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The Roles of the Couples Therapist

The roles that couples therapists perform with their clients depend on the approach to therapy that they prefer.  They can be advisors, experts, coaches, educators, facilitators, provokers, observers, diagnosers and many other roles throughout the course of the treatment.  Here I want to clarify which roles the neurodynamic couples therapist does and does not perform.

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Regulating vs. Metabolizing

The goal of affect regulation came to the forefront of therapeutic wisdom in the mid-1990’s, primarily through the work of the neuroscientist, Allan Schore.  In his writing, he advocated that any effective psychotherapy had to address the dysregulated emotions that are stored in the right hemisphere of the brain.  Other researchers and experts (i.e., Daniel Siegel, Diana Fosha, Pat Ogden, Peter Fonagy, Marion Solomon and Stan Tatkin) translated this dictum into techniques such as mindfulness and mentalization, in which the therapist enters the patient’s experience to calm that unruly right brain with left-brain understanding.

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Training & Competency in the Treatment of Eating Disorders

Becoming an expert in the treatment of eating disorders takes time. Scroll through any Psychology Today professional listing, and chances are you find a number of clinicians who seem to “specialize” in almost every disorder listed in the DSM-5. While I believe that everyone should be trained initially as a generalist, with exposure to as many therapeutic modalities and clinical populations as possible, it is also important as social workers to make sure that you are practicing within your scope of expertise and knowledge. As a Faculty and Supervisor, I often remind my students, that experience does not always equal expertise. Someone can attend a training on a treatment modality or specific diagnosis, and while that imparts some knowledge and experience, it does not make one an expert. Most complex mental health issues are best treated by a clinician who has specific knowledge, expertise, and practice treating them, and eating disorders in particular are a cluster of syndromes that necessitate specific and advanced training in order to be providing standard of care. Consider this, if you needed an operation, would you choose the surgeon who has operated on cases like yours a handful of times, or the surgeon who has spent the better part of their career understanding, treating, and operating on conditions like yours and is up to date on the most recent protocols? 

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Mutual Emotional Triggers

The emotional triggers that spark conflicts between intimate partners are well-known:  he says he’s going out with friends from work, his husband feels rejected, his partner gets angry; she asks for more time to talk, her husband gets angry and defensive, she feels guilty; she tells her wife she’s disappointed in her, her wife bursts into tears, her partner tells her she’s overreacting.  One partner’s action triggers an emotion in the other partner, which automatically evokes a predictable and patterned emotional response from the original actor.  I have repeatedly written about this cornerstone concept of Neurodynamic Couples Therapy–mutual emotional triggers are a natural, inevitable, and useful aspect of couple relationships.

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