[Countdown]
[This audiovisual has been acquired for distribution by the National Medical Audiovisual Center]
[Sexuality in the Medical School Curriculum]
[From the Center for the Study of Sex Education in Medicine, University of Pennsylvania School of Medicine]
[Produced by Ortho Pharmaceutical Corporation, Department of Educational Services]
[Aspects of Sexual Interviewing]
[Music]
[Dr. Harold Lief:] This is one of a series
of films dealing with sex and marriage counseling.
The goal of these programs is to increase
your powers of observation and counseling skills.
We are about to observe a conjoint marriage counseling session
with a middle-aged couple.
The problem presented by Mr. and Mrs. Palmer
is one of the most frequent encountered
by physicians and counselors.
As we do in each of these films, following the interview,
we will have a replay analysis of interview tactics
and interaction dynamics.
[Dr. Reed:] Now Mr. and Mrs. Palmer,
I understand you've been referred by your urologist.
Is that right, Mr. Palmer?
[Mr. Palmer:] That's right, Dr. Danforth.
[Dr. Reed:] Can you tell me, when did you see Dr. Danforth?
[Mr. Palmer:] About two weeks ago.
[Dr. Reed:] And the nature of the difficulty was what?
[Mr. Palmer:] Well, I, uh, problems with our...
physical problem with me, I thought.
And when I went to see Dr. Danforth,
I thought that would clear it up.
And we took all the various tests and so forth.
He then gave me a clean bill of health and uh,
hah, then referred us to you, which was a bit of a shocker, actually.
[Dr. Reed:] It was hard to take, his referring you to a...
[Mr. Palmer:] Yeah, I was very surprised, yes.
[Dr. Reed:] How did you feel, Mrs. Palmer,
coming to a marriage counselor today?
[Mrs. Palmer:] Well, it does seem a bit strange after 23 years.
But we've definitely had a problem in the last six months.
[Dr. Reed:] And your feelings about coming here
are in what line?
How do you feel?
[Mrs. Palmer:] Well, if it can help in some way,
then I think it's a very good thing.
I really don't understand what the problem is. We...
[Dr. Reed:] Well, we know...
[Mrs. Palmer:] Kevin hasn't made love to me for six months now.
And whether it's because he's got someone else or...
[Mr. Palmer:] Well, that's nonsense.
We've talked about that.
It's nonsense.
[Mrs. Palmer:] Well.
[Mr. Palmer:] Let's not get into that.
[Mrs. Palmer:] That's what you say.
[Mr. Palmer:] Well, let's get to the problem,
rather than talk about something that doesn't exist, okay?
[Dr. Reed:] What did you in specifics go to Dr. Danforth with?
Exactly what happened?
Can you...
[Mr. Palmer:] Well, I have been unable to,
on several occasions, get an erection.
And in those occasions when I've been able to do so,
been not able to maintain the erection.
And as I said, I thought it was a physical thing, a prostrate
or some kind of thing.
I don't know, whatever.
But it turns out that there's nothing physically wrong
and so that's why we're here.
[Dr. Reed:] You look rather upset or tense, Mrs. Palmer.
How do you see this problem?
What's your emotional reaction to it?
[Mrs. Palmer:] Well, I guess I'm really very hurt.
And I suppose pretty angry about it.
[Dr. Reed:] Why should it happen to you kind of a feeling, you mean?
[Mrs. Palmer:] Yes.
And well, it first started, oh, about six months ago,
and looking back on it, the first instance
seems to have been when they had an office party for him, and...
[Mr. Palmer:] I just got a promotion.
[Mrs. Palmer:] Yes.
[Dr. Reed:] Oh, I see, and you were at a party.
[Mrs. Palmer:] Yes, and he...
[Mr. Palmer:] And I was just there.
She was not there.
[Mrs. Palmer:] Yes, and he came back at about 2:00
in the morning, and having drunk quite a lot, and got into bed.
I was half asleep by that time, and started to make love to me
and then just couldn't.
Well, you know what those office parties are,
and there are secretaries around and whatever.
And I didn't really think about it then,
except that every time he tried after that, the same thing happened.
And then two months
[Mr. Palmer:] Let's get the record straight.
There is no other woman.
Now let's, you know, if we're going to solve this problem, Margaret,
then let's solve the problem.
[Mrs. Palmer:] Well, I don't really
have any other way of explaining it.
[Mr. Palmer:] Well, then let's not bring up your fantasies
about me and other women.
I mean, admittedly, I have the physical difficulty,
but if it is a psychological problem,
then it takes two to tango.
So part of the problem is yours, as well as mine.
[Dr. Reed:] You really think he's running around, do you,
Mrs. Palmer?
[Mr. Palmer:] Well, obviously, if she...
[Mrs. Palmer:] Well.
[Mr. Palmer:] ...keeps bringing it up.
[Mrs. Palmer:] I really don't know.
That's the only explanation that I can find.
23 years, we've had a very good relationship,
and all of a sudden, there's nothing there.
[Dr. Reed:] All right, now give me
your account of the first experience
you had with your loss of erection,
or impotence, or however you term it.
What happened from your point of view?
[Mr. Palmer:] Well, again, six weeks ago,
I was made head of the sales department at the firm.
[Dr. Reed:] And how did you feel at that time?
[Mr. Palmer:] Certainly not impotent, I'll tell you that.
Quite good.
[Dr. Reed:] All right.
[Mr. Palmer:] And if I may say so, I do a damn good job.
And we had a party.
I came home, and I'd had a few to drink, certainly not.
certainly not as much as she indicates.
And I attempted to make love, but you know, perhaps I did have too much,
and I figured, well, too much to drink.
And the two or three times after that in the succeeding days
that we attempted to make love, the same thing occurred.
Either I got an erection, and it didn't maintain at all.
Or I didn't get one at all.
And within the last five months, then I'd say
what we've been doing is just strictly avoiding contact.
And it's just been really hell because what we're doing
is we're fighting every night.
The eleven o'clock news comes on, and then that's
the cue to start fighting.
[Dr. Reed:] So you're drifting apart and irritable.
[Mr. Palmer:] Right.
[Dr. Reed:] Something like that.
[Mr. Palmer:] And basically, the relationship
has reached a point where it's not even irritable anymore.
It's just plain dull, which, as I say,
it seems to me is a two-way street.
[Dr. Reed:] Now let me learn a little bit more about you.
You've been married, you mentioned 23 years.
Is that correct?
[Mr. Palmer:] That's right.
[Mrs. Palmer:] Yes.
[Dr. Reed:] And your age is?
[Mr. Palmer:] 45.
[Dr. Reed:] 45, and you are?
[Mrs. Palmer:] 43.
[Dr. Reed:] 43.
Do you have children?
[Mrs. Palmer:] Yes, we have two children.
[Dr. Reed:] And their ages are?
[Mrs. Palmer:] 20 and 18.
[Dr. Reed:] Okay.
[Mrs. Palmer:] The youngest one just went away to college
in September this year.
[Mr. Palmer:] They're both in college.
[Mrs. Palmer:] They're both in college now.
[Dr. Reed:] So they're both away now?
[Mrs. Palmer:] Yes.
[Mr. Palmer:] Yes, right.
[Dr. Reed:] Okay.
Now is that a change?
It's the first time they've been away, for you in particular?
[Mrs. Palmer:] Yes.
They've been away to camp and things like that in the summer,
but it's first time they've been away for any length of time.
[Mr. Palmer:] Quite frankly, I feel
like a good deal of the problem
is that since both the kids have been in school,
we find that we don't really have anything to talk about.
I'm not going to discuss my work,
which would make no sense.
And Lord knows, I don't want...
yes, what?
Your hand went up.
[Dr. Reed:] Yes, she kind of went "Huh?" or something.
What?
[Mrs. Palmer:] Well, this is another thing.
I mean, why can't he talk about his work to me?
I try and fill him in.
When the children were home, he would come home in the evening,
and we'd talk about the children.
And we talked about what I'd done.
[Dr. Reed:] Turn towards him, and tell him
what you're saying.
Go ahead.
[Mrs. Palmer:] And well, I'd talk to you about the children
when you came home from work,
and what I'd been doing during the day and things like that.
And I still try and do that.
And you would discuss your work to some extent,
and tell me what you've been doing,
and what had happened at the office.
And he can't even talk to me anymore.
[Dr. Reed:] How do you feel at the end of the day
when he's going to come home?
What do you expect?
[Mrs. Palmer:] Well...I'm usually glad to see him,
at least I was.
There again with the,
I think I'm so afraid now that he's just
going to go away and do his work or watch the television set
or whatever that I'm almost afraid when he comes home.
It would be nice to have someone there to talk to.
[Dr. Reed:] You'd like him to talk with you, but
[Mrs. Palmer:] Yes.
But he hasn't for so long now
that I think I almost expect him not to.
[Dr. Reed:] Well, what's your view of this, Mr. Palmer?
[Mr. Palmer:] Well, I feel that, uh,
I mean, don't get me wrong now.
Margaret's been a wonderful wife,
and we've had a good 23 years, mind you.
Except the last six months, as I said, it's been a problem.
And quite frankly, you know, I can't see, coming home
after the kind of responsible job I have,
to listen to you talk about whether or not the kids wrote,
and if they wrote, having to listen
to what they've had to say beyond the point
of what seems to me endurance.
Now that doesn't seem to make any sense to her.
[Dr. Reed:] So you really don't want
to listen to what it is she wants to talk about.
[Mr. Palmer:] It just seems to me that with the kids gone, you know,
it's like we might as well be two strangers off the train.
I mean in the house.
[Dr. Reed:] Do you sense that the two of you
are pretty angry at each other?
[Mrs. Palmer:] Oh yes, certainly I get angry.
[Dr. Reed:] But you're not expressing it
in the same way he does.
[Mrs. Palmer:] Well, I don't really, I don't really like to get at him
in an angry fashion because I know that that
doesn't solve any problems,
and you just end up screaming and yelling at each other
and you get absolutely nowhere.
[Dr. Reed:] And with the sexual problem now,
it's even more touchy to let your feelings out.
[Mrs. Palmer:] Yes.
I mean, I understand that he feels badly about it.
And I really don't want to make his problem worse
by screaming at him.
[Mr. Palmer:] Well, let's not just think of it as my problem, okay?
[Dr. Reed:] Give me some more information
about the situation [?] in the sexual area,
Mr. Palmer, okay?
[Mr. Palmer:] Yes.
[Dr. Reed:] You had this experience
of losing your potency, your erection.
Do you still have erections when you awake in the morning?
[Mr. Palmer:] Well, it's hard...ahh...
I don't know whether you'd call them erections.
I go to the bathroom, and then it's over with.
[Dr. Reed:] OK, but that's still an ordinary part of...
[Mr. Palmer:] Yes.
I would hardly call it a sexual,
it certainly doesn't seem like a sexual thing to me.
[Dr. Reed:] And so you are in pretty good health
as far as, according to the doctor, your abilities.
[Mr. Palmer:] Yeah.
[Dr. Reed:] You lost your erection,
and you failed with your wife after the promotion party.
[Mr. Palmer:] Right.
[Dr. Reed:] And, um,
[Mr. Palmer:] And there have been no affairs.
[Dr. Reed:] No affairs, and you tried again.
[Mr. Palmer:] Several times.
Three or four times, I would say.
[Dr. Reed:] And now you've left it alone.
[Mr. Palmer:] For about--
[Dr. Reed:] Now what input have you gotten about it?
How are you explaining this to yourself?
[Mr. Palmer:] Well, my best friend Jerry said I was in menopause.
So I told him to take his and my doll and go home.
[Laughs] But then after the laugh, I started thinking maybe he's right.
[Dr. Reed:] Do you kind of have, what, tired blood or...
[Mr. Palmer:] Should I just take two spoons,
and then it just goes away?
No.
No, I mean, I feel fine.
And again, I guess it's in my head,
but I do feel like at 4:00, when the day's grinding down,
and I've been at top-speed all day.
[Dr. Reed:] Right.
[Mr. Palmer:] And then I'm going to come home.
I start feeling tired.
I start feeling fatigued.
[Dr. Reed:] You mentioned the word dull before.
Things were kind of dull when you came home.
Is this the kind of a routine going on?
[Mr. Palmer:] Well...
[Mrs. Palmer:] Well, how can I be interesting
if he won't say anything and if he just goes off into his own corner?
He won't let me talk.
[Dr. Reed:] Does it seem like a kind of a routine for you, too?
When the kids are gone, somebody emptied the nest on you.
[Mrs. Palmer:] Yes, and I go around and I do things all day.
I certainly don't sit at home all the time.
And I go out and play cards...
[Dr. Reed:] But there's no electricity,
nothing going with you all these days in some fashion.
Is that right?
[Mr. Palmer:] Yeah.
[Dr. Reed:] All right.
[Mr. Palmer:] The fire's gone out, no question about it.
[Dr. Reed:] Now let me ask a different kind of question.
I want you to go back in your mind
to the last good sexual expression you had together.
Okay?
What did you go through?
What did you do?
Can you tell me how you approached it?
[Mr. Palmer:] Well, you talk about,
I mean, I can't pinpoint the date.
[Dr. Reed:] It's OK.
[Mr. Palmer:] Yeah, I know.
Obviously, prior to the last roughly six months,
again, it's hard to be married 23 years
and certainly have a lot of habits involved.
In other words, I mean, I think in a sense,
that was part of the positive aspect of our marriage,
if you follow me.
In other words, I put down the newspaper...
and I look, and she knows, and I don't have to say.
And it's a nonverbal thing.
And it was always good.
I mean.
[Dr. Reed:] What about variety?
Did you have any?
Just go at it one favorite way.
[Mr. Palmer:] Well, I would say we're not an X-rated movie,
I guess.
[Laughs]
[Dr. Reed:] Give me your account of the last good time.
What went on from your point of view, Mrs. Palmer?
What did you do to make love?
[Mrs. Palmer:] Well, it's very much like Kevin says.
And there's something, I guess something sort of comfortable about it
after that length of time.
[Dr. Reed:] Okay, right, and what do you do to deal with it?
[Mrs. Palmer:] Well, recently, I've been getting the feeling that is, he's just not all there.
His mind would be off.
Your mind would be off somewhere else
and thinking about your work or whatever.
And more or less doing it, yes, as a matter of routine,
rather than as something nice.
[Mr. Palmer:] I resent the idea that it's my problem.
I mean, the physical manifestation is my problem,
but then you don't face the problem
in that sense, physically.
[Mrs. Palmer:] Well, no, but you've
just been saying now that you've been doing it
as a matter of habit for years.
I don't think I've ever considered it a habit.
It's been, yes, maybe more or less the same every time.
But there's still something sort of special about it,
even though it is comfortable and it's...
[Dr. Reed:] How about variety?
Was it very creative from your point of view, the way you made love?
[Mrs. Palmer:] Well, I guess not, no, but it was good the way it was.
[Dr. Reed:] Okay.
Now these days, let's suppose you were to make a romantic advance tonight?
What would go on in your mind?
Do you kind of...
[Mr. Palmer:] Failure!
[Laughs]
[Dr. Reed:] Don't want to touch you with a...
[Mr. Palmer:] Stop.
Do not pass go.
[Mrs. Palmer:] He doesn't want to try anymore.
[Mr. Palmer:] Well,
[Mrs. Palmer:] Why doesn't he want to try anymore?
[Mr. Palmer:] That's because it's, you know.
you fail so many times, and then it's no longer worth trying.
[Mrs. Palmer:] But I've never held that up to you.
[Mr. Palmer:] Well, I didn't say...
[Mrs. Palmer:] Have I?
[Mr. Palmer:] I didn't say you did.
And that's not what we're talking about.
We're talking about the fact that in my feelings, my mind--
well, the whole thing is totally,
the whole situation is embarrassing.
I mean, let's face it.
I can't cut the mustard.
And that's what we're really talking about here.
[Dr. Reed:] Now let's talk about different portions
of the problem for a moment, okay?
Now my understanding is that after an important experience
where you got promoted, and were feeling pretty good,
but you had had some alcohol in your system, all right?
You made a pass at your wife, and you failed.
And you did what most guys would do.
You tried again, but then you failed again
and got pretty tense about it.
[Mr. Palmer:] Right.
Because I hadn't been drinking the next time,
the next three times.
[Dr. Reed:] And since then you've been avoiding it because all you can think about
is failing again.
Does that make sense to you or no, Mrs. Palmer?
[Mrs. Palmer:] Yes.
[Dr. Reed:] What he goes through now.
[Mrs. Palmer:] Yes.
[Dr. Reed:] I wanted you to understand,
though, his vicious cycle that he's caught up in right now.
Okay?
It's something he wants, but he's so afraid he's going to fail, he can't relax.
When was the last time you could will yourself into an erection, Mr. Palmer?
[Mr. Palmer:] Ah geez, I never thought of it as willing myself.
[Dr. Reed:] You can't do it, can you?
[Mr. Palmer:] No, I suppose not.
[Dr. Reed:] No one can.
You can't think about... a man, man can't will himself.
In fact, the more he tries, the less, he's likely to succeed, any more than you can say
I must relax and have an orgasm.
Do you follow me?
I want you tounderstand how it works.
[Mrs. Palmer:] Yes, I understand.
[Dr. Reed:] All right?
Now let's talk about you for a minute.
You have an important change you've gone through, too.
The kids have left, right?
And it's all empty-nest kind of living.
And you're looking for more now from this husband of yours
when he comes near you than used to be.
You used to have the kids to talk about.
Now you've got only him to get some kind of satisfaction from.
[Mrs. Palmer:] Yes, I guess so.
[Dr. Reed:] So just when you want him the most,
he's able to give you less.
It's really frustrating.
Okay.
My impression is that you've got to both talk about
some of the frustration that this has put upon you.
You're a little more angry and put out with each other
than you've been able to demonstrate today.
So let's now think about that, okay?
The other thing that ought to be done
is have a different approach
to your sexual response.
Is there some way you can relate romantically
without going to the negative experience of intercourse itself,
is there any way you can relate sensually or physically
without having intercourse?
What do you think about that?
Could you?
[Mrs. Palmer:] It's like being back in high school.
[Dr. Reed:] What's your response?
[Mr. Palmer:] I guess we have the same, you know,
drive-in, here we come.
[Dr. Reed:] Why would it be reasonable to try?
Do you see any benefit from it?
Does it stop the intercourse demand for a while?
[Mr. Palmer:] Well, obviously, if it's like in making a sale,
I mean, you perform better if you're operating without the pressure.
[Dr. Reed:] Without worrying about whether you're being a good salesman.
[Mr. Palmer:] Good salesman or not.
Right.
[Dr. Reed:] OK.
[Mr. Palmer:] In other words, if you're concentrating on finishing that sale.
[Dr. Reed:] Yeah.
[Mr. Palmer:] Rather than on how do I look.
I mean, if you're worrying about how you look,
then you're going to be fumbling.
[Dr. Reed:] Fair enough.
[Mr. Palmer:] Is that what you're saying?
[Dr. Reed:] Okay, so let's suppose that we make an agreement.
That from now until the next time you come,
next week, no intercourse.
Just by agreement, no matter how excited
or romantic or concerned you get, no intercourse.
Because he's got to be kept away from having to go through something that he's anxious about.
And the both of you need to get back to fun.
It sounds to me as though you've got a sex life that's either a routine,
or it's on the edge of work.
Can you recall when you were courting or petting and all that?
Not too far back in the dark ages, hmm?
[Mr. Palmer:] [Laughing] It seems like the Stone Age now.
[Dr. Reed:] Can you recall?
[Mrs. Palmer:] It was a long time.
Yes, I think so.
[Dr. Reed:] Was it fun?
[Mrs. Palmer:] Yes.
[Mr. Palmer:] Yeah.
[Dr. Reed:] Can you recall and tell me why you had...
[Mr. Palmer:] Sure, yeah.
[Dr. Reed:] No intercourse was at stake at least at the beginning, I presume?
[Mr. Palmer:] No.
[Mrs. Palmer:] No.
[Mr. Palmer:] Not in those days.
[Dr. Reed:] So no strings were attached.
Nobody had to perform.
Right?
[Mr. Palmer:] Right.
[Dr. Reed:] I would suggest that this is the way to go for now, if I can take this kind of,
sort of educational approach with you.
You need to enjoy, rather than work.
And if you can give a little fun to each other,
particularly in this kind of, you're on the edge of a bad case of boredom.
You're going to have a case of the blahs
as a couple before too long, unless you start to find
some fun with each other.
You used to have it with the kids around.
Many couples go through this, when the youngsters are gone,
when you've got nothing to talk about.
So it looks like you're in the communications racket
just a little bit, but in a sexual zone in particular.
Let's try to have fun and hold off on intercourse
and see what happens.
Let's just learn from it.
Okay?
[Mr. Palmer:] OK.
[Dr. Reed:] All right.
Then we can get back in a week and follow up on this.
[Mr. Palmer:] OK.
Thank you, Dr. Reed.
[Dr. Reed:] How do you feel now about coming in?
Has any...
[Mr. Palmer:] Well, it's a little better now.
As I say, it's a...basically...
[Dr. Reed:] Talking some of this out, is it...
[Mr. Palmer:] Well, obviously, with a third person there,
it's a little embarrassing at first.
[Dr. Reed:] But you talked with each other.
Did you see that?
[Mr. Palmer:] Yeah, well, I felt that the very fact
that we've admitted we have a problem,
which was not easy to do.
[Dr. Reed:] But you talked with each other,
and it helps, right?
[Mr. Palmer:] Yeah.
[Dr. Reed:] So that's my commercial.
[Mr. Palmer:] Okay.
Thank you.
[Dr. Lief:] The interview that you have just observed
can be divided into three parts: establishing rapport,
making an appraisal, and initiating therapeutic responses.
Under rapport, we must give the couple
the feeling that not only are we able to help,
but that we are willing to help.
Under appraisal, we have to pay particular attention
to those non-verbal cues that give us information
about the patterns of communication,
about their feelings and attitudes.
The interaction between husband and wife
is particularly important because by observing
these patterns of interaction,
we better understand how they respond and react
to each other in real life.
The coping patterns that we see during the interview
are a cue to us to know what strengths they have.
Because it is these strengths that have to be emphasized as part of the process of counseling.
The therapeutic response has to be initiated in the very first interview.
We must educate the couple in order for them
to have the feeling that we understand them
and to reduce the confusion that creates so much anxiety.
We must reduce tension because
it is this tension that interferes with the process of communication.
At the same time, we must initiate motivation for change
because without this motivation for change,
all our efforts will be without avail.
Now let's go to instant replay and examine these three parts of the interview.
[Dr. Reed:] How did you feel, Mrs. Palmer, coming to a marriage counselor today?
[Dr. Lief:] As part of establishing rapport,
it is vitally important for the counselor
to know the feelings of the patient
about coming in for the initial session.
In addition, he will learn something
about the patient's motivation for treatment.
If there are significant resistances to therapy,
these may have to be dealt with immediately.
In conjoint marriage counseling, it is also important to know whether the husband or wife
see the problem as a problem within the marital unit
or whether they think it is the spouse's problem that must be dealt with.
Did you notice what the wife was doing while her husband was
in a fumbling way beginning to describe his problem with potency?
[Dr. Reed:] And the nature of the difficulty was what?
[Mr. Palmer:] Well, problems with our...
physical problem with me, I thought.
And when I went to see Dr. Danforth,
I thought that would clear it up.
And we took all the various tests and so forth.
And then gave me a clean bill of health
and then referred us to you, which was a bit of a shocker.
[Dr. Lief:] It is important in making
the appraisal for the therapist to watch the spouse's reactions.
Non-verbal cues are essential in understanding
the emotional reactions and attitudes of husband and wife.
Notice the body language.
The wife has her body turned away from her husband.
He emphatically makes a point which expresses his irritation.
Body language, along with facial expressions and vocalizations,
are three of the key dimensions of nonverbal behavior.
[Mr. Palmer:] Quite frankly, I feel a good deal of the problem
is that since both the kids have been in school,
we find that we don't really have anything to talk about.
I'm not going to discuss my work, which would make no sense.
And uh, Lord knows I don't want...
yes, what?
Your hand went up.
[Dr. Reed:] Yes, she kind of went "Huh?" or something.
What?
[Mrs. Palmer:] Well, this is another thing.
Why can't he talk about his work to me?
I try and fill him in, when the children were home, he would come home in the evening,
and we'd talk about the children and we'd talk about what I'd done.
[Dr. Reed:] Turn towards him, and tell him what you're saying.
[Dr. Lief:] An effective technique
in conjoint counseling is to get the couple
to talk to each other.
One may frequently ask them to turn to face each other.
This encourages communication in the session, which in a sense
is learning communication.
At the same time, the therapist is learning more about the nature of their interaction.
You will notice in this picture that the therapist
has allied himself with the husband in order to bolster his self-esteem.
This immediately evokes an angry reaction
on the part of the wife, who then must protect herself
from her angry feelings,
because this does not fit in with her picture of herself.
It is important for the therapist
to aid their coping mechanisms by making it possible
for them to take each other at face value
and not attempt to second-guess the feelings
or attitudes of the partner.
At this point in the interview, the counselor
has been watching and listening to the couple fight.
Their fighting indicatestheir inability
to evolve a coping pattern that works.
They are unable to develop a way of resolving tension without fighting.
He has the option of allowing the fighting to escalate or to intervene,
assume control of the interview, and to educate.
[Dr. Reed:] Let's talk about different portions
of the problem for a moment.
Now my understanding is that after an important experience
where you got promoted and were feeling pretty good,
but you had had some alcohol in your system,
you made a pass at your wife, and you failed.
[Mr. Palmer:] Right.
[Dr. Reed:] And you did what most guys would do.
You tried again.
But then you failed again and got pretty tense about it.
[Mr. Palmer:] Right, because I hadn't been drinking the next time, the next three times.
[Dr. Reed:] And since then, you've been avoiding it
because all you can think about is failing again.
Does that make sense to you now, Mrs. Palmer?
[Mrs. Palmer:] Yes.
[Dr. Lief:] By reducing confusion and giving the couple increased understanding,
the therapist is able to reduce tension, maintain empathy, and point the way toward therapeutic goals.
[Dr. Reed:] I want you to understand, though,
his vicious cycle that he's caught up in right now.
Okay?
It's something he wants, but he's so afraid he's going to fail, he can't relax.
Can you recall when you were courting or petting
and all that?
Not too far back in the dark ages, hmm?
[Laughter]
[Dr. Lief:] I think you may have been able
to notice the reduction in tension that has already occurred.
By referring back to their past successes,
the therapist is able to allow the couple
to build up once again their positive regard for each other.
Compare the beginning and the ending of the interview.
I think you will agree the emotional interaction
between the husband and the wife has changed remarkably.
A therapeutic alliance has been formed.
Suggestions for changing their patterns for Interaction have been made.
Motivation for change is beginning.
Note that the handshake that ostensibly ends the interview does not.
Sometimes important communications
occur after the formal closure of the session.
[Dr. Reed:] How do you feel now about coming in?
Has any...
[Mr. Palmer:] Well, it's a little better now.
As I say, it's uh, basically,
[Dr. Reed:] Talking some of this out...
[Mr. Palmer:] Well, obviously, with a third person there,
it's a little embarrassing at first.
[Dr. Reed:] But you talked with each other.
Did you see that?
[Mr. Palmer:] Yeah.
[Mrs. Palmer:] Yes.
[Mr. Palmer:] Well, I felt that the very fact
that we've admitted we have a problem,
which was not easy to do.
[Dr. Reed:] But you talk to each other, and it helps, right?
[Mr. Palmer:] Yeah.
[Dr. Reed:] So that's my commercial.
[Mr. Palmer:] Okay.
Thank you.
[Music]