In my experience working as a marriage and family therapist, most couples enter therapy explaining their problem/s to be a break down in “communication” and/or intimacy in their relationship. These couples begin therapy with a wanting to feel a love and connectedness similar to the day they first met, or the day they married; like on cloud nine. When in the moment what a person needs most are closeness, trust, and security, partners confusingly seek these out through behaviors such as distancing, yelling, anger, criticizing, blaming, or putting up defensive emotional shields against their partner.
Sue Johnson, developer of Emotion Focused Therapy, explains these behaviors as an adaptive protest against the loss of a primary attachment figure (2004). She bases her theory on John Bolwby’s and Mary Ainsworth’s theory of attachment, stating that a healthy course of child development is dependent upon a child’s ability to form a strong relationship with a primary figure in their life, typically a parent. For example, when a parent or caregiver provides consistent support and offers security, a trusting and securely attached relationship develops. Yet, should a parent/caregiver present themselves as aloof, inconsistent, and distant, an anxious or avoidant style of attachment would develop.
The manner in which this attachment is formed greatly impacts the dynamics of one’ romantic relationship as an adult. Problems develop in relationships when “partners organize or process their experience in a constricted manner, limiting awareness and rendering behavior responses inflexible” (Johnson, 2004, p. 46). In cases of romantic adult relationships, weak attachment presents itself as feelings of inadequacy, defensiveness, and a lack of intimacy. Where attachments are disorganized and overwhelming, one may experience issues of codependency, manipulation, and/or blaming.
My job as a marriage and family therapist working with couples is to help couples expand their understanding of current experiences, translate these experiences into emotion, and help guide couples toward modifying their interactional patterns in ways that will bring them closer in love. Also important to this process is helping each partner express what love means personally and guide them towards requesting and sharing love in ways that makes sense to their partner. Although I think most couples would prefer to take a magic pill, it takes effort, desire, and patience to create change in relationships.
Love is a universal phenomenon, yet its definition varies across differing people, genders, ages, and cultures. According to Karandashev (2015), “Culture is the main factor that transforms passionate love into romantic love” (p. 9). Critics of attachment theory argue that this theory doesn’t take into account cultural differences. When working with couples, it is important to recognize how ones’ culture (i.e., individualistic, collectivist, or patriarchal cultures) emphasizes, explains and encourages love. For example, American’s exhibit high levels of emotional investment in relationships, whereas, Eastern collectivist cultures place little value on emotional connection and engagement in relationships. In some instances, verbal expressions of love are reserved only for special occasions, where an everyday occurrence is seen as excessive, or love is shared through working through hardships, keeping promises, or helping one’s family.
In these cases, “Their love is not minimal or invisible, but instead, the love is omnipresent and understood, and there is no need to flaunt it” (Karandashev, 2015, p. 15). Johnson (2004) states, “From the cradle to the grave, humans desire a certain someone who will look out for them, notice and value them, soothe their wounds, reassure them in life’s difficult place, and hold them in dark” (p. 34). What this exactly means is different for each person, and in the end, it doesn’t matter to me what love means to each of these people, just that they can express it and share it in ways that make sense to their partners.
What are the benefits and problems associated with being true to one specific therapy model in contrast to being more “eclectic” in one’s clinical orientation?
While there are hundreds of theoretical positions, techniques, and models therapists can possibly use when working with clients, there are differing ideas as to whether there are benefits to being true to the practice of one specific model of therapy or not. Those therapists who strictly adhere to one model understand that models were developed through well-designed studies based on proven empirical data and evidence. Following one model allows for easier evaluation, implementing routine procedures and techniques, and can be practiced in any situation where there may be doubt in regards to problem identification or case management.
Therapists understand each model as including a theory, an explanation of human behavior, a unique understanding of key techniques that lead to change, and goals of therapy. This presupposes an over-simplification of problem identification and leads one in thinking of clients in statistical, not human, terms. Basic psychology teaches us that each person is built of differing experiences, perceptions, beliefs, cultures, and relationships. Those that oppose the idea of operating under one theory, approach therapy from an “eclectic” clinical orientation, believing that models do not offer a “one-size-fits-all” solution. To take an “eclectic” approach means to view an individual as a whole complex picture and to introduce multiple models of therapy that address all the aspects of a clients’ needs in any given moment. These therapists take a diversified view and argue that there is no single approach to treating clients; since every person, situation, and experience is unique. After all, “the whole is more than the sum of its parts”.
The benefits of an eclectic approach allow therapy to be tailored to the client’s specific goals (not the therapist’s), take into account the client’s personal and emotional limits, physical constraints, and introduce techniques that empower the client to set goals that make sense to the client (not the therapist). The key advantages to an eclectic approach are its flexibility and its focus on the whole individual. In this way, therapy can meet the client/s where they are. I believe, just as it is generally believed, that the most effective component of therapy, above any specific technique, is the quality of the relationship between the therapist and the client. Research finds that factors such as empathy, warmth, and the therapeutic alliance to be stronger predictors of client engagement and success as compared to any specialized treatment focus or intervention (Lambert & Barley, 2001). When an “eclectic” approach is taken, it forces the therapist to look beyond empirically based interventions and ask what else about this person (i.e., their strengths, their vulnerabilities) do I need to know? However, being “eclectic” means that one cannot ever be an expert in any one or all therapeutic disciplines. In essence, they are a “jack-of-all-trades, and masters of none”.
Is there one right answer? Of course there is no one right answer to this debate. While there are proven benefits to each therapeutic model, “it has not been possible to show that one therapeutic approach is clearly superior to another” (Grencavage & Norcross, 1990, p. 372). Therapists have to understand that each approach to therapy, i.e., a strict practice or allegiance to one specific model or integrating various models, has an equal amount of inherent benefits and potential limitations. Therefore, taking and either/or position would neglect the benefits of operating in accordance to either one. On one hand, when one becomes too fixed on techniques, they can inadvertently lose sight of the power of human experience and individuality. Research has found that the more technically focused a therapists becomes, they less effective they are in maintaining a therapeutic alliance, and thus, unintentionally interfere with creating therapeutic change (Castonguay, Godfried, Miser, Raue, and Hays, 1996). On the other hand, a theory or model offers clinicians an essential road map; a guide to understanding a clients problem and in their search for solutions. Just as patients would seek out the expertise of a cardiologist for a heart problem, clients need therapists to act as experts in their field.
In the end, therapists cannot dismiss one approach over the other and must be true to each side equally in accordance to what is needed by the client in the moment. As a practicing marriage and family therapist I have come to understand when a client needs me as the “expert”, and the will give them this side of me (As best I can, meaning I may have to refer them to another clinician depending on their needs). Other times, they need me to understand a part of them, and at that point, I allow them to be their own expert. I see the true answer in practice as honoring the whole of the profession and the whole of the client.