Structure of Sessions
Dr. Forshee’s approach to marital and couples counseling first begins with a thorough assessment and evaluation of the relationship’s strengths, and areas that need improvement. This is what you can expect during the first three sessions of marital and couples counseling:
During the first session, Dr. Forshee will meet with the couple together. This appointment is 60-minutes in length and consists of learning from both partners why they are seeking counseling now and what each partner expects to get out of attending marital or couples counseling. During this appointment, if conflict arises between the partners, Dr. Forshee will allow the conflict to unfold as it would in their natural environment without intervening. The purpose is to obtain a communication analysis, note behavioral observations, interpersonal conflict management styles, and observation of verbal, para-verbal and non-verbal communication patterns.
After the first session, Dr. Forshee will email a link to each partner to complete assessment questionnaires. These assessments are completed online via a HIPAA-compliant platform, are a total of 480-items to answer, take on average 1.5 hours to complete, and is paid by the couple at a nominal fee. Once completed by both partners, Dr. Forshee will receive an automatically-generated email informing her the assessment results are ready for her review. The function of the assessment questionnaires is to assist Dr. Forshee in determining the areas of strength and areas that require growth, as well as any individual clinical factors that may be confounding variables and potentially causing problems in the relationship. This will assist Dr. Forshee in the formulation and targeting of your individualized treatment plan.
During sessions two and three, Dr. Forshee will meet with each partner individually to conduct a thorough oral interview of each partner. This appointment is 60-minutes in length.
Session four is the feedback session, where Dr. Forshee will summarize the results of the assessment, integrating information from the first couples interview, the individual oral interviews. She will then provide a concrete treatment plan with objective rationale backing her proposed plan and interventions.
After session four begins the intervention sessions. Dr. Forshee usually begins each intervention session with whatever the couple brings in- a fight, the need for one, or the problem of emotional distance between them. The issue raised by the couple generates which alternatives to the couple’s ineffective patterns of interaction will be the focus for the session. The couple controls the road followed while Dr. Forshee has the building blocks of bridges the couple can use to grow both closer to one another and more connected with each other.
The frequency and length of therapy will be determined by your specific needs and goals. In the course of therapy, we will establish points at which to evaluate your satisfaction and progress. Also, Dr. Forshee encourages couples to raise any questions or concerns that you have about therapy at any time. In the later stages of therapy, we will “phase out”, and meet less frequently in order for you to test out new relationship skills and prepare for termination of therapy.
In Situations where There has been Infidelity
While structure of sessions and the assessment phase are the same as above, there may be a need for an additional session devoted to “contracting” prior to any interventions being started. The contracting session is essential in relationships where there has been an infidelity because of the shattered foundation of trust and assumptions of what the marriage once was, as well as the heightened emotions that follow. During the contracting session, we will outline what it will take to repair the relationship (potentially, the need for partner to disclose all details of the infidelity); cut off all contact with the other; rebuild a relationship; the disclosing of any further contact with the affair partner prior to your own partner inquiring; talking about the infidelity only during counseling appointments. Dr. Forshee will not provide marital or couples counseling in instances where one partner is continuing to have contact with the affair partner, unless it is to work through ending the marital relationship and there are children involved, at which point we can transition to parenting-time and co-parenting appointments.
There may also be additional individual sessions to meet with both partners for Dr. Forshee to learn about the infidelity and nature of the infidelity, as well as the post-traumatic symptoms the other partner may be experiencing as a result.
How Dr. Forshee Views Problems in Relationships & Couples Therapy
Beating up clients about their respective behaviors is not necessary. Instead, the focus is on inquiry, exploration and understanding. Overall, much of conflict resolution is an exploration of meaning behind the conflict, not the content of the conflict itself.
Most typically view marital and couples therapy as a way to fix major disorders in their partner, with perhaps some minor adjustments for themselves. This is called the “fundamental attribution error”, or attributing the sources of relationship problems to the other and not to oneself. In all relationships, each person’s behavior is affected by the other. This is called “circular causality”. Instead of labeling one person as pathological, each person’s pathology is viewed as a reaction to the other’s. Because Dr. Forshee approaches conflict from this perspective, she is able to maintain a neutral stance during sessions. This is imperative to the integrity of marital and couples counseling and to the desired outcome of treatment.
While exploration of childhood is necessary to understand how experiences have influenced how people view relationships, the world and themselves, marital and couples counseling is not intended to heal or change how these experiences may have affected the person they are today.
Dr. Forshee’s stance on emotions is in line with Darwin’s theory- all emotions are functional and serve adaptive functions. Anger and rage can be in the service of justice, or the establishment of specialization, leadership, and fair and equitable dominance in relationships and in couples. It is not necessarily true that behind anger lies the primary emotion of fear, nor is it necessarily true that behind anger is insecurity, attachment or psychiatric problems (though in some it may be). In marital and couples counseling, the expression and understanding of pure anger can be the basis for greater understanding, fairness, emotional connection, and bonding for partners.
Dr. Forshee encourages couples to fight in her office as they would at home. Her role is not to stop conflict, but to allow the process to unfold as it would in its natural environment (unless safety is compromised). This allows for a process called “state-dependent learning”, which when exposed to it, provides opportunity for both partners to learn how to self-soothe, and soothe one another. This renders the therapist replaceable, as you will learn to deal with conflict on your own and as a couple, ultimately minimizing a couple’s relapse upon termination of therapy.
The couples therapy process is mostly dyadic; meaning, between the couple. Dr. Forshee’s goal is to teach couples how to communicate with each other, not with her. Over time, this promotes confidence they can rely on each other and again, reinforces the notion that a third-party intervening in their relationship will not always be a necessary force for their relationship to be successful. Dr. Forshee will act more as a validating, compassionate coach and “translator” of the feelings and needs of each person in the interaction. She will also explain and teach constructive conflict management skills, and provide methods and concrete interventions for the couple to deepen their friendship and intimacy.
Confidentiality and Marital/Couples Counseling
Information disclosed during individual sessions may be relevant or essential to the proper treatment of the couple. Therefore, complete confidentiality is not guaranteed in marital or couples therapy. Anything shared in an individual session may be discussed in subsequent therapy sessions with your partner if it is necessary for proper treatment. If information is shared during an individual session that needs to be disclosed to the partner, Dr. Forshee will offer the individual every opportunity to disclose the relevant information and will provide guidance in this process. The same applies to phone calls, voice mails, text messages and email messages.
The goal of couples and marital counseling is the amelioration of psychological distress and interpersonal conflict, and that the process of psychotherapy depends on trust and openness during therapy sessions. Therefore, it is expected that information disclosed during the therapy process will not be used for legal purposes, or against any of the other parties in a court or judicial setting in any kind.