Academic journal article Journal of Marital and Family Therapy

Adapting Enactments to Couple Reactivity: Five Development Stages

Academic journal article Journal of Marital and Family Therapy

Adapting Enactments to Couple Reactivity: Five Development Stages

Article excerpt

Interest in change interventions that are common to different models of relationship therapy has spurred investigation of enactments as one such candidate. In change-focused enactments, therapists structure and coach couple/family interaction, as opposed to channeling interaction through the therapist. Still, varying levels of couple/family distress, volatility, and reactivity mean that readiness for enactment intervention varies along a broad continuum and changes over the course of therapy. This suggests the need for differentiated enactments. Currently, however, no model exists for adapting enactments to changing relationship conditions. We propose a five-stage developmental model of clinical operations in couple therapy that adapts the process and structure of enactments to changing levels of relationship distress, interactional volatility, and emotional reactivity. The model increases the possibility for therapists to use enactments successfully over the entire course of couple therapy. Issues to be considered in using the couple enactments model as a template for the development of enactment models for other relationship systems are noted.

Interest in change mechanisms that function across different models of therapy has spurred consideration of enactments as a possible common operation in relationship-oriented therapy. We propose a model of enactments developed from our clinical work with couples. In this setting, enactments seem to be a critical dimension of "best practice," providing a structure and process crucial to relationship mediation concerned with healing, enriching, strengthening, and empowering relationships. In addition, enactments-which are inherently relationally focused-may be viewed as a defining clinical operation that is unique and essential to relational therapies.

Therapist-centered and therapist-anchored clinical interaction, by concentrating and converging clinical dialogue and interaction in the therapist, is, as Bowen discovered and articulated (Kerr & Bowen, 1988), a straightforward approach to attempting to regulate negative affect and contain destructive expression-expression that readily leads to volatile, escalating in-session episodes, which have been linked to poorer clinical outcomes (Butler & Bird, 2000; Shields, Sprenkle, & Constantine, 1991). However, this simple resort, if employed over the entire course of therapy, may ultimately disempower couples or families, either leaving the system essentially unimproved at termination or permanently establishing the therapeutic system, interposing the therapist as an essential additional member of a viable couple system. Gottman and Gottrnan (1999) concur, and further warn that making the therapist "irreplaceable . . . may maximize the couple's relapse once therapy terminates" (p. 310). Therapist-anchored clinical process may facilitate containing and structuring couple/family interaction, but may ultimately be disempowering and counter-productive. Therefore, a more complex clinical technology appears to be necessary to enable therapists to empower couples/families through successful interactional experiences carefully promoted, structured, and coached by the therapist.

Sophisticated use of enactments may provide one means for therapists to regulate and guide the clinical experience, while still sustaining client-anchored clinical interaction. For this to be possible, however, clinicians need a dynamic, developmental model of enactments that adapts its operations and interventions to varying levels of clients' distress, volatility, and reactivity. Enactments have recently received significant attention (Allen-Eckert, Fong, Nichols, Watson, & Liddle, 2001; Davis & Butler, 2002; Nichols & Fellenberg, 2000), yet critical gaps in our theoretical understanding and clinical implementation still need to be remedied.

LIMITATIONS IN STATE-OF-THE-ART CONCEPTUALIZATION OF ENACTMENTS

Enactments are broadly conceptualized as therapist-coached couple/family interaction. …

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