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Example Treatment for this couple using Gottman’s Theory for…
Example Treatment for this couple using Gottman’s Theory for couples Therapy to help understand how the theory is actually used?
The following is a case study of a young married couple: Mike and Jan. A brief narrative containing basic information is provided, including data on psychiatric,medical and social history; and history of substance abuse, child abuse, and criminal involvement. A description of the presenting problem and a history of
the couple’s difficulties will also be explained in detail.
CASE STUDY
Jan and Mike are a middle-class Caucasian couple residing in a suburban neighborhood of the Northeast Central States. Jan is a 49-year-old sales associate for a pharmaceutical company. She has been a sales representative with the same
company for the past 14 years. Prior to this career, Jan was employed as a receptionist for a dental office and was also working part-time as a salesperson in a major clothing department store. Jan enjoys reading mystery novels and
caring for her animals, including three horses, two cats, and two birds. Jan has been married to Mike for the past 12 years. They have had no separations to date. They also do not have any children from this union. Jan was married once before for 3 years. Her marriage ended in divorce due to her husband’s continued drug abuse and infidelity. There were no children from Jan’s previous
marriage.
Mike was also married one time prior. His marriage of 1 year ended in divorce due to his drug abuse. There were no children from this union. Mike is 44 and currently employed as a welder fitter. He acquired this trade while in high school and has maintained various employment in this field for the past 25 years. He has been employed by four different companies; overall, the longest period with
his present employer, has been for the past 10 years. Mike enjoys taking care of animals and working on computers.
Mike and Jan met through a mutual friend during a summer outing. They dated only 4 months before deciding to marry. They decided to skip the formalities and were united by a Justice of the Peace in a rather impromptu fashion. They described their courtship as a fun time that they will always remember. While dating, Mike and Jan enjoyed seeing new films, dining out, attending parties,
skiing, and taking care of Jan’s animals. When they initially met, Mike had relatively few friends. When they would go out together with other couples, Mike and Jan generally socialized with Jan’s friends, whom, Mike claims, eventually became his friends as well. Rarely did they socialize with any of Mike’s acquaintances.
PSYCHIATRIC HISTORY
There is no prior history of psychiatric treatment for Mike. He has never been prescribed psychotropic medication, nor has he been hospitalized for any mental health reasons. Mike reports that during his adolescence, his mother received individual treatment for depression after divorcing his father. She was not treated
with any medication that he could recall. Mike’s brother received individual therapy for “behavioral problems” as a teenager. His father viewed therapy as something that only “crazy” people needed and looked upon therapy with disdain.
Mike states that he is interested in initiating therapy in order to reduce the tension that exists between himself and Jan, and denies maintaining any of the same type of biases that his father held about therapy.
Jan reports that she received individual therapy for depression approximately 20 years ago after undergoing a hysterectomy. She recalled this as being part of the aftercare plan recommended by her gynecologist. Jan attended approximately 12 sessions and viewed her time in therapy as being very helpful. She has never
been prescribed psychotropic medication, nor has anyone in her family. Jan reports that no one in her family, including herself, has ever been hospitalized for mental illness, and is unaware of any psychiatric history with her extended family.
MEDICAL HISTORY
Mike has a history of hypertension and elevated cholesterol levels. He inconsistently follows a diet plan to address these two conditions under the care of his family physician. His father had one heart attack, 5 years ago, and is still living. There is a family history of cancer and glaucoma on his mother’s side of the family. His mother is currently in good health. Jan has no current medical problems. There is a family history of cancer and diabetes on both sides of Jan’s parents’ family. At the age of 29, Jan underwent a hysterectomy as a result of ovarian cancer. Her first reaction to the news of having cancer was devastation. She was scared of dying. She said that, fortunately, her friends and family were very supportive and the surgery was successful. She also reported that having a child was never something that she was really interested in doing, yet the idea of having a hysterectomy bothered her. Jan recounted, “I
did my share of parenting when I was raising my younger brother John. I used to have occasional thoughts of what it might have been like to have a child, but not for the past 12 or 13 years.” Jan said what really helped her was when she met Mike and he expressed his lack of interest in children. This was a big relief to Jan and was one of the characteristics that she found attractive about him.
SOCIAL HISTORY
Mike is the youngest of two boys. His older brother, 2 years his senior, received part-time special education classes due to weaknesses in reading and math. His brother also had “behavioral problems” which became a central focus in the family during his upbringing. While growing up, Mike and his older brother Mark were not very close. Mike tended to stay more to himself, while Mark had
lots of friends, but tended to get in trouble for not doing his homework and being disrespectful to teachers. Mike was in regular classes and maintained a C average. He recalls not enjoying school very much. In fact, Mike reports that there was never anything he really liked to do. One of the things his mom always complained of was that Mike rarely finished anything he started. He remembers taking piano lessons and drum lessons, but quitting each one after a few months. He also tried out for a local baseball league, but quit after the second practice. Throughout elementary school, he was often teased for being the biggest kid in his class and for not being very coordinated. Finally, as Mike entered high school, his father made the suggestion that he become involved with football. This altered his reputation with his peers somewhat, and enhanced his social skills. Mike states that he was teased less by the guys, but still felt very uncomfortable and somewhat afraid of females. He dated on and off throughout high school but never maintained any serious female His mother never approved of any of the girls that he expressed an interest in. He recalls one of his mother’s typical responses being, “Don’t get serious, Michael, it will never last.”
Mike describes his parents as being supportive, but to a limited degree. His father attended every one of his football games, and was very lenient in disciplining the children. When Mike had a problem, however, his father’s usual curt response was, “Get over it.” Mike’s mother was always there to discuss any problems Mike encountered in life, but tended to be very critical of him in general. He said that no matter what problem he was experiencing, his mother always pointed out that it was somehow related to something that Mike did to cause it. This created a great deal of conflictual feelings toward his mother, whom he views as very controlling and maintaining the power in the family. In describing discipline, Mike reports that his mother set the rules in the house and that everyone was expected to follow them, even his father. Mike remembers one time that the family was having company. His father spilled a drink on the living room carpet and his mom reacted by yelling at his father and calling him a slob in front of the guests. Mike said his father just left the room and walked out of the house. He did not return home until the next day. The year Mike graduated from high school, he pursued his trade in welding something that he trained for in vocational classes and has practiced ever since.
That same year Mike’s mother filed for divorce after 20 years of marriage, due to her husband’s numerous affairs. Mike described his parents’ marriage as involving frequent arguments and several separations. Mike was aware of his father’s affairs, and believed they were due to his mother’s constant “nagging” and “put-downs.” When Mike’s mother decided on the divorce, his father moved out.
Mike was very surprised and angered by this decision, but never shared his feelings with anyone. Mike rarely saw his father after he moved out, although
they did talk over the phone every couple of weeks. He described his mother as becoming more and more critical and demanding of him. Mike said 2 years later, his brother Mark moved out of the house to live with his girlfriend. Mike lived with his mother until he got married for the first time at 29 years of age.
Mike has maintained contact with both of his parents throughout the years. His father never remarried. The year before Mike married his first wife, his mother married her second husband, to whom she has been married for the last 20 years. Mike describes his mother’s second marriage as good, and he currently
maintains a fairly positive relationship with his stepfather.
Jan is the oldest of two children. Despite being 5 years his senior, Jan reports a close relationship with her brother, John, during their upbringing. Her parents both had careers, and had little time for Jan and her brother during their childhood. She describes her parents as very lenient and supportive in a remote sort of way.
Her parents rarely denied her anything, and frequently bought her and her brother whatever they wanted. Her parents placed a great deal of responsibility on Jan, since she was 5 years older than John. As a result, Jan spent a large portion of her childhood as a caregiver to John. She recalls that often, after school, she would make a snack for her and her brother before they began their homework. Sometimes when her mother was running late, Jan would make dinner for the entire family. She reports having enjoyed this type of responsibility until John started high school and became involved with drugs. Jan had been experimenting with marijuana herself, but saw her brother’s use as extensive and clearly destructive. This led to frequent heated arguments between herself and her brother. Her parents were quite liberal regarding the drug use, and saw experimentation as “normal.” Jan remembers one time that she was expressing her concerns of John’s drug use to her parents. Her parents responded by saying, “As long as he only
smokes it on the weekends, we don’t think he has a problem.”
Throughout high school, Jan did well academically, and had a number of friends. She reports that her friends were her “real supports.” Anytime she had a problem, it was her friends who she went to. After graduation, Jan attended college and received a bachelor’s degree in philosophy, with a minor in marketing. Upon graduating from college, Jan began working full-time in a local clothing department store.
SUBSTANCE ABUSE HISTORY
Throughout his senior year in high school, Mike drank alcohol quite heavily on the weekends. At the age of 20, he was introduced to marijuana by a co-worker. His alcohol and marijuana use continued on and off for approximately 10 years. At one point during this time, Mike lost his job as a result of coming to work late and frequently hung-over. Unfortunately, his dismissal did not change his frequency or quantity of substance use, which continued. This did not change
until Mike became involved in an auto accident due to his drug use. After running over and killing a dog, he crashed into a telephone pole, totally destroying his car. He was charged with driving under the influence and spent one night in jail. This also resulted in Mike’s dismissal from his second job. That same year, Mike’s first wife divorced him. At that point, Mike began thinking that his drug use was becoming out of control. He decided to stop using all substances except alcohol. This lasted for 3 years, until one day a co-worker offered Mike some marijuana after work and he accepted it. He explained this relapse as a result of stress from work. In particular, Mike described experiencing difficulty getting along with a female
co-worker with whom he was competing for a position. Mike claims that the last straw to this conflict was when his co-worker was finally chosen for this position over him and received a substantial raise. Mike believed that she was underqualified for this position, and consequently he resigned from his position 2 weeks later.
Mike continued to use alcohol and marijuana for another 10 years. One night, after using alcohol rather heavily, Mike was driving home from a friend’s house when he passed out and remained unconscious for several hours. When he awoke, Mike realized that he was in the middle of a cornfield and could not remember how he got there. Following this blackout period, Mike went through a 28-day
in-patient drug and alcohol treatment program. As a result, he has been substance-free for the last 7 months and has also been attending Narcotics Anonymous meetings on a weekly basis.
Jan experimented with marijuana and alcohol while in high school and college. After graduating from college, she stopped using controlled substances, except for an occasional glass of wine. During her first marriage, she began using marijuana again. She and her first husband used together frequently. One year prior to separating from her first husband, Jan stopped using and began attending Narcotics Anonymous meetings.
CHILD ABUSE
Mike was sexually molested between the ages of 7 and 9 by a paternal aunt. This involved her fondling and kissing Mike on a sporadic basis. He reports that this ended when his aunt moved away. He has not disclosed this information to anyone besides his wife, Jan, and the therapist. Jan reports no history of any type of child physical or sexual abuse.
CRIMINAL HISTORY
Mike was arrested for driving while under the influence and spent one night in jail. His license was suspended for 6 months. Jan has no criminal history.
PRESENTING PROBLEM
Jan made the initial call for an appointment for marital therapy. She stated that she and her husband were experiencing difficulty achieving emotional intimacy due to continual conflicts and lack of effective resolutions. Jan and Mike tend to avoid discussing conflicts with each other. When they do argue, Jan tends to criticize Mike, and he simply dismisses what Jan says as being trivial. At times,
Mike will avoid being around the house, particularly when Jan is at home. He does this to avoid tension in the relationship. This conflict-avoidance pattern of interacting has led to a lack of trust and emotional distance between them, which has naturally affected their intimacy. There have been times when attending therapy was discussed, but neither followed through due to periodic improvements. For the past 7 months, Jan and Mike reported, they were getting along fairly well. Mike was calling Jan and letting her know where he was and what time
he was coming home. Jan felt that she had begun to trust Mike again. This trust was violated, however, when 2 weeks prior Mike came home at 2:30 AM. Mike said he went to Jennifer’s house for a party. Jennifer has been a family friend for the past 20 years and the party was for those who helped her to relocate to her new residence. Jan did not want to go to the party and secretly wished that
Mike would decline as well. Unfortunately, she never told Mike her true feelings, and Mike ended up going by himself. Mike said he had fallen asleep while at Jennifer’s home and did not wake up until 1:00 AM. Jennifer lives an hour and a half away and Mike said that he drove straight home when he realized what had happened. Jan felt that Mike should have called her immediately and had erred in his judgment. Mike said he just wanted to get home as fast as he could and knew in advance that Jan would be upset. This incident resulted in a heated argument, that included a discussion about divorce. Jan told Mike she was not willing to continue the relationship because she didn’t feel as though she could trust him any longer. Mike felt this was totally unfair of Jan. Mike pointed out to Jan that in the last 6 weeks he has done everything he said he would and that Jan should still be able to trust him. Despite Mike’s efforts, Jan said she still wanted to pursue a divorce. Mike angrily responded by saying “Fine, if you want a divorce, go for it. Let’s do it tomorrow.” The next day Jan reconsidered her position and apologized to Mike, but did admit that she was confused about her
feelings. Mike acknowledged Jan’s confusion and admitted to his own frustrations with the marriage. It was at that point that Jan suggested they begin couples therapy, and Mike agreed.
HISTORY OF PRESENTING PROBLEM
Throughout the marriage, Mike and Jan have avoided discussing any conflicts, and do not recall ever really resolving any of their disagreements completely. Usually, arguments would end with Mike leaving the house for several hours. When they would reconvene, they would avoid bringing up the issue of contention,
and the matter would simply be dropped. The majority of their arguments involved Jan’s complaints about Mike’s being undependable, and especially concerning his drug abuse. Mike would rationalize that he continued to use substances because of Jan’s “nagging.” Whenever there would be disagreements, Mike would
tell Jan to “just drop it.” This tended to infuriate Jan, and she would yell and cry more profusely. Eventually, Mike would leave the room and, sometimes, the house. Unfortunately, the matters would never be resolved and would only be tucked away until they resurfaced in another argument and continued to erode the relationship.
