Couples Therapy Goals and Interventions: Internal Check-In


Private practice, Arvada, Colorado

Key Points

  1. Setting treatment goals and planning interventions in couples therapy involves thorough assessment and prioritization of the couple’s concerns.
  2. Teaching couples to manage autonomic flooding is essential for emotion regulation during intense discussions.
  3. Mark had low awareness of his internal cues, while Lisa had an intense awareness of stress, tension, and autonomic arousal in her body.

Goal Setting and Interventions

Dr. Squyres Groubert discusses Lisa and Mark‘s treatment, both treatment goals and the interventions used to help the couple. She talks about goal setting and working with them on individual and joint goals.

She spent the first few sessions getting to know the couple and doing a thorough assessment. She talked with them about their pasts, families of origin, previous relationships, values, priorities, spiritual issues, and work histories. She noted down what seemed important to them, and they went over the notes together.

At the end of each session, Dr. Squyres Groubert gave a quick summary and talked about what had been discussed. Sometimes she set a small homework assignment based on a goal, asking the couple to think about it and take notes. She might also ask them to watch a movie or read a section of a book to help them understand the things they had talked about in greater depth.

At the beginning of each session, the therapist talked about the goals and concerns discussed the previous week, and how the week had gone. She asked if they had any input on or would like to talk about that. Through these dialogues they hit upon what seemed most important and the order of priority.

As a therapist, Dr. Squyres Groubert focuses on what’s critical for the couple themselves. She lets them set the tone and pace, and prioritize the goals. If she feels there’s something they’re avoiding or which is hard for them, she’ll say, “This is what I think we need to talk about today,” and, ”What’s the best way to talk about it?”

The first goal for Lisa and Mark was improving constructive communication. With so many intense issues to address, it was difficult for them to talk about things without rapidly escalating into blaming, name-calling, and yelling.

Internal Check-In and Autonomic Flooding

The first skills the couple were taught were internal check-ins and managing autonomic flooding. The latter was discussed in terms of what it is, how it feels, and how to know another person is feeling it. It is an autonomic arousal in response to feeling intensely upset.

Some people know they’re getting flooded, and notice when their heart rate goes up and breathing becomes shallow. They may feel dizzy, or their stomach may start to hurt. But some others don’t notice it happening to themselves at all. Either way, it impacts how rational people are, and how and whether they can talk about issues.

Mark’s Flooding

Mark noticed that he had little awareness of his internal cues. He believed he didn’t experience flooding at all. He valued being logical and rational like Spock or Data from Star Trek. In session, Dr. Squyres Groubert asked Lisa to grill him about the details of his affair, and asked Mark to check his smartwatch.

He was shocked to see his heart rate skyrocketing, and found that unnerving and worrisome from a health perspective. He said, “I’m not getting any younger and I don’t want to drop dead of a heart attack because I’m fighting with my wife.”

Once Mark was convinced that flooding and autonomic hyperarousal were occurring, there was discussion about how to increase his awareness of and manage the sensations better. He recognized that he had a strong preference for avoiding emotional conflict and shutting down. He’d always explained this to himself as being rational.

As soon as he felt defensive, Mark was prompted to do an internal check-in. “How am I breathing? Is it rapid, shallow? How is my heart rate? What is my smartwatch telling me is happening to my body? Am I building up tension somewhere? If so, where? Neck, back, shoulders?”

When Mark noticed flooding signs, he’d breathe slowly and deeply, lower the volume and reduce the pace of his voice, do some stretching, take a short break, and sip some water. He decided to sip tea while discussing difficult topics. He agreed to ensure he was physically comfortable and not in a rush when he and Lisa set aside time to talk.

Lisa’s Flooding

Lisa had an intense awareness of her internal cues. She realized she was hyperaware of signs of stress, tension, and autonomic arousal in her body. Though her smartwatch data surprised her as to the elevation of her heart rate, she knew it escalated quickly, which scared her. She noticed she would gulp air and have trouble getting her words out.

She started taking a yoga class after work, learning how to relax her body and breathe better. She realized that she held tension in her stomach and shoulders. She noticed her shoulders rose up to her ears when she was stressed.

Lisa learned to do an internal check-in. She used the mantra “ground and center” when she noticed autonomic arousal rising to uncomfortable levels. She slowed down her breathing, relaxed her shoulders and abdominal muscles, and adjusted how she sat for greater comfort. Sipping hot tea helped her to stay relaxed.

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