3.2 Western methods of relationship therapy
3.2.1 Cognitive behaviour therapy
The first method of marriage counselling in which I was trained through working at FAMSA Durban, where it was used, was basic cognitive behaviour therapy. This type of counselling arose in reaction to and as a challenge to psychodynamic methods of marital counselling. Brown and Brown (2002) describe the following elements of cognitive behaviour therapy that are useful in marriage counselling. This therapy includes the use of positive reinforcement, where a positive event such as affirmation, praise or acknowledgement occurring after a particular behaviour, increases the likelihood of that behaviour re-occurring. Extinction occurs when a reinforcer is removed, and so the behaviour is diminished. Reciprocity refers to an exchange of rewarding behaviours between spouses, whilst coercion refers to attempts to control the other person through negative comments. The therapist attempts to get the couple to move from general complaints about each other to discussing specific observable behaviours that they want to decrease, or positive behaviours that they want to
Page | 49 increase. In order to do this, FAMSA used the Goal Attainment Scale (Petty, 1984) whereby the couple described their presenting problem in terms of specific observable behaviours. They then discussed what an ideal goal would be for this particular issue;
and then using this they would set a realistic, measureable, specific goal to overcome the problem.
The FAMSA counsellors tried to determine firstly, the client’s basic expectations of each other; secondly, what attracted them to each other; and finally what their individual decision was in terms of their own behaviour towards each other. Ruth Keech (1993) describes these aspects as the tripod of marital love.
The couple's physical and emotional needs, and how they attempted to fulfil them, were examined using Maslow’s hierarchy of needs. Maslow (1943) postulated that there was a hierarchy of needs from physiological survival needs of food and shelter, to safety and security needs, to belongingness and the need to love and be loved, to self-esteem and finally to self-actualisation (Keech, 1993). He stressed that the lower order needs had to be fulfilled in order for the following ones to be addressed. Over the years there have been many criticisms, for example Hofstede (1984) criticised it for being culturally biased towards individualised societies. However at FAMSA it was found to be a useful framework to view clients’ problems. Thus, for example, when looking at their survival needs aspects such as budgeting, employment, and roles were explored. When looking at ‘the need to love and be loved’ they discussed how they showed caring towards each other as well as the ability to deal with in-laws.
Issues of parenting would be clarified. When looking at social needs versus the need for self growth, the balance between individual, couple and family time was explored (Keech, 1993).
The FAMSA counsellors also engaged in psycho-education; and practical guidance with regard to communication skills in terms of conflict management, negotiation skills, dealing with criticism, and assertiveness skills. Although much of this information is old, it is still valid and very useful to discuss with the couples.
Thus for example in conflict management, three aspects were focused on. The first was the purpose of the discussion; sometimes the couple may have tried to solve a
Page | 50 problem, but may be very reactive if either of them is feeling upset about a previous argument, they are still hurting from the other’s behaviour, or if they want to win the fight. Secondly, the timing of the conflict needs to be examined. If either of them were tired, hungry, stressed, in a rush, in a bad mood, premenstrual, or if they had consumed alcohol; they may become more irritable and reactive than usual. Thus important or sensitive discussions need to take timing into consideration. Thirdly, the manner in which the couple discusses an issue needs to be explored. If either of them exaggerates, generalizes, blames or shames the other, ignores or shouts, swears or is violent, or calls the other person or their family names, this will exacerbate the problem. Gottman (1994) describes the ‘four horseman of the apocalypse’ of conflict management as the warning signs that the marriage is in serious trouble. The first
‘horseman’ is criticism where a person’s personality, as opposed to their behaviour, is attacked. The second is contempt where the partner is insulted, mocked and emotionally abused. The third is defensiveness where responsibility is denied, excuses are made, ‘but you…’ cross-complaining occurs, and the past is brought up. The final horseman is stonewalling where a person ignores the other or reacts with a cold, stony silence.
When discussing negotiation, Fisher and Ury (1992) indicate that it is not about winning or losing, as this focuses on the position and not the underlying issue. In a typical example of a couple negotiating an issue, each person will take a position, argue about it and then make a concession in order to compromise. However, this pattern of negotiating does not necessarily find the best solution. Often couples get caught up in the emotion of an argument, and attack each other rather than the problem. It is therefore necessary to firstly separate the person from the problem, so that the couple can work as a team to overcome the problem together. Secondly, it is also necessary to avoid win/lose positional thinking by forbidding the positional solutions. Thirdly, it is extremely important to determine what the underlying common interests are for both people. This may be difficult as it requires both members of the couple to step away from their win/lose positions and look at ‘what do we both want?’ This is an extremely important step and is often the turning point in a negotiation. Finally, once the criteria for common interests are explored, it is then possible to brainstorm and invent options for mutual gain. These need to fulfil the common interests; and where applicable need to be based on fair and objective
Page | 51 criteria. These four steps are necessary when analyzing a problem, when planning and getting ideas, and when discussing how to reach an agreement. This type of negotiation according to Fisher and Ury (1992), and in my own experience in marriage counselling, is respectful, efficient and effective; resulting in wise decisions and an amicable agreement.
A criticism of using cognitive behaviour therapy was that the marriage counsellor could be seen as the expert; searching for flaws and problems within the marriage, and then providing information and advice from his/her own frame of reference on how to fix and improve things. Its epistemology was therefore based on a Western linear, medical model with one set view of the correct way of doing things. However, the idea of the counsellor as an expert may be likened to the head of the family, or family elder, or a sangoma instructing the couple how to improve their problem, and may thus have some relevance for work with Zulu couples. An important aspect to consider from an African world view (as discussed in the previous chapter) would be that the information and advice offered by the counsellor would need to take into account that concerns are seen from a communalistic perspective, rather than just from the particular couple’s perspective. As mind, body and soul are closely interlinked, all these aspects would need to be part of the counsellor’s input. As discussed in the final chapter, a combination of this information with the other therapeutic theories and methods mentioned below can be relevant.