Go for the Jugular Gently: Confrontation as the powerhouse of Couple Therapy

Recently Dr Ellyn Bader presented an online therapist workshop on Confrontation. In this she described “the how, the when and the what” of using confrontation skilfully in couple therapy. Here’s Paula’s report on the training

Essentially the technique (or HOW) of therapeutic confrontation involves being able to help each partner see which specific aspect of their behaviour is getting in the way of moving ahead relationally. In holding up this mirror, the therapist must also be able to induce the right amount of anxiety to create motivation to change without eliciting defensive reactions. The aim is to support individual accountability, personal development which, in turn, impact on relationship growth.

However finding the right level of muscle for any particular person is important. Ellyn described six types of confrontation which enable this. They can be used in sequence to build tension, within or across sessions, to facilitate or sustain positive momentum. These types can also be switched around so that a lower level confrontation is used to prevent regression whilst holding therapeutic tension when too much resistance occurs.

The six types of confrontation Ellyn described were:

  1. Soft (the mild mention)
  2. Empathic (brings to the surface the unmentioned feelings)
  3. Gentle but Tough (kindly yet explicitly exposes dysfunctional behaviour)
  4. Indirect (talking to one partner about what is intended to be heard by the other)
  5. Hard/Tough (strong descriptions stated, restated and held firm) and
  6. Bombshell (forcefully setting the limit or stating the consequences of a behavior).

In using any type of confrontation technique, it is important to do so clearly and non-judgementally.

Deciding which confrontation type to use, the WHEN will depend on your (the therapist’s) “read” of what you believe your specific client can tolerate without regressing. This might include taking into account their upbringing, culture, gender, the couple’s history and both old and new information at hand. Therefore trusting our own therapist intuition and sharpening our atunement skills are a part of this process. A further important factor in deciding WHEN is the therapist’s own level of development and self-awareness, It is recommended that we do NOT confront when we are personally activated by the clients or the material in the session!

In choosing WHAT to confront, Ellyn highlighted the types of problems where some form of confrontation, either coming from their partner or the therapist, will be essential. She included examples such as the denial and dishonesty surfacing in addictions and varying forms of infidelity.   She also raised the more subtle patterns where confrontation has a powerful therapeutic role such as disrupting specific symbiotic* trends and challenging emotional regressions to facilitate differentiation** growth (e.g. financial, parenting, sexual /intimacy responsibilities).

Challenging the “hypocritical bind”, was presented as one of the other subtle patterns. We see this bind in relationships where one partner demands something from the other that they themselves are unwilling or unable to give.

Watch out for our upcoming blog which discusses how to work through a lack of responsibility taking around sexual connection.

*Symbiosis – the first stage of relationship development in The Developmental Modal, in which forming a couple bond occurs and the “WE/US” dominates as a system. This is a normal healthy stage of relating intimately and and couples move through this onto the next stage during the first 6-24 months of a relationship. However if they get stuck and hold onto this stage (the fantasy of love –the expectation that you will be there to meet all my needs) developmental growth is interrupted and problems arise as unrealistic expectations are held along with the loss of individual accountability.

**Differentiation – the second stage of relationship development.  Focusing on the skills of establishing a sense of self as unique  (differentiation of self), while at the same time being able to accept the unique in your partner (differentiation from other). So now there are two entities within the system of US – ME AND YOU to consider.

To learn more about compassionate confrontation and the stages of relationship development join us in one of our training opportunities (click here)