date has been even remotely successful at treating characterological domestic violence. Most mental health workers have given up, counseling female victims to abandon these relationships and to go to a women’s shelter as soon as they can after creating a safety plan. However, one research strategy pioneered in the Gottman lab is called conducting “proximal change” experiments. That is an experiment in which the goal is to change specific dysfunctional aspects of the conflict interaction, rather than trying to change the whole relationship. In that proximal change experiment an intervention is placed before and after a conflict discussion to determine if one is on the right track in changing a recalcitrant problem like characterological domestic violence.
“What we found is that the interventions worked to make the second half of the argument better,” said Babcock. “Batterers could learn these communication skills and when they applied them in arguments with their female partner, it decreased aggressive attacks on the female partner, contemptuous behavior, criticism and put downs in both the woman and the man. The idea is that reducing such psychological abuse may reduce intimate partner violence. Whereas most therapies are built top down from theory, the new technology allows us to build a therapy package--technique by technique--from the lab up.”
Babcock’s experiment was a proximal change study. It focused on changing the perpetrators’ behavior during arguments rather than addressing his potentially sexist beliefs. The behaviors targeted were identified from Jacobson and Gottman’s basic research on what differentiates characterological from situational domestic violence, namely accepting influence and editing out negativity. “There is a lot of research that studies the victim of intimate partner violence, but not the perpetrator,” said Julia Babcock. “The predominant model for IPV intervention is based on what was gleaned from women in battered women shelters and focuses on men’s patriarchal attitudes about power and control. Since most domestic violence occurs in the context of an argument, the experiment I conducted evaluated whether I could change how the communication goes during an argument with the batterer and his partner. The findings indicated the batterers could learn communications skills and when they applied them in an argument with their female partners, the argument improved and the participants felt better about the argument and more understood.” Babcock notes this research is significant in that it breaks new ground in applying experiments to domestic violence and may improve batterers’ intervention programs. By listing an advertisement in local papers that said, “couples experiencing conflict,” the research team recruited 120 couples in the Houston area qualified for the experiment. Candidates for the study were screened over the telephone to make sure they met criteria. To meet the criteria to participate in the study, two acts of violence had to occur in the last year that might include: pushing, shoving, choking, using a weapon or a beating. If there was no physical abuse, but the couple scored low for marital satisfaction, Babcock included them as a comparison group. The couples in Babcock’s proximal change experiment were then invited to participate in an experiment in the “Emotions in Marriage Lab,” where the research team observed a couple in a 15minute argument. Both male and female partner were connected to monitors to measure heart rate, respiration, skin conductance, movement, pulse, transit time of blood flow from the periphery to the heart, skin temperature while affect (such as anger, contempt, fear, disgust, etc.) was noted. Midway during the 15-minute argument, the researchers interrupted the argument at 7½ minutes and randomly assigned the male batterer to one of three conditions:
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Babcock’s article based on this UH experiment, “A Proximal Change Experiment Testing Two Communication Exercises with Intimate Partner Violent Men,” won the “Best of 2011 Violence Research” award for the most exemplary research being conducted on violence and aggression. Five senior researchers convened by the Psychology of Violence Journal selected articles they believe have the potential to advance the field and direct the future research on violence. The interventions used in the Babcock study present problem situations and require an immediate response from the subject in each situation. A narrator then discusses which kinds of statements do and do not qualify as competent responses to each problem situation. The intervention is highly repetitive, and our experience at The Gottman Institute is that most clinicians do not find the interventions much fun to do, probably because the skills are so elemental and simple. Yet so far they are the only treatment that has any chance of working with these perpetrators. These tapes will be made available again on the Gottman web site now that research supports their efficacy. Of course, much more research remains to be done. The big question is, “Are these interventions sufficient to eliminate characterological domestic violence in the short term, and in long-term follow up?” About Babcock’s Center for Couples Therapy at the University of Houston The Center for Couples Therapy is a clinical research center to provide state- of-the-art services for couples in committed relationships. The services are appropriate for couples experiencing specific relationship difficulties as well as those who want to make an already good relationship even better. For more information, see www.psychology.uh.edu/couples/ or contact The Center for Couples Therapy at 713-743-8600 or couples@uh.edu. About the University of Houston The University of Houston is a Carnegie-designated Tier One public research university recognized by The Princeton Review as one of the nation’s best colleges for undergraduate education. UH serves the globally competitive Houston and Gulf Coast Region by providing world-class faculty, experiential learning and strategic industry
Relationship Research by Colleagues: A Proximal Change Experiment Testing Two Communication Exercises With Intimate Partner Violent Men Best Violence Research of 2011: Selections From an Invited Panel of Researchers
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The Application of Gottman Theory to Collaborative Practice Michael Basta, L.C.S.W. Collaborative Practice is an approach to legal dispute resolution that has evolved since the early 1990’s as an alternative to litigation particularly in the area of family law. It involves a settlement-based methodology to help separating and divorcing couples to respectfully come to agreements regarding child custody and estate issues. In the collaborative process, the separating or divorcing parties retain Collaborative attorneys, and sometimes therapists trained as Collaborative coaches or child specialists, and Collaborative financial specialists. The couple and professionals agree to work collaboratively to gather and share information necessary to reach a settlement out of court. The couples and their attorneys agree ahead of time not to go to court for a judge to resolve their dispute. If either partner chooses to go to court at any point, neither Collaborative attorney will provide representation in the process of litigation (Tesler and Thompson, 2006). Collaborative Practice authors and innovators, Pauline Tesler, M.A., J.D., and Peggy Thompson, Ph.D. note that Collaborative Practice has the advantage of a non-adversarial framework, which emphasizes mutual agreements rather than a zero sum winner-take-all approach. They note that the collaborative process helps couples “deal with the emotional challenges and changes associated with divorce” and provides resources for each partner to make the transition to life as a single person. Perhaps the most compelling argument for Collaborative Practice is that it is less likely than the traditional litigation-based approach to divorce to place children in a position of having to choose sides (Tesler and Thompson, 2006). Furthermore, it has been shown that the Collaborative model fairs well compared to litigation in terms of cost. According to the Collaborative Council of the Redwood Empire, couples should expect to pay $5,000 to $25,000 for collaborative dispute resolution and $15,000 to $50,000 and up for litigation (Collaborative Council of Redwood Empire. 2005). In May of this year, my fellow Gottman Method Couples Therapist, Marcia Gomez, L.C.S.W, and I were invited by the Collaborative Council of the Redwood Empire to provide training to Collaborative professionals on the applicability of John Gottman, Ph.D.’s research and Gottman Method (developed by John Gottman, Ph.D. and his wife, Julie Gottman, Ph.D.) to Collaborative Practice. We noted that Joseph Shaub, J.D., LMFT had done such a presentation from the perspective of a collaborative professional at the annual conference of the International Academy of Collaborative Professionals in October 2011. In his presentation, he stated the reason marital therapy should be discussed in a conference about divorce is that “the things that couples fight about and the ways that they fight while they are married can teach us a lot about how they will divorce and how we can help them divorce.” Clearly he had read Dr. Gottman’s research regarding the persistence of couples’ perpetual problems (Gottman, 2007).
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Furthermore, the concept of perpetual problems becomes even more poignant when considering that many divorcing couples have children that bind them together as co-parents for a lifetime. As Gottman Method teaches us, imbedded in every perpetual problem is a hidden agenda (Gottman, 2007). It is reasonable to assume that these hidden agendas persist whether a couple stays together or separates. In working with divorcing couples, we suggest that the Gottman Method practice of helping to uncover the deeper meaning of each partner’s position remains relevant. Collaborative Practitioners Kate Scharff, M.S.W and Lisa Herrick, Ph.D., use the analogy of “identifying the rocks beneath the surface of the whitewater journey of the separation process” (Scharff and Herrick, 2010). We propose that these “rocks” are the hidden agendas and deeply held emotions that we believe are the basis of perpetual problems in couples’ relationships. Moreover, we concur with Scharff and Herrick that it is necessary to provide an approach to work with divorcing couples that seeks to address a separating/divorcing couple’s deeper agendas in order to help the couple move out of an adversarial posture and to develop a meaningful settlement agreement. We suggest that the same basic relationship skill set that Dr. Gottman identified as necessary for healthy committed couples is also necessary for separating/divorcing couples. The Sound Relationship House Theory, with some adaptations, continues to apply to these couples. Furthermore, interventions that 1) block the Four Horsemen and offer their antidotes, 2) invite the sharing and validation of subjective reality (such as the Rapoport Intervention), and 3) help the couple understand the dreams or hidden agendas behind their positions (such as the Dream Within Conflict Intervention) can be adapted to Collaborative Practice. Marcia Gomez and I received enthusiastic interest from the Collaborative Professionals that we trained in May, and we encourage more scholarly investigation and clinical adaptation of Gottman Method to Collaborative Practice. Anderson, Margaret, Henry, Moss, Rodney, Amy, & Walker, James (2005). “The Collaborative Approach to Resolving Conflicts”. Santa Rosa: Collaborative Council of the Redwood Empire. Gottman, J.M. (2007). Marital Therapy: A research-based approach. Training manual for the Level I professional workshop for clinicians. Seattle, WA: The Gottman Institute. Shaub, Joseph (2011). From presentation at the 12th Annual Conference of the International Academy of Collaborative Professionals, October 30, 2011, “How We Fight: John Gottman’s Lessons for Collaborative Practice.” Scharff, Kate, & Herrick, Lisa (2010), Navigating the Emotional Currents in Collaborative Divorce: A Guide to Enlightened Team Practice, Chicago : Section of Family Law, American Bar Association
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Case Study #2: Working with a Couple when One Partner had Depression and PTSD Submitted by: Mike McNulty, Ph.D, LCSW
Referral Information John and Joanne were referred to me by Joanne’s individual psychotherapist. They are both in their late thirties, and have been married for sixteen years. They have significant problems with communication, emotional intimacy, coping with her diagnosed psychological disorders (depression and posttraumatic stress disorder).
Initial Presentation They are a very attractive couple in their late thirties. He is an articulate, polished gentleman, and very successful entrepreneur. She is a friendly, engaging, and articulate homemaker.
First Interview: Presenting Problems In the first session, they acknowledged a number of issues they hope to address in couple therapy. They are having problems communicating about past and present problems in their relationship. These include: understanding and coping with Joanne’s psychological disorders, Joanne’s ongoing unemployment, John’s critical nature, and his tendency to withdraw from her. John is a leader, who tends to identify his goals and pursue them relentlessly. He has a high need for stimulation in all aspects of his life which is counterbalanced, at times, by a tendency towards introversion. He is a very goal directed pragmatist and rarely stops to reflect on his emotional life. Joanne has spent the past two years in individual psychotherapy trying to understand traumatic experiences from her childhood and how they contribute to her chronic depression. Her ability to reflect upon her emotional life has significantly improved during this time. Their ability to dialogue about conflict is quite limited. Their conversations get quickly negative and intense. Consequently, they avoid such conversations.
Oral History John and Joanne met at a local, state, college when they were both 20 years old. He transferred from a community college downstate in a very affluent community where his family lived. His parents created and ran a very popular restaurant there. At one time, the restaurant was quite successful. However, his father was diagnosed with cancer in his junior year of high school. The family experienced a series of related financial difficulties, and was unable to provide financial support for John’s college education. Joanne was raised in a chaotic home with parents who suffered significant trauma in their lifetimes. They were both alcoholic, and quite volatile, both verbally and physically. She moved out of the family home when she was eighteen to separate from the chaos. Her parents refused to provide financial support. She moved from one marginal roommate situation to another, and took a number of part-time jobs to pay her expenses. The couple met in class. They were immediately attracted o one another. She felt he was quite handsome, strong, and ambitious. He thought she was breathtakingly beautiful. He appreciated her sense of humor. She was sensitive, creative, and nurturing. Due to their financial situations, they decided to live together just months into their relationship. They married, at age 21. Together, they found creative ways to have a very meaningful event on a shoestring budget with their family and closest friends. They continued to attend college. She waited tables, he tended bar. John completed college first. He began to work with a group of partners. Together, they developed a highly successful, popular retail business. He achieved financial success much more quickly than either had anticipated. At the same time, Joanne began to struggle with depression. She was unable to finish her degree until years later. When overwhelmed by her symptoms, she often remained home, and was unable to work. She did not seek treatment, primarily due to the stigma associated with doing so. She felt she would be conceding that “there was something wrong” with her. She took courses as she felt able to do so, and cared for their home life. About ten years ago, a series of events triggered Joanne’s memories of childhood trauma. She became much more withdrawn and depressed. John became very concerned about her wellbeing, but she refused to seek help. When he would call home to check on her, she was 6
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often too dissociated to answer the phone. She eventually attempted suicide through overdose. He found her, conscious, and took to her to the hospital Joanne was hospitalized briefly until her depression stabilized, and began to see a psychiatrist and take antidepressants. She also had some limited, supportive psychotherapy therapy. Her condition stabilized. She continued to experience mild depression. He continued to build his business. They acknowledge that hospitalization led them to grow more distant from one another. He felt abandoned and was admittedly ashamed of her illness. She seemed to resent his insensitivity to her struggles. One course at a time, she completed her college degree. They were happiest together on weekend excursions, they took each month. They also maintained a regular group of friends and family members who they socialize with. They felt a sense of community within this group. At home, they we were much more emotionally distant from one another. About two years and three months ago, she went off medications as they attempted to become pregnant. She gradually developed the depressive symptoms she had experienced in the past. This resulted in a second acute depressive episode, which produced anxiety for both of them. Upon the recommendation of her psychiatrist, she entered an intensive outpatient program, which enabled her to significantly improve her coping skills. She began to develop insight into the connection between her childhood trauma and her depression. She started intensive individual psychotherapy, which she continues to this day. On medication, with those supports, and others, she has been able to do more effective trauma work, and is much less depressed than before. She remains vulnerable to stress which aggravates her depression. In the past six months, John and Joanne have tried to
Relational Interview Partner 1 Joanne was approachable and relatively easy to connect with. She had obviously worked hard in individual psychotherapy to understand the nature of her depression and the impact of her childhood trauma on her emotional life. She described her childhood, which involved an extremely chaotic family life, where parents were consistently volatile with one another. Her other siblings tended to be quite rebellious. In contrast, she was well behaved. She noted she had to be very careful with both parents, in terms of what she said and did, to avoid or contain their volatile behavior. They rarely, if ever, affirmed her feelings or positive qualities or acknowledged her accomplishments. Joanne has developed insights into her psychological life, which serve to ground her in times of stress. They also enable her to better manage and address symptoms of depression and PTSD. Her insights are recently acquired; her sense of self remains tenuous. She remains prone to fragmentation or feeling like she is falling apart, as she approaches conflict or feels judged by others. During the interview, I found myself having to be very careful as I attempted to understand her perspective. If I did not repeat statements almost exactly as they were said, she experienced a breach in empathy, which seemed to jeopardize our connection. She is clear that her husband and marriage are very important to her. She is frustrated by the fact that he does not understand her struggles with depression or her childhood trauma. She feels that having a child would help improve their relationship. Based on her experiences caring for children, she is confident she would function well as a mother. She wishes he could better relate to her need for self-care, particularly those related to managing her illness. She is well versed in the concepts such as “self-care” and “balance” and how necessary they are to have a healthy life.
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John also presents as a warm and thoughtful person. He is also very bright and articulate. He is an only child, who was the sole focus of his parents during his childhood. He was raised in a very loving home, in a conservative, stoic community where emotions and emotional expression were discouraged. He reports positive connections with both parents. He always did well in school. He was successful both athletically and academically. As an only child, he could also be very independent-natured, and often entertained himself through taking on challenges and independent projects, such as building things or physical activities. He did so as his parents built their business and coped with his father’s illness. (He reported that his family never discussed any aspect of his father’s illness and treatment, let alone their emotional responses.) He clearly loves Joanne. Their relationship is very meaningful to him. He is very frustrated by her illness. He resents her unemployment. He admits he is both judgmental and critical of her. As I attempted to discuss his feelings about these issues, he had great difficulty identifying them. He is so articulate and well mannered. One might conclude he is very “emotionally intelligent.” However, in-depth conversations with him seem to reveal that his “emotional intelligence” is uneven. While he will not participate in individual psychotherapy, again due to associated stigma, he is willing to do couples work, as Joanne has asked him to do so. 7
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Assessment of Sound Relationship House Based on Oral History and Relational Interviews John and Joanne’s oral history indicates a very rich meaningful relationship, during which they have survived and built a significant life together. They were each other’s first loves. They warmly discussed the earlier years of the relationship. As they discussed gridlocked perpetual problems, they alternated between escalation, and becoming cool and distant. Their relationship remains meaningful to them. While they are distant with one another, primarily during their day-to-day home life, they continue to have positive ways they connect in the life they have created together. These include: their interactions with family and friends, and their weekend excursions. The level of her depression seems to be masked from those closest to them. At his work and other social events, she is gifted with a wonderful ability to connect with others, which has helped them in business and socially. Their relationship has suffered from poor regulation of conflict. They remain gridlocked on issues, such as: whether or not Joanne should work outside the home and how they cope together with her illness. Another important gridlocked issue involves the balance of work and leisure in their lives. (To better manage her depression, Joanne seeks a less stressful lifestyle. John is driven by his success, and works long hours.) They appear to be in patterns of attack-defend and attack-stonewall as they approach conflict. He has difficulty relating to emotions in general. He can become harsh and judgmental towards Joanne and her illness. Her history of trauma resulted in a longstanding pattern of conflict avoidance. Her feelings, impressions, and strengths were rarely validated prior to their marriage. Consequently, she has difficulty hearing his point of view without feeling as if hers is being dismissed. Her growth through individual psychotherapy has enabled her to assert herself more than before with John, but the discussions between them quickly escalate and become negative. Questions • What should be the initial goals of treatment for this couple? • What should be the intermediate and longer-term goals? • How would a therapist begin to help this couple with gridlocked conflict, given their tendencies towards attack-defend and attack stonewall? • How would a therapist help them with conflict given her trauma-based vulnerabilities and his lack of exposure and If you’re already a member of GottmanTherapists.com, click here to join the discussion on this topic. Not a member of GottmanTherapists.com? Registration is free – it’s quick and easy! Click here. This is a detailed case study (within the limits of this newsletter) and contains elements common to working with couples on depression and PTSD. The intent is to generate a discussion on the Gottman Forum on this topic. A second purpose is to jump start use of the Gottman Forum in general, which is a place where we can share our therapeutic dilemmas and receive feedback from each other from within a Gottman Method framework Before you reply or post in this thread, please be sure to review the Forum Rules here.
New Certified Gottman Therapists Five new therapists have become certified since our last issue of Gottman Connections. They are:
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Peter Williamson. Vancouver BC, Canada
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Jana Anderson. Laguna Beach, CA
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Stacy Hubbard. Medford, OR
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Regina Austin. Murfreesboro, TN
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Kristin S. Alldredge. Visalia, CA Gottman.com
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Therapist Self-Care: Staying Grounded During Moments of Intensity Peg Davies, MS, LMFT As therapists, we’ve all been there—one moment your clients are thoughtfully answering the Oral History interview questions, and the next moment they are hurling attacks and counter-attacks at each other like their lives depend on it. The emotional landscape in the room goes from peaceful to confrontational in the blink of an eye. Or, perhaps a couple is in the middle of describing a challenging parenting situation when a memory surfaces from a time when one partner felt abandoned by the other in a time of great need. Tearful accusations ensue. Suddenly the room is awash in the powerful emotions of sadness, grief, anger, and loss. This rapid escalation of emotional intensity is, no doubt, bewildering and perhaps even frightening for the couple. It can be overwhelming for us as therapists, too, for no matter how seasoned or skilled the therapist may be, the presence of mirror neurons in our brains ensure that when our clients feel a strong emotion, whether it is sadness, anger, pain or joy, we experience those feelings too (Johnson, S. 2008). Furthermore, the more connected and empathetic we feel toward our clients, the more strongly we “mirror” their emotions. But in order for the therapeutic process to be beneficial, the therapist must find the right balance between empathy and neutrality. This is no easy feat. If the therapist becomes too immersed in the emotion in the room, and gets flooded along with the couple, we not only lose our ability to bear witness to the client’s suffering, we also become unable to help our clients to verbalize their needs. On the other hand, if we appear unaffected by the intense emotion, the clients will experience us as cold and distant, and will likely begin to censure their feelings in future sessions. Most therapists are naturally empathetic—we chose this profession because we want to help others to live fuller, healthier lives, to influence relationships in a positive way, and to make meaningful connections. Doing our job well means being emotionally attuned and open to our clients, but this very quality also makes us more vulnerable to stress hormones, such as cortisol, which is secreted by the adrenal gland during moments of conflict or intense emotionality. Elevated cortisol levels can result in a host of negative effects, such as higher blood pressure, impaired cognitive performance, lowered immunity and inflammatory responses in the body, increased abdominal fat, suppressed thyroid function, decreased bone density, decrease in muscle tissue, higher levels of “bad” cholesterol (LDL) and lower levels of “good” cholesterol (HDL). 9
The ability to staying grounded and relaxed during these moments of intense emotion is not only important for our effectiveness as therapists, but also for our own emotional and physical well-being. If we want to maintain a thriving, longterm psychotherapy practice that enriches the lives of others, we must practice self-care, especially in these high intensity moments in our sessions. To that end, I offer these suggestions to practice the next time you find yourself in a high intensity moment in a session: Most importantly, have compassion for yourself, as well as toward your clients. Remember John Gottman’s wise words: “we’re all in the same soup.” The more we, as therapists, can model compassion toward our own emotions and imperfections, the more we give our clients permission to do. the same.
1. Take a moment to become aware of what is happening in you. Observe what is happening in: a. Your physical body: is your heart racing, are your palms sweaty, is your stomach clenched? b. Your emotions: are you feeling frustrated, sad, guarded, angry with the couple or helpless? c. Your thoughts: are you thinking that you should have said something differently? Are you wondering how long this argument could possibly go on? Are you counting the minutes till your lunch break? 2. Once you have observed your physical, emotional and mental states, try to accept whatever you are feeling without judgment or rationalization. 3. Breathe. Taking three deep, full breaths will initiate the relaxation response and will reset your physiological state. Let your exhalation be twice as long as your inhalation. Remind yourself that each moment, like each breath, is a new beginning. Gottman.com
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GOTTMAN CONNECTIONS
FALL 2012
Why Should Therapists Use Social Media?
There is a revolution occurring and there's no getting around it. Michael Fulwiler Director, Social Media Marketing
It’s called “social media” or “social networking,” and it includes popular platforms such as Facebook, Twitter, LinkedIn, YouTube, Pinterest, and a variety of blog sites. The number of people joining these sites each and every second of each and every day is staggering. But where to start? Is it better to "friend" or "tweet?” More over, do mental health professionals really need social media to promote their practice? The simple answer: absolutely. Your current and future clients are looking to connect online with experts who can help them sort out their problems and pain. Take a look at these numbers:
• 62% of Americans use the internet to find health care info (Pew Internet and Family Life Study, 2009) • 28-35% of Americans look online specifically for mental health information. (Pew Internet and Family Life Study, 2009) Not sold? Consider that over 500 million people are on Facebook, over 200 million are on Twitter, and over 200 billion people watch YouTube videos daily. People want to engage and participate in the conversation. It’s part of human nature. Your potential therapy clients are signing up for social media websites in droves and spending hours every day connecting to these sites on their computers and on their smart phones. Not only are they looking for information that will help them solve their relationship struggles, but more importantly they are looking for “connection.” They are “following” and “friending” thousands of other savvy therapists who are already using social media websites to share helpful information.
There are three fundamental ways that social media can benefit your practice: • • • 10
Increase brand awareness by growing your reach. Build customer loyalty by engaging clients and providing support. Increase number of clients by getting more people to register for therapy.
Pick one of these goals and prioritize your social media campaign accordingly in order to put yourself in the best position to succeed. If your goal is to build brand awareness of your practice, emphasize what sets you apart from other MFT practices – your status as a Gottman Certified Therapist. This is easily accomplished by sharing TGI postings to build brand legitimacy. If your priority is engaging more and providing support, focus on creating and maintaining a blog that posts in-depth exercises, quizzes, and other activities to help your clients outside of your therapy sessions. While I manage a number of platforms for the Gottman Institute, our Facebook page is at the foundation of our social media presence. It allows us to share photos, videos, and news articles instantly with tens of thousands of couples and clinicians. We are able to engage in direct conversation with followers, offering referrals to free resources as well as Gottman products. I use our Twitter account to post “quick tips” (limited to 140 characters) more frequently than I post on Facebook, and use the Gottman Relationship Blog to dig deeper into relationship self-help topics. If you already have a Facebook page for your practice, you are on your way to building a loyal following. If you do not, I recommend you watch this short video tutorial on creating a page for your practice. Fears regarding breaches of confidentiality and the potential dual relationships on social media are common and legitimate concerns; however, there are ways to set up social media accounts so you’re not mixing personal and professional information and relationships. Whatever you decide to do, it has to be consistent. The biggest mistake businesses make is to establish a social media platform and then neglect it. Starting a platform and being inactive is more harmful than having no social media. The first time someone comes in contact with you may be through your Facebook account. If it hasn't been updated in six months, it will have a negative reflection on your practice. Good luck developing your social media presence! If you have questions, please do not hesitate to contact me. Gottman.com
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GOTTMAN CONNECTIONS
FALL 2012
Marketing Corner: Facebook Ads Offer Targeted Alternative to Other Web Marketing
An article from Psychotherapy Finances Online Online advertising continues to evolve. A practice website was the first step. Next, some clinicians got involved with Google AdWords to raise their profile in search engine results. (See the August, 2010, PsyFin for more on that.) And over the last couple of years, some therapists have become active on social networking sites like Facebook, Twitter, and LinkedIn. But now, we’re hearing from clinicians who have gone s step further by creating Facebook ads. That doesn’t mean simply creating a Facebook page for your practice, and signing up a gaggle of "friends." This is a targeted ad campaign that puts your ad in front of potential clients as they use Facebook. Targeted how? Remember that Facebook profiles contain personal data on millions of users. For a price, Facebook will let you select criteria like age, geographic location, and even personal interests, and then put your ad in front of the people who fill the bill. Below, we talk to a pair of clinicians who’ve gone down this avenue. Joe Bavonese is a Michigan therapist and marketing consultant who started experimenting with Facebook ads in 2009. After playing around a bit, he launched a more concentrated program last year, and he tells us he’s drawing eight new clients a month this way. He’s spending $200 a week to get them, but says it’s well worth the cost. (He runs a 15-clinician group.) "The average therapy client brings in about $1,200," Bavonese says. "So if I can spend $200 to make $1,200 times eight, that’s a pretty good return on investment." What kind of client is Bavonese trying to reach? His practice is called The Relationship Institute, so couples counseling and therapy groups are emphasized. And like every therapist we know, Bavonese is interested in expanding the self-pay segment of his business. With all that in mind, he’s set his sights on women aged 35-to-60 who: A) have a college degree, and B) reside in any of 10 affluent towns near his office in the suburbs north of Detroit. Facebook ads must be succinct--not exceeding 135 words. But you can use a photo. (That could be a picture of you, or a practice logo.) When a reader clicks on the ad, you can send them wherever you like--to your Facebook page or your own website. Like Google AdWords, you have to bid for placement-paying a "click through" fee every time a viewer clicks on your ad. But because you choose who sees your ad in the first place, you can limit the "wasted clicks" that are inevitable when you advertise on Google and other search 11
engines. Bavonese is paying between $1 and $1.10 for each click-through. (See the box above for a couple of Facebook caveats.) Bavonese has chosen to send his click-throughs to his homepage, rather than a Facebook fan page. "The fan pages really aren’t helping anybody," he believes. "I know therapists who have thousands of fans on their fan page, but they don’t really convert to actual contacts.” David Sternberg, disagrees. A Washington, DC, therapist we profiled last August, he specializes in treating clients in their 20s and 30s for depression, anxiety, and relationship issues. Sternberg tells us he’s sending his click-through to his Facebook fan page, not his website. Why? As a Facebook user himself, he thinks it’s annoying when the ads he clicks on take him away from Facebook. "My idea is not to lead people away unless that’s what they want. They’re on there for a reason. And there’s all kinds of information about my practice on my Facebook page--with a link they can use to go over to my website if that’s what they choose to do." Sternberg started using Facebook ads last spring. In the first 10 months, he gained six new clients--four of them just recently after making refinements to his ad. That’s made the program profitable, though not greatly so. He pays 85 cents per click-through, and has a daily budget limit of $6. "I’ve gradually increased it over time," he says. His original limit was $2.50 per day. He averages seven to eight click-throughs per day. On average, the ad has cost about $180 per month. Sternberg’s target market is collegeeducated men and women age 25-39 who live within 10 miles of Washington. "I keep experimenting with the ad... And eventually, I decided it’s imperative to have a photo." His ad’s headline is: "Need to talk?" "I think it engages the reader. Below the headline, I use the words ‘psychotherapy’ and ‘counseling,’ which seem to work well. I also have my phone number in the ad, which pulls people in. "Facebook has worked out well," he feels. "I’m not getting the return I’ve had on Google, but I think it’s worthwhile. More and more people are going on Facebook, and the average amount of time they spend on each visit is 20 minutes. That’s a significant amount of time. And while they’re on with their friends, these ads are appearing in the right-hand column...These numbers are going to keep going up."
Interested in reading more? Click here. Gottman.com
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GOTTMAN CONNECTIONS
FALL 2012
Everything That Was Not David: Sculpting Emotional Connection in Gottman Method Couples Therapy
Written by Reba Connell, LCSW
“Cowboy Tombstone” or Five Rules for Men to Follow for a Happy Life: 1. It's important to have a woman who helps at home, cooks from time to time, cleans up, and has a job. 2. It's important to have a woman who can make you laugh. 3. It's important to have a woman who you can trust, and doesn't lie to you. 4. It's important to have a woman who is good in bed, and likes to be with you. 5. It's very, very important that these four women do not know each other or you could end up dead like me. Clearly, this cowboy and her lovers could have benefited from an Art and Science of Love workshop before someone ended up dead. This cowboy joke making the internet rounds actually reveals some accurate longings of real people uncovered by the research of our teachers John and Julie Gottman -- trust, humor, honesty, acceptance, Eros, and emotional connection. Someone to clean for you... and who has a job. A cowboy can dream, can’t she? In Gottman work, the first intervention after the three-stage research-based assessment is often Dreams within Conflict. Each partner in turn becomes an interviewer, like a blogger writing about an Olympian or an anthropologist visiting a new culture with an open mind. With their body, face, tone, and a series of questions provided, the interviewer helps make it safe enough for the partner to reveal their dreams hidden in the conflict, like a sparkling geode in a rough stone. Even with a dream that may at first sound totally unrealistic, the interviewer does not take it personally, does not point out the impracticalities, but moves toward the partner with compassion and curiosity, and asks "Tell me why it is so important to you to have a woman who will clean for you." And "What do you need?" Couples come to us frustrated, wounded, and wanting solutions. LGBTQI, same-gender loving and two spirit couples are especially vulnerable from at least five directions -partner, family of origin, self, society and us. I find I need to clearly articulate heightened respect and care to people from our lesbian, gay, bisexual, transgender, questioning, and intersex community who have made the decision to reveal their relationship vulnerability to me. The research shows that solutions are not always solutions... and problems are not always a problem. Say we’re arguing about whether to live in San Francisco or raise our kids in Berkeley. Moving to Treasure Island off the Bay Bridge is halfway -- but might make nobody happy. And as they say, if mama ain't happy, ain't nobody happy. If I agree to the delights of Noe Valley or the Gourmet Ghetto, I can do it resentfully, or we can do it feeling emotionally connected as a team. When is a problem not a problem? Over the last 30 years, thousands of couples, including those in a 12-year study of same-sex couples have agreed to be videoed talking about a conflict. 68% of the time, they bring up the
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same conflict when they come back to be studied again. Being early or late. Neat or having everything out where it can be found. Sex at night or in the morning. Amazingly, successful couples do not differ from the couples who divorce or are unhappy in the percentage of unsolvable problems. Where they differ is that they use their differences as a way to connect -using patience, humor, repair, and complaining without blame. I tell the couples in my practice that it's like Legos. In order to build something with Legos, you have to connect the two pieces together. Once they're connected, you can make anything you want together -- a house, pirate ship, the Garden of Eden in the whimsical Brick Testament blog. It’s all about emotional connection. Emotional connection must precede advice or problem-solving. Without it, you struggle to build anything. Once you have connection, you find the conversations about solutions flow much more easily, with heightened awareness of each other’s values and enduring vulnerabilities. When the connection gets lost during a conversation, and things devolve into misunderstanding and hurt, we teach couples to temporarily put down the topic at hand completely. It doesn’t matter if it’s peanut butter or parenting. At that moment, the only topic becomes repairing the connection in the moment by revealing feelings, expressing appreciation, apologizing, and calming down. After an exchange of repair and accepting repair, they’re ready to get back on track with their topic. People really long to be listened to well. In Gottman therapy, we constrain the speaker as well as teaching top-quality listening. We teach the speaker to replace the Four Horsemen that predict the apocalypse of divorce and separation -contempt, criticism, defensiveness, and stonewalling -- with their antidotes -- appreciation, complaining without blame, responsibility, and self soothing the heart rate. This learning to refrain from attack/defend is like how Michelangelo made David. “I simply removed everything that was not David.” Removing everything that's not a healthy, vibrant relationship leaves a marble sculpture shining with honest expressions of longing and meeting this longing with grace and openness. The chiseling, like any art worth doing, is hard work. And we are privileged to give our clients the tools.
Gottman.com
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GOTTMAN CONNECTIONS
FALL 2012
Treating Hassidic Arranged Marriages with The Sound Relationship House Rena Goldin, PsyD and adapting the Gottman model to this system first began with re-evaluating the Assessment Phase. I learned not to ask “How did the two of you meet and get together?”, nor explore the couple’s dating period. Rather, I inquire into their level of trust in their parent’s decisions, their readiness at the time to enter into a relationship and, what it is like marrying someone that was basically a stranger.
I want to bring you along my journey traveling between two lands, one being the Gottman therapeutic model and the other the traditional community of my Ultra Orthodox Hassidic Jewish couples. In this second land, there is monumental importance placed on the creation of a family through the union of a man and a woman. It is thought to be the ultimate goal in life to reproduce in order to continue the family lineage. The culture is one of arranged marriages and therefore, it is the parents that determine when a child is ready to be married and to whom s/he will marry; a decision based on the belief of common family dynamics, similarity in personalities and mutual life goals. For most couples, there is only one meeting during which time they are allowed to interact and given the opportunity to voice their opinions. The next step is engagement, with marriage following within the year. During the engagement period, there is usually no contact between the couple, and it is at the wedding that the couple reconnects for the third time to begin their life together. As you can imagine, this system can lead to significant marital difficulties as couples are not only learning to interface with a member of the opposite sex for the first time, but also attempting to build the foundation of an effective marital relationship. I have been navigating this narrow path for the past seven years with the help of the unique road map that I created integrating the Gottman Sound Relationship House with this culture that builds relationships through the practice of arranged marriages. Modifying 13
The road tapered further with my realization that I needed to adapt my reliance on the assessment questionnaires, based on my clients’ willingness and ability to complete them in their entirety. As a result of the community’s insular nature and the essentiality placed on the creation of offspring, I have observed a general apprehension in committing to writing any negative feelings spouses have about each other. There is a fear that the parents of potential spouses for their children will find out about their “dirty laundry”. Additionally, for many of my male clients, Yiddish is their first language, leaving them with little understanding of the nuances of the assessment questions. I have learned to accept that despite my explanation of the benefits, I have to be prepared, and prepare my clients, that in the absence of the questionnaires, the therapy process may be slower. These modifications during the Assessment Phase have allowed me to understand and connect with my clients better, but they have also led me to another fork in the road, the Intervention Phase. Instead of rebuilding of “Love Maps” and “Fondness and Admiration” to help the couple rekindle the “friendship, romance and passion” that they had at the beginning, I often first need to build and kindle. That is to say, much of the time the couple has not discovered these concepts themselves. Therefore, it is my role to educate them about the significance in order to help them learn how to relate to each other on a deeper level without changing, or leaving the comfort of, their cultural belief system.
Gottman.com
GOTTMAN CONNECTIONS
FALL 2012
New from Dr. John Gottman! In this wise, accessible, and long-awaited book, John Gottman plumbs the mysteries of love: Where does it come from? Why does some love last, and why does some fade? In this new release, he applies his 40+ years of research with tens of thousands of couples to fundamental questions about trust and betrayal.
Available now.
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