E2 - Elective Module Two - Couples Therapy
E2 - Couples Therapy
Content Level: Advanced
Relational (betrayal) trauma and its posttraumatic and dissociative sequelæ typically complicate relational functioning with difficulties in communication, pair-bonding, desire and sexual arousal. The fearful-avoidant attachment style typical of relational trauma survivors features an alternation between fluctuating and competing needs for closeness, and overt avoidance. Partner responses to trauma survivors may maintain or even exacerbate posttraumatic symptoms or else such partners may suffer vicarious traumatization and adopt maladaptive coping.
One third of couples presenting for couple therapy will have one or both partners a relational trauma survivor; such couples have a higher divorce rate and are challenging to treat.
Childhood trauma survivors have difficulty listening and not becoming defensive and overwhelmed with emotion, especially shame, when negotiating unmet needs and perceived hurts. Their partners have difficulty acknowledging their role in the conflict and repairing the relationship (MacIntosh, 2013; MacIntosh & Johnson, 2008). In couple therapy, there is a need for enhanced safety, affect regulation skills as well as psychoeducation regarding the difference between re-enactments of past trauma and here-and-now relational challenges and facilitation of secure bonding interactions. The therapist as a new attachment figure may be an added challenge for survivors with attachment insecurity, complicating emotion regulation, and perspective taking.
This module will explore the role of trauma and dissociation in various treatment paradigms with couples.
1. Outline the symptomatology and attachment patterns engendered by relational trauma, and their repetition in couple relationships
2. Define the challenges unique to childhood sexual trauma survivors in couple therapy
3. Describe the process of reenactment and its effect on relational conflict, on both the childhood sexual trauma survivor and also on his/her partner
A. Dalton, E.J., Greenman, P.S., Classen, C. & Johnson, S.M. (2013) Nurturing Connections in the Aftermath of Childhood Trauma: A Randomized Controlled Trial of Emotionally Focused Couple Therapy for Female Survivors of Childhood Abuse, Couple and Family Psychology: Research and Practice, Vol. 2, No. 3, 209–221.
B. MacIntosh, Heather B. (2017). Working with male survivor couples, In Richard Gartner, ed.: Healing Sexually Betrayed Men and Boys: Treatment for Sexual Abuse, Assault, and Trauma. Chapter 12, pp.233-260, Routledge.
C. MacIntosh, Heather B. (2012). Dissociative Identity Disorder and the process of couple therapy. Journal of Trauma and Dissociation, 14( 1), 84-96.
D. Weinberg, M., Besser, A., Ataria, Y., & Neria, Y. (2016). Survivor-spouse dissociation and posttraumatic stress disorder: Personal and dyad relationships. Journal of Trauma and Dissociation, 17(4), 448-459.
30 minutes: Discussion of Reading A
45 minutes: Discussion of Readings B and C
30 minutes: Discussion of Reading D
45 minutes: Discussion of student’s disguised cases, or further discussion of readings A,B,C and D if no case material available.
- 2.50 APAThe International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.