Resiliency-Focused Couple Therapy - 14th June 2021 View online at https://aedpinstitute.org Resiliency-Focused Couple Therapy A Multidisciplinary Model By David E. Greenan Abstract: With a focus on resiliency, this article presents a three-phase systemic treatment model for working with high conflict couples. Initially informed by the work of Salvador Minuchin, the author uses joining and enactments with the couple to identify circular behavioral problems that maintain homeostasis. Using the teachings of Sakyong Mipham Rinpoche, the therapist in the middle phase of treatment introduces mindfulness practices to quiet the central nervous system, and then incorporates aspects of John Gottman’s communication exercises for skill-building and resolution of conflict. In the final stage of treatment, Diana Fosha’s Accelerated Experiential Dynamic Psychotherapy concepts are implemented. The couple is encouraged to identify their defensive behaviors that preclude intimacy and to metaprocess with one another their experiences of core affect. Introduction: The Healing Journey of Intimate Connections In the early 1980’s, I was an actor living in New York City which was the epicenter of the AIDS epidemic. I was horrified and scared of what was happening all around me as friends and colleagues in the theatre community contracted pneumonia one day and died the next. Torn between wanting to flee and wanting to help, I learned about an innovative care program at St. Vincent’s Medical Center. Rather than quarantine young men who had the disease, they provided hands on end-of-life care. In order to serve the rapidly increasing numbers of men being diagnosed with the disease and to provide a supportive community for their partners and friends who were often isolated due to homophobia, a Sister of Charity, Patrice Murphy, had the courage to create a hospice program that not only provided services for the men with AIDS but also bereavement support services that honored their invisible partners and friends. Over the course of several months, I trained to be a volunteer. I began to be “a buddy” for men who were no longer capable of living independently. Through this one-on-one time with men whom I was assigned to help and in supporting my friends who had contracted the illness, I experienced a lessening of my own fear and isolation that I was experiencing during the epidemic. Eventually I began to co-lead bereavements groups for partners and friends at the hospital. My world view changed as I experienced the power of connections and community to reduce both shame and the seemingly unbearable aloneness as survivors connected with other men and women in these groups. We made a film, The Hidden Grievers (1987), to document this innovative work which later became a training film for other hospice programs throughout North America. Although I had a successful career as an actor at that time, I was inspired by the healing Page 1 Resiliency-Focused Couple Therapy - 14th June 2021 View online at https://aedpinstitute.org power of these therapeutic connections that these groups provided. I decided to go back to school to earn a doctorate in Counseling Psychology at Teachers College, Columbia University. Not surprisingly given my volunteer experiences in hospice care, I found myself drawn to psychological modalities such as group therapy that provided an environ for the healing potential of community to address isolation and shame. Repeatedly in my clinical training at Teachers College with Dr. Debra Noumair and in my continuing volunteer work at St. Vincent’s and Gay Men’s Health Crisis, I witnessed the power of groups to be a corrective antidote for internalized shame and to mobilize people’s inherent strengths as they discovered their resiliency in the face of profound loss. As I continued my training in Counseling Psychology, first in an internship and then in a postdoctoral fellowship at NYU/Bellevue Hospital Center, I had the opportunity to be mentored by several people who held similar strong beliefs in the efficacy of both dyadic and group interventions to heal trauma in the face of unbearable aloneness. Diana Fosha was then consulting to NYU/Bellevue, training interns with the theory and illustrating that theory with taped clinical sessions in what would eventually become her Accelerated Experiential Dynamic Psychotherapy (AEDP, 2000) model of treatment. What resonated so deeply for me was not only her empathy for patients but her ability to focus on the resiliency and strength of people struggling to heal extraordinary failures of attachment relationships in their lives. Her insistence on the clinical necessity of metaprocessing core affect that surfaced in these therapeutic interactions between the therapist and patient, combined with her demonstration of the transformative power of these clinical interventions to elicit healing connections to self and other, would become a cornerstone of my work as I later developed this resiliency-focused couple systems model of treatment. The following year, in my postdoctoral fellowship, I had the opportunity to work with another person who changed the direction of my life. Through the NYU Family Studies and my family systems training with Dr. Linda Carter, I was introduced to Salvador Minuchin, one of the founders of family therapy. Jewish, Argentine and wise, he embodied everything that I aspired to be in my new profession. He had created his own innovative model of family therapy, Structural Family Therapy (1974), with a focus on empowering disenfranchised poor families as he activated their dormant strengths. Through his institute, he and his senior staff that included Ema Genijovich were consulting to Bellevue Hospital’s outpatient drug treatment program. The federal government had funded a study of perinatal women with histories of substance abuse to ascertain what if any clinical interventions might be effective to retain them in treatment and preclude the placement of their children into the foster-care system. Challenging the prevailing drug treatment philosophy that substance abuse is a disease that required the isolation of a patient in a therapeutic community, he advocated that these “homeless” women should not only have their children in treatment with them but that their significant others who supported their recovery should also be included in the day treatment program (Gushue, Greenan & Brazaitis, 2005; Minuchin, Minuchin & Colapinto, 2007). The focus of the consultation was on the resiliency of these marginalized women and identifying clinical Page 2 Resiliency-Focused Couple Therapy - 14th June 2021 View online at https://aedpinstitute.org interventions to empower them. In the way that synchronicity often works when we are open to such opportunities, he was just starting a new family therapy training group as I entered my postdoc year of training at NYU/Bellevue. I applied to study with him. I was accepted. My life changed in ways that I never could have imagined. Similar to Fosha’s work that I had observed in the previous year, my training with Minuchin inspired me as he focused on context, not psychopathology, as a precursor and determinant of human behavior. That physical and mental disabilities could challenge people was not arguable for him but what was so innovative was Minuchin’s curiosity on how context either contributed to or resolved the family’s presenting problem. As I observed him create connections between people, I could see a treatment map emerge informed by his belief in the essential resiliency of people. Both Fosha and Minuchin hold fundamental beliefs in the essential strength of all human beings, if we can create connections for them to feel safe and valued. Phase I: Structural Family Therapy as the Initial Cornerstone of Resiliency-Focused Couple Therapy During the next ten years, I studied and worked with Dr Minuchin. For the last seven of those years, I was executive director of The Minuchin Center for the Family. Minuchin’s focus on the resiliency of families and the use of enactments as a means of identifying what complementary interactive behaviors keep a family stuck in predictable circular behavioral patterns became a benchmark of the way I learned to join with families (Greenan & Tunnell, 2003). Twenty years later, I continue to use enactments to identify what complementary behaviors within the family, and in the relationships that the family has with other systems such as health and education, organize and maintain symptoms. Equally important for me, from the initial moment I meet with a family, I’m curious about exploring where are the strengths that can be activated to resolve their presenting problem. Identifying these inherent strengths is probably the singularly most important intervention that a therapist can make to give a family courage and hope. The primary focus of the Minuchin Center’s work was consulting with organizations that served poor inner-city families. Focusing on how context rather than psychopathology organized human behavior was a novel concept for disenfranchised populations. His beliefs empowered people that had traditionally struggled to be seen as resilient. For instance, with the perinatal women whom I had worked with at Bellevue, bringing in extended biological and non-related family who supported a woman’s recovery and her desire to mother her infant served to expand her identity. She went from a clinical case description of a homeless, unfit mother lacking in resources, to a new narrative of a potentially competent caring woman who given the resources could effectively parent her children. In addition, we found that if we included key representatives of the multiple agencies that she interacted with in treatment (i.e., health care system, child welfare and housing), we could co-construct a treatment plan with the woman that she would comply with. This was significant on many levels. A population that historically had been seen as untreatable transformed into responsible mothers-in-recovery.