If Only I Had Known... provides the reader with a realistic take on couples therapy. The book identifies the possible pitfalls involved in treating couples, and the particular kinds of issues that appear peculiar to couples work by its nature.
Any therapist who has had a couples session go horribly wrong will relate with a shudder to the themes, example dialogues and scenarios discussed in the book.
The book is structured according to particular themes that can lead to problems or mistakes in therapy. The need for structure in couples work is discussed, emphasising the difference between couples and individual therapy, with clear instructions for setting rules and what to do if these rules are broken. Maintaining a strategic focus is emphasised. Some valuable, practical suggestions are given for handling hyperemotionality, as well as creating enough emotional intensity for change to occur.
Couples therapy presents some complex confidentiality issues and the therapist can make some mistakes in this area due to confusion and lack of clarity as to who the client is. The chapter on confidentiality considers issues such as keeping secrets, dealing with requests for individual sessions and appropriate documentation.
The need for neutrality and the difficulties for the therapist in maintaining this are considered, such as pathology in one party, countertransference and the values of the therapist. Again, specific guidelines are given to avoid the common pitfalls, including the potentially problematic first session where neutrality is essential in order to form an alliance with the couple.
Whilst ensuring that an effective working alliance is developed with the couple, it is important that the therapist does not allow one partner to take over with stories of hurt and disappointments from the past. The authors advise that "the purpose of such stories is to demonstrate that the partner was wrong, bad, villianous, or the like" (p.92), and discuss some of the less effective strategies that can allow this pattern to continue and lead to a poor outcome in therapy.
Failing to listen for hidden problems, such as addictions, abuse, affairs and swinging, can result in misdirected and ineffective treatment. The authors provide typical clues to watch for to ensure that the 'real' issue is being discussed, and the need for a thorough and well timed assessment and intervention plan is emphasised.
Dealing with anger, fostering commitment and working with agreeable and disagreeable couples are also dealt with. The final chapter is a sensitive exploration of the issues relating to imposing or overlooking the significance of spirituality with a couple.
The book provides an overview of the problematic areas of couples therapy, and while themes do not depart significantly from other contemporary couples therapy literature, the authors do manage to summarize an impressive range of information into a manageable and accessible text likely to be useful to beginning therapists. It would be a useful text for students of couples therapy used in conjunction with theory based texts, as it does assume the reader possesses a background theoretical knowledge of couple therapy theory and process. Although references to relevant literature are sparce, the strength of this book lies in the practicality and applicability of the specific strategies outlined in response to the common mistakes made by therapists. Clearly the authors are experienced in the area and provide the reader with a user friendly collection of wisdom gathered over many years of therapeutic work.
© 2008 Marieke Geoghegan
Marieke Geoghegan is a Registered Psychologist from Western Australia.