Cognitive Therapy with Couples: The Initial Phase of Treatment

Abstract

Cognitive Therapy with Couples: The Initial Phase of Treatment Frank M. Dattilio. Sarasota, FL: Professional Resource Press, 1994, (Video: 56 minutes). In this videotape, Dattilio demonstrates the application of cognitive therapy techniques to counseling with couples. The 56-minute videotape is accompanied by a 19-page program guide that highlights the techniques demonstrated and outlines the content of the sessions. Both the videotape and the program guide are intended to supplement the book Cognitive Therapy with Couples (Dattilio and Padesky, 1990). Actors portraying a white married couple are shown meeting with Dattilio for an initial conjoint session, two individual sessions (one with the wife and one with the husband), another conjoint session, and a final follow-up session several weeks later. The five session excerpts range in length from a very brief 3 minute follow-up session to longer session excerpts lasting approximately 14 minutes. In the opening pages of the program guide, Dattilio offers a brief summary of his use of cognitive therapy with couples. He focuses on the expectations that each partner brings to the relationship and how these expectations may grow increasingly negative over time resulting in a breakdown of communication. In order to explore these expectations, Dattilio presents a variety of techniques including the comparison of current negative frames with former positive frames, the use of the "downward arrow" technique to identify personal meanings, the use of the dysfunctional thought record to identify and record automatic thoughts, the identification of feelings, and the assignment of homework, primarily from the book Love is Never Enough (Beck, (1988). In his closing statements, Dattilio notes that the video is designed to be an introduction to the techniques discussed in Cognitive Therapy with Couples (Dattilio and Padesky, 1990). The degree to which this video is successful in introducing these techniques will be discussed from three perspectives: the perspectives of the student, the practitioner, and the consumer. This video was watched and reviewed within the context of a supervised practicum experience for doctoral students in counseling psychology. From the perspective of student trainees, the context within which to use the techniques presented is unclear. Dattilio successfully demonstrates the cognitive therapy techniques mentioned above, but because this is done through a series of relatively short session excerpts, the larger contexts of the complete therapy sessions are lost. As a consequence, trainees may feel confused as to when to apply these techniques. Dattilio could have avoided this problem by either presenting the techniques in one full-length session or by presenting the techniques in isolation as microskills. The therapist models some positive skills that may be helpful to the student trainee such as using humor to reduce rising tensions and focusing on strengths in the relationship between the couple. However, Dattilio displays some behaviors that may be inconsistent with those commonly taught to students. For example, Dattilio often uses the technique of challenging negative automatic thoughts, but he does not follow those challenges with empathic support for the client's experience of emotion. This process is particularly evident in the individual session with the wife. The therapist uses the downward arrow technique with the client to arrive at a core belief. Once this core belief is unearthed, she begins to cry, but Dattilio does not offer empathic support for the client's emotional reaction. More experienced therapists should understand that in the real world of therapy, this display of emotion would likely be acknowledged and explored by asking a question such as "How are you feeling right now?" However, based upon the demonstration of techniques in this video, novice student therapists may come away believing that cognitive therapists ignore clients' emotions. …