Counselling With Couples
Administrative
Any counselling that involves more than one party involves a couple extra steps.1) Ask Brittany for a couples/group/family counselling session option
2) Add each party to Jane
3) Follow the the following "group guide" to add the couple to a group.
- https://jane.app/guide//group-appointments
4) Connect the two profiles by following this guide: Connecting Two Profiles . Make sure you have consent (and chart said consent) to enable different permissions. For example, if client A will be using client B’s credit card then Client B must consent to this (and complete an automatic billing authorization form)
Note, every time you work with more than one member, they should be added as as group.
Intake
During couples consultations, you won't really have time to get to all of the detailed questions, as two people typically are talking instead of one. Focus your questions to the absolute basics: presenting problem, availability, finances & therapist fit, then if you have extra time you can go into their current life if you'd like to.
You want to make sure you're getting a balanced perspective, so ask confirmation from the partner. for example if Suzy says "we're struggling with communication and we yell all the time, I want to fix it that." your response should look something like "Thanks for sharing Suzy, John would you agree with the presenting problem Suzy proposed and is there anything you would like to add or change to what she said? We cannot simply take what one partner says as fact, we have to confirm it with the other partner to ensure we have a balanced perspetive :)
Admin Set Up
Couples rates start at $110. If $110 is too tight for them, we can do sliding scale on couples therapy as well but only if really needed.
When you go to set up a couple in Jane, you want to create a separate profile for each partner and send each of them a consent form. If one of the partners is putting it through on their insurance, you will probably want to book the client sessions under that partners name so that they can claim it.
In Jane, you're going to want to connect the two partners profiles so that they can both access the appointment reminders, billing etc. To do this, go to one of the partners client profiles on jane. Scroll down to the bottom of the page and you'll see something that says "add relationship" you're going to want to add a relationship to this client and link their partner. From there you'll be able to set all of the permissions.
First Session
For the most part, the first session will be similar to an individual session with a few changes.
During the initial review of the consent form (all the little check boxes you go through), there's a couple extra things you MUST go through.
1) Setting the rules of no secrets - The client in this case is the relationship, meaning you need to look out for the BEST INTEREST OF THE RELATIONSHIP, not each of the individual clients. That being said, you need to explain that to them, and as such there are to be no secrets. If one partner tells you ANYTHING individually via email, you will bring that to the next session to share as a group. You need to chart that the clients each consent to this "rule"
2) Fairness - In couples therapy we want to ensure that this is a space where both clients get to be heard and feel safe sharing. That said, the therapists goal is to ensure relatively equal talking time for each partner. This will mean that each partner is expected to be patient and allow the other to talk, not overstepping talking time. The therapist will step in at times to ensure both partners are being heard. The therapist does not want to operate as a referee, so this is something we want to establish as a respectable practice from the very beginning.
When you're going through the initial questions, same thing with the intake you're going to want to pair down on what's important. It would take 5-6 sessions to get through every single one of those questions with a couple. So, you want to select what's most important or make some of the questions more general to cover more ground in a shorter time.
I.e "Tell me a bit about your lives growing up"
"tell me a bit about your relationship history"
"tell me a bit about your current life - what do you both do for work, play and day-to-day life?"
"Tell me a bit about your relationship and the struggle(s) you're experiencing"
"What are each of your goals for therapy?"
Things you are looking to identify in the first couple couples sessions (this is for YOUR OWN information):
1) SHARED GOALS - is the couple on the same page? do they have shared goals for this relationship? One partner may want a divorce while the other wants to renew their vows aha. This won't necessarily just show up in the things they say.. partner A might say they want to get married but then be super hostile, disengaged and uninterested in working on their relationship during session..
2) CONFLICT PATTERN - most couples have a pattern of conflict they engage in and repeat over and over, with slight nuanced changes. You want to identify this pattern through the examples they provide and what they see in session. Again this won't be something they explicitly state to you. We aren't trying to fix one fight, we're trying to find the process and pattern underneath so that we can target the root of the problem.
3) Fighting - your couple may fight or disagree in session. The first couple times, it can be healthy and beneficial to let this fight or disagreement play out without interrupting. Again the goal is to see how they fight. After one or two examples, we will then bring this discussion into therapy....
" the last two sessions we've experienced some fights. I've let these fights proceed as a means to see how you both argue, to give me a better idea of the conflict pattern we're working with. There's definitely some room for improvement on both sides and I'm wondering if you'd be willing too explore this with me? From here on out, I will be come more involved in your arguments as a means to CHANGE the old ways of fighting and practice new ways of disagreeing with one another.
** Goal is to sset the precedent that you wont tolerate their fighting moving forward, that the disagreeing needs to happen differently now and you willl be intervening :)
Ongoing
Couples get EXTREMELY caught up in content - the "he said, she said" crap.
Your goal is to do lots of "making meaning" exploring where these patterns came from, why each individual is being triggered. This will involve a lot of deeper explorations - sometimes looking at childhood attachment stuff, past unhealthy relationships that have caused wounds, each individuals insecurities, traumas & triggers etc. You want to focus way more on the AFFECT work (feelings and emotions tied to the content) instead of the content!
Any homework should be small and specific as you now have to get 2 partners to buy in to it, not just one.
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Occasionally you might uncover a deep wound and have to spend larger portions of a session focusing on one partner. This is okay, but be sure to check in and get consent for everything you do. "is it okay if we focus todays session on the childhood struggles we began talking about a moment ago? I think it would provide some great insight into current relationship patterns"
Then do a check in "John and Suzy how are you feeling about this session so far, I know we've focused a lot on Suzy today, and we can definitely spend other sessions focusing more on JOhn but I want to make sure we're all on the same page and feeling okay?"
Some couples may ask to see you individually. Every therapist has their own opinion of how to handle this, some do, some don't. In the beginning, I think seeing them EXCLUSIVELY as a couple is critical to uphold the boundary of no secrets. It's also less complicated for you and protects you from some ethical dilemas
These should be some overall tips to get you both started with couples work! I know there's LOTS more to learn but I hope this helps kickstart you both!! Please let me know if you have any questions :)