A WORKING CLINICAL FORMULATION
Video Credit: 2013 Jason Headley 1:41 Min.
Her: “It’s just, there’s all this pressure. You know? And sometimes it feels like it’s right up on me. And... I can just feel it -- like literally feel it -- in my head. And it’s relentless and... I don’t know if it’s gonna stop.”
Him: “Well... you do have a nail... in your head.”
Her: “It is not about the nail!”
Him: “Are you sure, because, I mean, I’ll bet, if we got that out of there…”
Her: “Stop trying to fix it!”
Him: “No, I’m not trying to fix it! I’m just pointing out that maybe the nail is causing…”
Her: “You always do this! You always try to fix things when what I really need is for you to just listen!”
Him: “See, I don’t think that is what you need…I think, what you need, is to get the nail out”
Her: “See, you’re not even listening now!”
Him: “OK, fine. I will listen. Fine.”
In this short video, creator Jason Headley captures an interactional pattern that drives many couples to therapy. Headley masterfully demonstrates what it’s like for the partner who is inclined to fix it instead of talk about it.
It’s nearly impossible to ignore the nail in the woman’s head while she talks about the pressure, sleep loss and snagged sweaters. The restraint it takes her partner to see beyond the nail and “just listen” not to mention validating her experience instead of fixing it - hello, there’s a nail in her head - makes us question the validity of her expectations.
Early-career couple therapists feel a similar pressure to do something to help the distressed couples they work with. And listening long enough to understand what’s happening between them before they do something with what they understand, requires a level of clinical restraint that many couple therapists haven’t yet developed.
The pressure to help can lead to suggestions that are not helpful. Such as the common suggestion to one partner to “just listen” instead of “trying to fix it” before understanding what’s happening between the partners, what the suggestion communicates to them or what it requires from the partner expected to practice self restraint.
The last article in this series on having sessions, but not getting anywhere, focused on what you are doing to help a couple when you listen long enough to understand their relational difficulties.
In her September 9, 26 Substack Note about building a formulation Sarah Ozol Shore makes this clinical task easier with three questions to help you write your own “beginning of an explanatory account.” Ozol Shore’s instructions are as follows:
Thank you for sharing a VIRTUAL CUP with me.
If this newsletter was forwarded to you,
please subscribe so you don't miss an issue.
Never more than 2 issues a month.
Easy Unsubscribe At Any Time For Any Reason