A CLASSIFICATION SYSTEM OF COUPLE RELATIONSHIP PATTERNS
Over the years, clinical observations in our outpatient psychotherapy practice reveal that some individuals and couples respond differently to the therapy relationship than others. They seem to resist your efforts to help them manage their marriage and are more difficult to engage and maintain in therapy. These differences appear to be related to the couples’ relationship style or pattern than to the symptoms for which they were referred.
In analyzing our observations, we’ve developed a classification system of individual and couple relationship patterns to help therapists understand and manage these difficult clients in therapy. Careful assessment of their relationship pattern can predict the course and duration of therapy, predict typical resistances and crises, and manage difficult feelings evoked in the therapist.
Difficult couples are a unique challenge in that they demand considerable time and follow-through. They present with complicated emotional and medical histories and often have chronic relationship dysfunction with recurring psychiatric symptoms. To help us manage their resistant, avoidant or otherwise difficult patterns, we have organized our clinical assessment and intervention according to a classification system of couple relationship patterns.
Individuals and couples seen in our clinic have been classified into three observable patterns: Detached/Avoidant, Chaotic/Ambivalent, and Competent/Secure. The classification system assesses the relationship patterns across four domains: the couple’s engagement in the helping relationship, the therapist’s response to the relationship, the couple’s relationship history and the couple’s ability to use and maintain support networks.
The couple relationship style appeared to be repeated during the development and negotiation of the therapeutic relationship. It showed a consistent pattern across the different therapy modalities (individual or couple sessions) and appeared to be related to the couple’s reported history of relationships.
The Classification System draws its theoretical foundation from attachment theory object relations theory and family systems theory. Attachment theory supports the assessment of predictable patterns of relationship development. Object relations theory supports the assessment of painful early relationship experiences which have been internalized and repressed and seek repetitive expression in the therapeutic relationship. Family systems theory supports the assessment of individuals developing in the context of interdependent and intradependent family relationships which are resistant to change. All three theories support the notion that the quality of a couple’s relationship environment is influential in shaping an individuals’ capacity to engage in meaningful and satisfying relationships later in life.
The Four Domains
The first domain of assessment is the couple’s engagement in the helping relationship. How partners engage in a helping relationship in a time of distress, such as in seeking psychotherapy is seen as a manifestation of the balance of frustrating and satisfying experiences in their early and current relationships. Couples for whom relationship experiences have been consistently accepting will present different styles of engagement and expectations then couples who have relationship experiences in which members have been rejected or responded to in an unpredictable way. This domain enables us to assess a couple’s attachment behaviors and their expectations of others in times of distress.
The second domain to be assessed is the therapist’s response to the relationship. How the therapist feels in the relationship with the couple helps us determine the couple’s internal world or model of relationship experiences because we believe that a couple’s relationship history will be repeated in the helping relationship. These feelings provide an invaluable diagnostic window from which the therapist can affectively begin to gather information to describe the affective experiences of relationships within a particular couple. When the therapist’s response to the relationship is congruent with the couple’s engagement style, the therapist can reach an initial impression of the couple’s relationship pattern prototype. This domain helps us assess a couple’s affective response to needing others. Careful monitoring of these emotional reactions will help prevent empathic blocks which may lead to difficulties in the development of the therapeutic relationship between the therapist and the couple.
The third domain of assessment is the couple’s history of relationships. This domain provides the therapist with a consolidation of the initial impression of the couple’s pattern by comparing present relationship styles with the couple’s reported history of significant relationship experiences. This information is obtained from each partner using a “Family Relationship Development” form. Questions about how each partner (past and present) experienced closeness, separation and times of distress are reviewed. Our focus on different styles in reporting about how early childhood experiences appears to have some resemblance to Main and Goldwyn’s (1995) classification of the Adult Attachment Interview. This domain analyzes the degree of congruence between current relationship styles and childhood memories by measuring partner’s current perceptions of “others availability” and their past memories of significant others’ availability.
The fourth domain of assessment is the couples perceived availability and use of social support networks. The therapist assesses the couple’s degree of isolation from potentially significant and helpful relationships and determines the extent of dependency the couple will exert upon the helping relationship. To the degree that the couple is isolated and does not use available resources, their utilization of the helping relationship will decrease. This domain confirms the therapists impressions of the couple’s expectation of others availability in times of distress. In addition, it helps the therapist predict the couple’s responsiveness to the therapeutic relationship and the length of treatment. The evaluation is completed when the therapist has observed congruence of the relationship pattern across the four domains.
We will now discuss the characteristics of each of the three observable relationship patterns assessed across four domains when assessing couples as they present for therapy. Individuals and couples usually have characteristics of all three patterns, but one pattern remains consistent over time. These relationship patterns are the unit of analysis.
This assessment tool was developed to manage resistant and avoidant couples. It focuses on the development of close relationships and evaluates difficulties in the development of attachment and differentiation. It is useful in predicting the course of treatment, managing crises, working through resistant behaviors and helping the therapist manage countertransference issues.
The Three Patterns
The Detached/Avoidant Couple: These couples may present with a traumatic relationship history or one that appears non-eventful or idealized, and will dismiss any connections between that history and their current difficulties. Current couple interactions will be characterized by detachment, control and unexpressed rage. These couples are isolated and do not have close friends. They are avoidant of therapists and usually call for help after a crisis “forces” the issues and their relationship feels at risk. Even then, they are devaluing of the therapeutic relationship and do no see it as a source of comfort or support. One partner is often presented as “crazy” and needing to be “fixed”.
During the engagement phase, these couples evoke feelings within the therapist that the couple themselves have denied or repressed when interacting with each other. These are often difficult feelings for the therapist to admit and include hate, rage, boredom and disgust. These feelings, when identified, help the therapist understand the couple’s affective experience in relationships. They can also help the therapist understand the couples’ underlying fear of attachment and rage over unmet needs.
Their history is revealed over time and is not readily available for investigation early in the assessment process. Eventually, they may report a traumatic history of one that appears uneventful or idealized, but most importantly they will dismiss any connection between their history and their history and their current difficulties. Those who remember a “perfect” childhood cannot provide any details. They avoid describing significant attachments while dismissing the importance of early family relationships. Perhaps their idealization of early relationships protects them from the terror and depression once felt during separation and other painful losses. This is consistent with Main and Goldwyn who identified a group of adults, labeled “dismissing of attachment”, who either idealized or lacked memory of their relationship with their parents.
Finally, these couples do not seek the support of others. They are isolated and do not see others as a source of comfort or advice. They prefer to handle problems on their own and avoid disclosing their issues to others.
The Chaotic/Ambivalent Couple: These couples present a history with unresolved trauma, particularly losses and separations with which they are still preoccupied. Their relationship difficulties appear to be chronic. Couple interactions are typically chaotic and ridden with anxiety. They have unstable support networks which often “burn-out”. They can evoke high levels of anxiety and ambivalence in therapists who usually empathize with and care about the family, but also feel ineffective as they try to contain he couple’s anxiety.
These couples enter the helping relationship in a chaotic whirlwind of need. They present with anxiety and lack clarity when describing their current problems. Significant events related to their crisis are confusing. They report unsuccessful attempts at resolving their issues, even though they may have seen several therapists or helping professionals before. They attach quickly, seeking therapy as a source of relief but remain ambivalent about trusting the therapist to meet their needs.
These couples evoke caring and sensitivity from the therapist. Their genuine need for relationships helps differentiate their style from the detached couple. Their chaotic and impulsive engagement style evokes anxiety, ambivalence and confusion in the therapist. This insecurity provides a window into these couples’ experience of relationships.
They report a history of unresolved trauma, loss and separation and are still emotionally preoccupied with these losses. Their history of relationship stress is chronic and revealed inappropriately. They describe early memories with anxiety and intense emotion. Memories of separation evoke rage and loss of self esteem as they relive their abandonment in the context of the therapeutic relationship. Their present problems reflect a predictable pattern of inconsistent and ambivalent relationships in their early history with which they still experience an enmeshed insecure attachment. This reminds us of Main and Goldwyn’s “preoccupied” group, described as confusing and lacking in objectivity.
These couples are less isolated then the detached couple, but it appears that the couples source of support often “burn out” and become unavailable. They are dependent on the helping relationship butt end to change from one system to another in am effort to disperse their overwhelming needs and manage their anxiety about the consistency and availability of others.
The Competent/Secure Couple: These couples present histories which may or may not involve trauma and are capable of connecting past relationships with current relationship styles. Couple interactions are direct and caring, although in therapy they may involve uncovering painful emotions. They have stable support network on which they can rely in times of crisis. They seek help in response to recent stressors or losses and manifest basic trust in the therapist’s ability to help them. These couples evoke feelings of empathy and competence in the therapist.
They are in distress when they first present, but appear calm and organized when describing their problems. They willingly seek help and trust that the therapist will be there for them. They present with a sense of humor in the face of their pain and value the therapists ability to provide support. They evoke a relationship experience of competence and connection. The therapist feels valued and empathizes easily as they engage in the relationship.
They report histories that may or may not involve trauma ad are capable of connecting past experiences with their current relationship style. When describing their problems, they remember both frustrating and satisfying childhood experiences and can provide specific examples. Experiences of separation evoke guilt and sadness and a longing for reparation. dThey want the secure feeling of closeness and see their relationships as enduring over time through periods of hardship and distress. They have a realistic view of current and past relationships and respond appropriately to their current distress. They show similarities to Main and Goldwyn’s “secure/autonomous” adults who value attachment relationships and can be objective and independent in evaluating any particular experience or memory. They report available and reliable social support networks. They may have reached out to a friend before seeking therapeutic support.
Discussion: A diagnostic formulation of the couples relationship pattern has been achieved after the therapist has found congruence across all four domains. Although a couple may present with characteristics of each pattern, one consistent pattern will emerge. It is important to remember when assessing relationship patterns that the unit of analysis is the relationship, not each individuals characteristics. In the next segment, we will discuss management strategies helpful for each pattern.