Family/Couples Therapy – Improving Relationships

These are some of the questions explored in an interview with Laurel Wiig, Ph.D., MFT., who is a Licensed Marriage and Family Therapist. Laurel has advanced clinical training and 20 years of experience including 7 years of private practice.

Laurel’s specialty is working primarily with adolescent/teens and their parents. In terms of methodology, she employs depth psychology along with cognitive behavioral techniques.

Without further ado, Laurel, could you describe a bit of your background?

I received my Doctorate in Clinical Psychology from Pacifica Graduate Institute, which has a clinical psychology program enriched by the traditions of depth psychology. 

I initially gravitated toward psychology through an internship at a private inpatient eating disorders treatment program for substance dependent females. During the internship, I was required to attend all group therapies and follow the treatment as if I were a patient there. 

I learned a great deal from this unusual experience as it taught me a lot about substance abuse and eating disorders.  In addition, I experienced the vulnerable feeling one has in attending treatment as a patient; it provided me with a patient’s viewpoint and experience in recovery and treatment.  

I learned a lot about the field of psychology, as well as a lot about myself through this process. I will remember how brave every person was in taking the first step to get help there.

The steps that led me to private practice included working in various contracted agencies (various school districts, contracted agencies with the department of mental health and police departments), which gave me an unbelievable amount of experience with neglect and trauma issues.

However, the stress level was high and this type of work requires the therapist to be excellent in self-care to avoid vicarious trauma and therefore therapists employed at these agencies have an extremely high burned-out rate.

I started my private practice 7-years ago to have more freedom and less stress.  I absolutely love the freedom that it allows me to have – freedom in working in a way that allows me to utilize depth psychology in treatment. 

Freedom in my own life for collaborating with other therapists on additional projects and in assisting me to keep my passion in psychology alive and kicking!

Could you describe the types of therapy you typically conduct?

My theoretical orientation is steeped in depth psychological roots but also incorporates cognitive-behavioral work because it is essential and shown to be more effective for treating many diagnoses (depression, anxiety, panic attacks, fears, obsessive compulsive disorders and autism spectrum disorder).  

My specialty is in working with adolescent/teens and their parents. A large part of my practice is also devoted to adult male issues, which I have found to be a fairly neglected population in behavioral/psychological health.  

What is Depth Psychotherapy?    

Depth psychotherapy is an exploration of what lies below the surface — in depth, “the unconscious.”  The unconscious that can affect our well-being, inhibit our enjoyment of relationships in our life and most importantly, our potential of being. 

The unconscious is a collection of thoughts, behaviors, and emotions that have been repressed and beneath the surface.  Essentially the inner material (thoughts and feelings) affect our outer behaviors. 

The unconscious is revealed in the psyche through dreams, impulses, fantasies, slips of the tongue, imagination, metaphors, body gestures and art. 

Depth psychotherapy encompasses the whole person — the heart and soul.  The capacity to explore to the depth of our experience and seeing a new mode of being or acceptance of being.  

What drew you to family/couple work?

Illness, infidelity, sex, anger, communication and money problems all can contribute to distress in marriages or other relationships. Couples counseling or family counseling can help resolve conflicts and heal wounds. 

The dynamics of working with a family and/or couple is fast-paced and exciting.  Most of the time, many things are happening at once and I love that about family/couple’s counseling. I love seeing how relationships evolve and improve in the context of a family or couple.     

What are the aspects of your work that you find most enjoyable? 

The most enjoyable aspect of my work is that every day is different.  No two clients are alike.  No two problems are alike.  Each and every person is different and my treatment is based on that individual, which encompasses gender, religious preference, cultural & historical background and issues as well as symptoms.   

What aspects of your work do you find most challenging?

The business-side is the most challenging —  Keeping up with billing and record-keeping!  Let’s face it, what therapist enjoys paperwork?

What are a few key takeaways that you could offer parents (or couples) based upon the work you have done with families/couples who are in conflict?

• Don’t hesitate or wait to seek therapy. Many people wait too long to see a therapist.

• Take the time and really listen to your partner/family member.  Repeat back what you heard your partner/family member say in order to ensure you understand and heard them correctly. 

• Communicate how you feel but do it clearly & concisely. 

• Speak from the “I”.  “I” statements simply are more effective in conflict and aid in reducing defensiveness.

• Take deep breaths, stay calm & have an open mind.

• Keep in mind that this isn’t about “winning” or “being right.”

Could you describe an intervention with an unidentified/fictional family that has been/would be helpful?

The interventions:  Discussion of past experience and Identification of recurring theme and pattern.

“Lily” is a 30-year old female and has been diagnosed with Bipolar Disorder since she was 16-years old. She takes multiple medications to control mania and psychotic symptoms. She tells me that she saw an elderly man walking on the street.

The man appeared to be very frail and had a difficult time walking. Lily discussed how she felt conflicted with feeling that the old man should not be outside and walking around but at home as she felt he was too frail and should be confined to his home.

She also discussed her strong and conflicted feelings surrounding other “handicapped” people and also people she perceived as “ugly” or “not pleasing to the eye”.

Lily reported that she feels conflicted because she knows she should feel compassion and that all people have the “right to be out and experience life in the world” but on the other hand feels they should be in their home and secluded from the world.

Upon further exploration of Lily’s past experience with her family’s views of her Bipolar Disorder as a teenager and young adult, she shared how she was shunned from the world and confined to her bedroom in the family home when she was struggling with symptoms, such as mania and psychosis.

The family felt they were protecting her. “Lily” has grown to have much anxiety when she visits her parents’ home, which was identified to be due to her memories of being confined to the home when she was feeling “unwell”.

The exploration of her past experiences and identification of a recurring theme allowed for additional factors to be explored further in future sessions.

• What is her experience of her diagnosis?  What does it mean to her to be diagnosed with Bipolar Disorder?
• What feelings has she internalized from being shunned from the world when experiencing symptoms of Bipolar Disorder?  What is the impact?  
• Does she feel limited by her disorder?  Exploring the parts of her that may feel less desirable and possibly uncomfortable (i.e., feeling shamed, different, an outcast, etc.)? Assisting her to become more accepting of these parts of her self (the shadow).
• Identifying and assisting her to see the correlation between how she perceives others’ differences and her own differences.  To find compassion for herself.  To ultimately assist her in finding compassion for others’ differences.

Regarding transference, counter-transference and defenses, do you happen to remember when you were able to identify these in a client and yourself without much effort?

Identification of transference, counter-transference and defenses can be obvious or “tricky” and hard to figure out at times.  Transference is like feeling thirsty — It just happens and transference occurs in body language as well as in verbal communication —  A normal process of life. 

Transference is present in ALL relationships.  When transference is illuminated and revealed in a session, it can provide rich information of unfulfilled desires or wants to remain hidden. Revealing the transference can be complex, but provides a wealth of information and may be powerful to a therapeutic relationship. 

My best advice for a clinician to become better at recognizing a transference process, is to become aware of your own issues and “hot spots and buttons” through your own therapy.  The more aware you are of your own issues, the better you will become at recognizing a transference process. 

On a personal note, I have become a better clinician and become aware of transference moments due to participating in my own therapy throughout the years.  As therapists, I believe that we are ultimately the ones who are responsible for recognizing the process.

My most obvious transference issue occurred during my doctoral program.  An administrator, with whom our class had to deal with on a regular basis, had continually become upset, annoyed and even enraged (verbally yelled) at me. 

I had discussed the issue with other students but they couldn’t understand me because their experience was a pleasant one.  Most of my interactions were with the administrator on the campus and outside of her office. 

At one point, I went to her office and saw a framed picture on her desk.  The photo looked like me.  I asked her who the female was in the photo.  She responded, “my daughter.”  That was my “Aha moment.” 

It helped me in understanding her aggression toward me because from that point on I knew that this was a “transference” process was most likely occurring.  I was probably not the subject of her anger.  I no longer took her anger personally and changed the way I interacted with her in response to my realization of the “transference.” As a result, our relationship improved.

Finally, what career advice do you wish you had been given while you were still in school and/or before you started your private practice?

Take the time to interview someone who has your ideal career choice.  You, Dorlee, have made that easier for all of us as you provide interviews on your blog —  Love it! 

Know what your ideal position would look like and what steps you need to take to get there (how much money and time will be involved).  For example, having an area of expertise or “specialization” is key in having a successful private practice business. 

Specializations typically require additional education, money and time.  Also, if your goal is to have a successful private practice, having some business/marketing experience or training will be helpful. 

I have heard from many students in psychology/social work that they feel they are jumping through hoops with no real end in sight.  Having a plan of action and knowing the steps to get there will help alleviate this feeling. 

Thanks so much, Laurel, for sharing all this valuable information about family/couples counseling, transference and improving communications!

You may follow Laurel on twitter @therapy4help or visit her website at Laurel Wiig Milan, Ph.D., MFT.

What thoughts or questions do you have about this type of therapy? Do you have a lesson you could you share from having worked with couples/families yourself?