Case Studies in

Couples Therapy
THEORY-BASED APPROACHES

Edited by David K. Carson

and Montserrat Casado-Kehoe

New York london

Contents
Series Editor's Foreword ............................................................................................. xi
Preface ..................................................................................................................... xiii
Acknowledgments ...................................................................................................... xv
About the Editors .....................................................................................................xvii
Contributors ..............................................................................................................xix
Introduction: Couple Therapy in Contemporary Society and a Theory-Based
Case Study Approach............................................................................................. xxvii

David K. Carson and Montserrat Casado-Kehoe

1. PREPARE/ENRICH Program for Premarital and Married Couples ......... 1
Amy Olson-Sigg and David H. Olson
2. Preparing Couples for Marriage: The SYMBIS Model... ............................ 13
Les Parrott and Leslie Parrott
3. Lessons Learned From Recruiting Diverse Couples for Clinical
Research on Relationship Education.............................................................. 29
Marcie Pregulman, Shauna Rienks, Howard J. Markman,
Martha Wadsworth, Lindsey Einhorn, and Erica Moran
4. Adlerian Therapy With Couples ..................................................................... 41
Patricia A. Robey and Jon Carlson
5. Working With Couples From a Psychodynamic Perspective Using
Cognitive Maps ................................................................................................. 53
Albert Brok
6. Object-Relations Therapy With Couples ....................................................... 65
Carl Bagnini
7. Integrated Intergenerational Couple Therapy .............................................. 79
David M. Lawson
8. Cognitive Behavior Therapy With Couples ................................................... 93
Jan Dickson, Frank M. Dattilio and Lisa Cherrington
9. Cognitive-Beha\'ioral Couple Therapy: Multiple Couple lllustrations
and Comparisons............................................................................................ 109
Terence Patterson

vii

viii

Contents

10. Ecosystemic Structural Therapy With Couples .......................................... 121

Marion Lindblad-Goldberg, Edward A. Igle, and Steven Simms
11. Problem-Solving Brief Therapy: The Palo Alto Approach to Working
With a Latino Couple..................................................................................... 133
Karin Schlanger
12. Mental Research Institute's Brief Therapy Approach to Couple
Therapy ........................................................................................................... 145
Barbara Anger-Dfaz and Katharina Anger
13. Strategic Couple Therapy.............................................................................. 161
Wendel A. Ray and lana P. Sutton
14. A Path to Wholeness: Couple Therapy Within the Satir Model ............... 177
Jean A. McLendon and lames Robert Bitter
15. Emotionally Focused Couple Therapy: A Military Case Study ................ 191
Kathryn D. Rheem, Scott R. Woolley, and Susan M. Johnson
16. Imago Relationship Therapy .......... ............................................................... 205
Harville Hendrix and Mo Therese Hannah
17. Imago Couple Therapy and the Relational Paradigm................................ 217
Wade Luquet
18. Creative/Experiential Therapy With Couples............................................. 229
David K. Carson and Montserrat Casado-Kehoe
19. An Application of PragmaticlExperiential Therapy for Couples ............. 249
Paul Weiss, Brent Atkinson, Ahna Holzinger-Young, and Anna Larsen
20. Group-Oriented Experiential Couple Therapy: An Adventure-Based
Approach ......................................................................................................... 263
J. Paul Burney
21. Solution-Focused Brief Couple Therapy ...................................................... 275
Thorana S. Nelson
22. Narrative Therapy With Couples ................................................................. 289
Paul Gallant and Ilene Strauss
23. Collaborative Couple Therapy: Turning Fights Into Intimate
Conversations............ ...................................................................................... 303
Daniel B. Wile

Contents

IX

24. Collaborative Therapy With Couples........................................................... 317

Susan B. Levin and Diana Carleton
25. Gottman Method Couple Therapy: From Theory to Practice .................. 331
Robert J. Navarra and John Mordechai Gottman
26. Affective Reconstruction: An Integrative Couple Treatment Applied
to Parental Bereavement ............................................................................... 345
Molly F. Gasbarrini and Douglas K. Snyder
27. Integrated Couple Therapy: A Family Developmental Approach
to the Treatment of Couples Incorporating Psychoanalytic and
Systemic Models ............................................................................................. 357
Michael D. Zentman
28. The Hope-Focused Approach to Couple Enrichment and Counseling ..... 369
Jennifer S. Ripley, Everett L. Worthington, Jr., and Vickey L. Maclin

Index ........................................................................................................................ 383

22
Narrative Therapy With Couples
Paul Gallant and Ilene Strauss

This chapter is the authors' interpretation of the theoretical and practical contributions of Michael White in what has come to be known as narrative therapy and can be
found in the abundant articles, chapters, and books that are part of his legacy (White,
1989, 1997, 1999, 2000, 2004, 2007a; White & Epston, 1990; Vodde & Gallant,
2002). The intention is to demonstrate that ideas from the narrative therapy approach
are particularly suited to couples work through its multi perspective stance and its
recognition that there are many perceived truths and many possible accounts of the
same experience (Payne, 2006).
Narrative therapy is an optimistic and invigorating orientation that allows for
curiosity and collaboration on the part of the therapist. The primary thrust of narrative therapy is the importance of focusing on meanings or interpretations clients
have of life events and not simply on the events themselves (Polkinghorne, 2004).
In the authors' view, what makes this work refreshing and revitalizing is the focus
on the human capacity to tell stories, how people live out the stories they have of
themselves and others, and the construction of their identities and senses of self
through these creations. As Polkinghorne noted (2004, p. 61), "The purpose of
narrative therapy is to assist people in changing the narrative meaning they have
given to their own lives from one that is restrictive and victimizing to one that
opens possibilities and is empowering." Much of narrative therapy is derived from
Michael's belief that problems are not inherent in individuals but are brought about
in the context of their cultures. He believed that people derive the meanings of their
lives from stories that come about in their social contexts, and that these stories
can be reauthored.

Narrative Therapy Assumptions and Treatment Goals

Goals for treatment in the narrative therapy approach for working with couples come
from the core assumptions that form the foundation of Michael White's work. In his
numerous workshops, trainings, and publications, Michael stressed the importance of
collaboration; paying attention to clients' grand narratives of culture, race, class, and
ethnicity; externalizing conversations; and the multistoried nature of people's lives.

289

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Case Studies in Couples Therapy: Theory-Based Approaches

Collaboration
In narrative therapy, goals are coconstructed within the collaborative conversations
between the couple and the therapist. Remaining decentered, yet influential (White,
2007b, 2007c), the therapist has the responsibility as an interviewer to respect that the
couple decides the focus of the conversation and defines the problems to be addressed.
It is through staying decentered in conversations with couples that the therapist is able
to give priority to their wisdom and skills, so that they may set the direction of the
work. Being influential refers to the responsibility of the therapist to ask the kinds of
questions and offer reflections that support couples in bringing forth the intentions
they have for themselves and their relationships, and highlighting their knowledge
and skills that are available to address their goals and concerns.

Grand Narratives
Like other poststructuralists, White views reality as being socially constructed. The
emphasis is on the narrative quality of a couple's experience and the ways in which
people organize their lives around particular meanings they ascribe to their experiences (White & Epston, 1990). However, itis important to note that White's focus was
also on the power relations and social forces that constitute such narratives. White
was concerned with the oppressive effects of grand narratives that are embodied in
dominant discourses and in cultural practices. It is in this area that White built upon
the ideas of Michel Foucault (1979). In therapy, these are the "shoulds" that are hidden in the "constant droning background murmur of cultural discourse" (Winslade,
2008). Just one example in many cultures is the idea that a man should be the head of
the household. Therefore, a key element of narrative therapy is to remain sensitive to
the effects of discourse on a couple's relationship, particularly those cultural practices
that have the effect of objectifying one's partner in the relationship and the objectifying of one's self (White, 2004).

Externalizing Conversations
White believed that people can become agents of power as well as suffer the effects
of power exerted over them. In collaboration with David Epston, he devised a process
that serves the purposes of deconstruction, which they referred to as "externalizing
the problem." According to White (1989), externalizing is a process of questioning
that encourages persons to "objectify and at times personify the problems that they
experience as oppressive" (p. 5). The goal is to separate the person or couple from
the problem in such a way as "to make the problem the problem" (White, 1989, p.
5) rather than identifying a person or a relationship as the problem. For example, a
couple who present with the problem, "We are always in conflict," are invited into a
conversation wherein Conflict becomes viewed as a force, separate from the couple,
that has occupied the couple and recruited them into a conflict-saturated view of
themselves and their relationship. Questions such as "In what ways is Conflict affecting your relationship?" and "How were you able to control Conflict so you could come
here today?" may be used in conversation. This externally situated focus on Conflict
may allow the couple to mobilize counterforces of strengths, resistance, and personal

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Narrative Therapy With Couples

291

hopes that exist within each partner. Extemalization extends to revealing those social
forces whose interests lie in maintaining such personification.
White and Epston (1990) focused on the empowering effects of rejecting such negative self-narratives and challenging the authority of those grand narratives. Hence,
White and Epston appeared to have used Foucault's (1979) analysis of the "practices of power" (p. 76) to help couples undo the influences of those dynamics in their
relationship. Those who are not familiar with the concept of narrative therapy may
struggle to appreciate that it is a self-contained practice model with the basic goal of
pursuing this form of social justice (Gallant, 2008).

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A core assumption of narrative therapy is that people usually present one-dimensional stories of their lives when consulting a therapist. They have negative and
thin conclusions about their identity and their relationship, and think the future
will be a reproduction of the past. White (2007a) offers that life has a multistoried
dimension and that many of the stories of peoples' lives are not visible to them. He
believed it is the job of the therapist to build a scaffold through the clients' questions, making it possible to get into the other, uncharted stories of their lives. In
this context of exploration, people feel acknowledged and get in touch with their
knowledge and skills, and they become fascinated with the neglected aspects of
their own lives. Through this process, people are able to come up with ideas on how
to move forward.
In one of Michael's last presentations in North America (White, 2007b), he included
the following in his opening remarks:
If we can get onto some of the thin traces of these subordinate story lines of
peoples' lives, if we can support them in the rich development of those thin
traces so the subordinate story lines come out of the shadows, people find
themselves suddenly standing in another territory of identity. They begin to
experience other conclusions about their value, and about their worth. So a
sense of worth displaces a sense of worthlessness. A sense of competence
displaces a sense of incompetence.

Case Study
Treatment Process: Early Phase
Presenting Issues and Difficulties
Diane and Ira requested individual and marital therapy with the first author. Diane initiated the first couple's meeting, concerned about her husband being socially isolated,
shutting people out of his life, and feeling generally depressed. Diane explained that
the smallest things seemed to upset him. For example, she stated he is an extremely
neat and tidy person and becomes angry when she leaves things around the house.
The situation had her convinced that Ira had personal problems and needed help.

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Case Studies in Couples Therapy: Theory-Based Approaches

Background Information
The couple had been together for 10 years and married for the past 3 years. They
both were in their early 308 and did not have children. Both of their parents were
immigrants to the United States from their native Colombia. They explained that their
families had different cultural practices and expectations, particularly when it came
to religion.
Diane described growing up in a family of privilege. Her father was a successful
businessman and her mother had a maid who assisted with housework and child rearing. Diane became a social worker supervisor and administrator, said she loves her
job, and is proud of her career accomplishments.
Ira described a more difficult upbringing in his family life, with a struggle to make
ends meet financially and conflict with parents. After high school, Ira went to work in
the home construction business. He eventually owned his own flooring company. Ira
described his one sibling, an older brother, as extremely antisocial, living with his parents and having difficulty finding employment. Ira employs his brother when there is
enough work for both. Ira has held onto a longtime goal of becoming a police officer.

Assessment and Case Conceptualization

The couple had a desire to improve their relationship and strengthen their marriage;
however, they were concerned about the increasing frequency of arguments and the
increasing sense of isolation and depression with Ira. They both wanted to have children, but were concerned about the lack of stability in their relationship. Ira claimed
that Diane looked down upon him, regretted marrying him, and was very demanding.
He stated that he felt no support for his dream of changing careers. Diane believed that
Ira had low self-esteem, was extremely critical of her, and showed less and less affection. Both perceived that the other's family contributed to their marital problems.

Treatment Goals
Ira and Diane stated their goals were: (1) to receive help for Ira to feel less depressed,
and (2) to decrease the amount of conflict and arguments between them. The therapist's goals involved attending to these goals by employing narrative therapy practices. The overall goal was to participate in rich story development (White, 2007a)
of the couple's life through the deconstruction of the dominant plot of the couple as
conflicted, of their being troubled persons, and of their situation being unstable. The
process involved generating a conversational partnership with Ira and Diane in which
dominant stories were deconstructed and new storylines of each person's self and the
relationship emerged. Techniques from narrative therapy were employed, including
discovery of unique outcomes, externalizing the problem, and exploring hopes and
intentions for their lives. These techniques and others are demonstrated in the following session segments.
During a 1993 conference in Atlanta, GA, Michael White spoke about the first
step of therapy having to do with opening couples to break free and challenge the
interactional patterns that are impoverishing their relationship. The second step is
to work with couples to help them generate alternative patterns of interactions and

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Narrative Therapy With Couples

293

alternative stories about their relationships that bring with them preferred effects in
their lives and relationships. This notion is based on his idea that how we see ourselves in relationships is not fixed, but that it is merely the meaning the couple makes
of these patterns. The understanding and meanings people have of themselves and
of their relationships are created through language and society, and these meanings
can be changed, deconstructed, and reconstructed through different ways of engagement in the telling of stories. Therefore, Michael explained that he had couples share
alternative stories about their relationships that would bring about preferred effects
in their lives.
Michael stated that in asking couples to tell him about what they were most interested in talking about in the session, they usually responded by describing certain
concerns. Concerns are usually cast in terms of problems. Often these problems have
seemed to the couple to be relatively immoveable and relatively insoluble. At times,
couples reach a point where they believe that these problems actually speak the truth
of their relationship with each other and who they are as people. For too many couples, the problems appear to reflect certain, maybe inherent, flaws in a relationship as
well as certain negative qualities that are intrinsic to the characters of the partners.
Michael stated it was particularly apparent when their problems were long standing
and the couple had resisted many efforts to modify them.

An Example of Externalizing the Problem

According to White (2007a), externalizing makes it possible for people to experience
an identity that is separate from the problem; the problem becomes the problem, not the
person. In this session, the author asked the couple about the conflict they were experiencing by attempting to externalize it in order for Diane and Ira to see that the conflict
is the Problem and not either of them. Arguments are externalized in this segment:
Paul: So arguments creep in sometimes? Or you were saying frustration?
Ira: Yeah, sometimes.
Paul: Things show up?
Diane: Yeah.
Ira: Yeah.
Paul: Yeah, do arguments come around a lot in your relationship?
Ira: Sometimes ... but for stupid things. About things that shouldn't be argued
about.
Paul: Yeah?
Ira: You know, after we think about it, we say we argued about something stupid.
Diane: (nods her head yes) Right, right.
Ira: Yeah, it's not worth it, you know.
Paul: It is almost like a habit.
Diane: It could be.
Paul: What would you call this issue that you are struggling with? What is getting in
the way of your being in a place where you can really feel ready to have
children and go on in a way that you would be happy with?
Diane: I thought about that. .. I don't know what's wrong.
Paul: Ira, what would you call it?

294

Case Studies in Couples Therapy: Theory-Based Approaches

Nc

Ira: I really don't know.

Paul: I mean, is it disagreement?
Diane: I think it is disagreement, and a lot of things. Um, I think he is used to getting the say in whatever he wants always ... when Ira says something, his
parents just hide and do whatever he wants ... in my household it was
totally different.
Paul: So you come out of different lifestyles. I mean, you are from the same culture
with a lot of richness that is unique to your culture. But in terms of your
styles with how men and women are together, you came from different
kinds of experiences.
Diane: Yeah.
Paul: And are those different life experiences getting in the way here?
Diane: Melting it together.

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White (1993) explained that his next step is to engage the couple in exploring some
of the effects of the problem on their relationship and on their lives. Therefore, when
a couple comes to therapy and states that they have a conflict-oriented relationship,
White would likely ask questions about how the problem had been interfering in their
relationship, and about how it had been limiting their interactions with each other.
Additionally, White (1993) asked about how the problem had been affecting the
perceptions that the partners had of themselves and of each other. In other words, he
really wanted to know what the problem had talked them into about themselves and
about each other. He also asked about whether or not the problem had the partner saying and doing things that went against his/her better judgment. If this was the case,
he requested they give him some details about what they believed to be their better
judgment. He encouraged couples to evaluate the real effects of the problem and then
to justify this evaluation. He asked the partners if they were comfortable with the
effects of the problem or not. He also explored which of the effects were most distressing to them.
White often found that the problem had, among other things, distanced the partners
from each other, and he wanted to know if this was a positive or a negative thing. He
knew some partners wanted to be very close and some partners preferred to have
some distance. He was not assuming to know whether the problem was problematic
or not. He asked them to share their thoughts with him about why they judged these
effects to be so negative, and about why they thought these effects were so disadvantageous to their relationship and their personal lives.
Michael explained that it was very important that space be provided for couples to
take a clear position on the problem and its effects on their relationship. Otherwise,
the therapeutic efforts would likely be run on the evaluations and justifications of
the therapist. Hence, in therapy, the therapist explores the effects of the problem and
identifies the processes of the recruitment that determine the negative "truths" the
partners have arrived at, and assists couples in noticing that these problems no longer
speak to these couples about the identity of their relationship or about their personal
identities. These partners then experience the possibility of a relationship and personal identity that is apart from the problem. Michael explained that when couples

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Narrative Therapy With Couples

295

experienced the possibility of alternative ways of viewing the problem, they were then
able to explore new possibilities for their relationship.
In the exploration of the effects of the problem on a relationship, couples will always
speak of an event, idea, or experience that doesn't fit with the dominant story about
a partner or about the relationship. According to White (2007a, p. 61), "Re-authoring
conversations invite people to continue to develop and tell stories about their lives, but
they also help people to include some of the more neglected but potentially signi ficant
events and experiences that are 'out of phase' with their dominant story lines." In
the segment that follows, the therapist is privileging an alternative story of changes
the couple have made together. The new story line is that they are a couple who will
accommodate. Through this conversation, the therapist helps to bring out the evidence of this accommodation, in order to thicken this story.
Michael emphasized that people regularly present their lives as if they were singlestoried. He advocated training ourselves to listen for traces of subordinate storylines.
There are always traces of these stories, he asserted. He was constantly on the lookout
fur points of entry to these subordinate stories so that they could become known, and
emerge from the shadows of dominant stories so that they could become more visible.
White also spoke about change. He did not advocate that therapists should aim
to produce change. Instead, he argued that change was happening all the time in
people's lives. People are constantly constituting and reconstituting their lives. Thus,
the therapist's job is to join in both recognizing these changes and developing significance around them.
Paul: There are a number of things that Diane has noticed that you have changed.
I started this discussion by asking what have you noticed? And you said,
"Nothing, really," and then you began to say you have done many things
and made many adjustments ... you know, just to accommodate, and then
you started to talk about Ira's adjustments. So it sounds like there have
been some.
Ira: (looks at Diane) What about the church thing?
Paul: Oh, that was another one.
Diane: Oh, well that's been like a positive change, then a negative change, then a
positive change. Because he did go to church. Yeah, that was it.
Ira: But you know it's kind of difficult for me to go to Catholic church because of the
things they say and the things they do. Things I see that I don't, you know,
I don't agree with.
Paul: But you went for Diane, right?
Ira: Yes.
Paul: Right, it wasn't about the church; you did it for her because that was important
to her.
Ira: Yes, I really didn't want to be there, but I went for her.
Paul: Mmmm, yeah.
Diane: I was surprised. I sat on the aisle ... the first 20 minutes he was playing with
the baby and making him laugh then ... he walked the baby outside. It was
a surprise because I would usually be the one doing it. I'm grateful that
he did that and went to church for me, because usually Sundays I go by
myself. That's also been a fight.

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Case Studies in Couples Therapy: Theory-Based Approaches

Paul: And yes, I'm also writing down "open to counseling" because you had said
. .. it was a while that you wanted Ira to come with you to see someone,
but (looking toward Ira) you did. You came, and that's another sign of
accommodating.
Ira: Yes (nods his head).
Paul: So you are a couple who accommodate?
Ira: (nods yes)
Diane: (nods yes)
Paul: What do you think that says about you as a couple? That on both sides you can
look at the changes that are occurring. There are some things you wish
were different, no question about it. That you wish the other person was
different, but there is already in your three years of living together, there
is accommodation that has already taken place. Are you surprised with
that, that there is a list on both sides?
Ira: (Diane looks to Ira to answer) Yeah, it's just very difficult to see the changes,
unless you start talking about it.
Paul: Yeah.
Ira: Unless things come out, you really don't see the difference; you just think it's the
same thing over and over and over. It's like nothing is changing until you
stop and start to realize and you talk about it.
Paul: Yeah, so what do you think that says about you as a couple?
Diane: That we are willing to work together. Long enough to drive each other crazy
... nah (looks at Ira and laughs).
Paul: Yeah, yeah, well we haven't got to that point yet, have we?
Ira: (nods his head) No, not yet.
Paul: No, no, but willing to work together to try to make things work. Do you think
that would describe you as a couple?
Ira: Yeah.

Michael described another step in his work, which was to ask questions that
helped bring forth the context of these experiences that the couple found problematic. He stated that most interactions or relationship patterns that couples get
locked into are patterns that they didn't dream up for themselves; that is, they
did not radically create or invent them. "You may have seen sometimes that
couples are very adversarial in their interactions upon separation. It is not that
they dreamed up that relationship pattern. There is a whole process involved that
inevitably recruits them into very adversarial ways of dealing with these things"
(White, 1993). Michael observed that many of these patterns were familiar or
were cultural in nature, and that these were actually shaping their couple relationship. Indeed, they determined the accounts the partners had of each other.
Michael suggested that the familiar and the cultural nature of these patterns could
be brought forth with questions like the following: "How did you get recruited
into these ways of interacting with each other? Could you tell me about that?"
He called these recruitment questions. Or, "Have you witnessed these patterns of
interaction in other couples?"
It is of paramount importance to explore the effects of the problem in this way
and identify the processes of the recruitment that determine the negative "truths" the

297

d Approaches

Narrative Therapy With Couples

you had said

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partners arrived at about their relationship and about who they were as persons. The
result may be that these problems no longer speak to these couples about the identity of their relationship or about their personal identities. Indeed, the partners might
experience the possibility of a relationship and personal identity that was apart from
the problem.

An Example of Meaning Making

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Narrative therapy works with the idea that there are no facts; there are just different
meanings that can be made from an event. "Rather, this therapy is associated with
the proposition that the meanings that people derive in these acts of interpretation
are determined by the interpretive resources that are available to them, and further,
that these meanings are negotiated in communities of people and within the various
terms and institutions of culture" (White, 2000, p. 9). The following segment attempts
to show people engaged in creating new meaning by expressing their preferred ways
of being together. Diane noticed changes with Ira and developed a new story of their
relationship through new meanings.
Diane: I wanted to show you that I am grateful that it happened.
Ira: (interrupts) Notice it ... just don't, just don't ... you know.
Paul: Don't what? Don't what, Ira?
Ira: Don't like, you know, uh, like a little kid, you know (moves his arms around,
starts speaking in baby voice). "You did something good. Here is a treat.
Let me give you a kiss."
Diane: Oh, I wasn't. Oh, okay.
Ira: See the good things that I do; don't think that I am never changing.
Diane: (moves to hold his hand) Okay, when I do something good, I like to be treated
like a little kid.
Ira: Oh, and that's you.
Diane: So go ahead, just so you know, go ahead and do that to me.
Paul: So you don't like to be '"
Ira: Sometimes she is like, too ... how do you say it?
Diane: I am very affectionate.
Ira: I used to be very affectionate, but it's rubbing off. I don't know Why.
Paul: You lost your interest in being affectionate?
Ira: Not just with her, but with everybody.
Paul: Really?
Ira: Even my parents and my sister say that, before, I used to always be giving kisses
and hugs. Now I am just not like that much anymore. I guess it just went
away.
Paul: Do you miss it?
Ira: Everyone starts saying you are so like this and you are so like that ... you know,
too much kisses (looks to wife). How do you say bobosa?
Diane: There is no English word. A bobosa is just someone who is so affectionate
that you can't stand it, you know?
Paul: Was he like that?
Diane: Never to me, because to me that is an impossible point.

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Case Studies in Couples Therapy: Theory-Based Approaches

Ira: In the beginning?

Diane: In the beginning you were extremely jealous. I would not call that bobosa.
Ira: Oh, okay, that is something else. Didn't I change?
Diane: Yes!
Ira: Oh, okay then. I was tremendously jealous.
Diane: When we first started going out. I was 19 ...
Paul: (interrupts) I think you, I have to stop for a second ... because you have mentioned several things that you have noticed really changing in Ira.
Diane: (puts her head back and starts laughing out loud) Oh, okay, yes, yes. (nods her
head) Yes, yes, the jealousy.
Paul: Do you remember what they were? The last thing was the jealousy.
Diane: The last thing was jealousy; he is no longer jealous.
Paul: And the one just before that? He is being accommodating around your parents,
your parents being able to watch their show.
Diane: Oh yes, that was yesterday, yes.
Paul: What would you call that-sacrificing, able to, willing to? What would you
call that?
Diane: I would say to share.
Ira: (looks at Diane) Accommodating.
Diane: Accommodating and thinking of others. Accommodating would be fine.
Paul: Oh, thinking of others.
Ira: (looks at Diane) I actually called John (looks at Paul) ... John's my brother ...
when we first came here I was not even talking to my brother; I was very
negative about things. You know.

Clients as Experts
White (2007a) encouraged clinicians to write down the exact words that people use.
He spoke of this as decentering himself. He made an ethical point about the many
ways in which therapists are centered in therapeutic conversations and his need to
keep working to decenter himself in order to invite a person to take up agency in his
or her life.

Paul: Now we can't name what it is that you guys want to get out of your relationship
so you are able to move on in your life.
Ira: I think maybe it is probably more me than her. I mean, she has her things, but I
probably have more problems than she does.
Paul: What makes you say that? '
Ira: I guess from what I hear from people. I have bad anger problems or I don't like
dealing with people ... If you do something bad to me, I say fine, but
twice-that's it, I don't talk to you.
Paul: You cut things off?
Ira: Yeah.
Paul: You forgive someone once but not a second time. Is that right?
Ira: Right.
Paul: Is that a good thing or a bad thing?
Ira: It's not a good thing. I feel like it's not right. You know that I am like that.

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299

Paul: Is that something you would like to change?

Ira: Yeah.
Paul: (looks at Diane) What does that mean to you to hear your husband say that?
Diane: Wow. I am going to cry right now.

Treatment Process: late Phase

Overview of Termination and

The couple and therapist worked together for eight sessions. Diane and Ira decided to
end the work at this point, stating they felt their goals had been achieved. They indicated that they had decided to pursue getting pregnant and starting a family. Diane
also felt especially supported by Ira in relation to his increasing involvement with her
in church activities. She stated that she felt his commitment to the marriage and to
parenthood. Ira expressed that he could feel Diane's support for his pursuing a career
as a police officer. She was pleased that she had worked through her fears of having a
gun in the house and the dangers of this occupation.
The therapist made a telephone follow-up call one year after termination. He spoke
with Ira, who stated that life was going well for them. Ira mentioned he went through
the lengthy process of applying to the local police department. He did not pass the
final tests, but after initial disappointment, Ira was able to accept his fate. He gave
up his flooring business and was working for the city in building maintenance and
pleased with his new job. Ira stated that Diane was very busy in her work and continued to love her job. They were still trying to get pregnant.

Conclusion
Therapist's Reflections/Commentary on the Case
It is the therapist's perception that the couple benefited from joining with a third
person, that they came to view and accept the idea that the Problem was the
Problem, and that Ira was not a person with problems inherent to his character.
They appeared to benefit from sharing the effects of the stressors in their lives (i.e.,
their concerns about the influence of their in-laws on their relationship, effects of
depression, feeling a lack of fulfillment). They both appeared invigorated by the
exploration and expansion of the stories of commitment each felt to the other, of
their hopes for the marriage and their future, and the amount of caring expressed
by their partner.
The therapist noted that he could have made further use of the technique of
repositioning in sessions. This involves interviewing one person in the presence of the
other, e.g., assigning one person to listen and take notes while the partner was being
interviewed, and then turning and interviewing the other person about the experience
of listening in on the conversation. In the therapist's previous work with couples, this
has proved invaluable in reducing conflict in the room between couples and offered
practice in the skill of listening intently.

300

Case Studies in Couples Therapy: Theory-Based Approaches

Implications for Training and Supervision

Michael White encouraged participants in his workshops to continually practice the
skills associated with the narrative therapy approach. He promoted the study of his
own writing and the teaching of those philosophers and theorists from whom he drew
inspiration. Michael also strongly encouraged therapists and trainees to tape their work
whenever possible so that they could present their work and share it with others in supervision. He believed that it is in the attempt to copy the style, manner, and technique of
others that clinicians succeed in developing their own unique modes of practice.
As in the practice of narrative therapy, Michael believed strongly that supervision
should also focus on the rich story development of the supervisee. Russell (2010)
noted that narrative supervision can be viewed as a collaborative, negotiated process
interested in assisting supervisees to connect with what they give value to in their
work and in appreciating the intentions they have for a particular person or persons
they are working with, and for their work in general. Supervision provides the space
for the exploration, naming, and externalizing of those forces of depletion and stress
that attempt to interrupt effective practice. Finally, isomorphic to clinical practice,
supervision is perceived as a place for the exploration of identity and a recognition of
the multi storied nature of people's lives.

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