M2 Written Assignment 2: Angry Couple Case Note
Instructions
Construct a case note on the first therapy session of the video “The Angry Couple.”
Imagine that you were assigned to observe the interaction by the therapist in the video. She asked you to take notes and record as much as you recall from the first session of the video. She asked you to include quotes and descriptions of behaviors. Your note should be dated and no longer than half a page, single-spaced, (about 250 words).
Click the link below:
https:
video-alexanderstreet-com.li
ary.esc.edu/watch/the-angry-couple
I also added the transcript just in case you couldn’t open the link.
00:00:40SUSAN HEITLER Hello, I am Susan Heitler. Angry couples pose difficult challenges for a therapist. Their tu
ulence and imposes to hurt can be frightening to them and to the therapist as well. Anger creates an unpleasant atmosphere, yet it signifies that a problem exist. Conflict focused therapy utilizes anger to guide treatment.
00:01:00CONFLICT-FOCUSED TREATMENT Symptom Reduction Conflict Resolution Skill Building
00:01:05SUSAN HEITLER This approach includes three main thrusts. Symptom reduction, the main symptom in this case being anger. Resolution of existing conflicts. An improvement of conflict resolution skills, so that subsequent problems can be resolved without arguments. These three dimensions of treatment form a structure for organizing the diagnostic data that a therapist collects in the first session.
00:01:25WHEN ANGER IS PROMINENT Physical Violence Drugs/Alcohol Fixed Ideational System
00:01:30SUSAN HEITLER When anger is a prominent symptom, I want to know if it escalates beyond words to physical violence. If drugs and alcohol complicating the episodes or if either partner is angry in a paranoid fashion with a fixed ideational system, these conditions would need additional attention for therapy to proceed productively. As to the content of their conflicts, I ask couples to create a list of the topics that generate tension. This laundry list serves as a basic treatment outline, with regard to the process of conflict resolution, I identify skill deficits and reciprocal interaction patterns.
00:02:05SUSAN HEITLER In addition to this diagnostic assessment, a successful first session also needs to show the couple that treatment will be safe and worthwhile.
00:02:15Session 1
00:02:20SUSAN HEITLER Judith and Richard have been ma
ied two and a half years. He is 34, she is 32. Before their first session, I asked new patients to fill out intake forms. These include a symptom checklist. I quickly review these checklists as the session is about to begin.
00:02:35RICHARD I would say more heavily in the last half a year, two year.
00:02:40SUSAN HEITLER Hmm… hmm…
00:02:40SUSAN HEITLER Richard and Judith both have noted anger and communication problems.
00:02:45SUSAN HEITLER And have you been to therapy before…
00:02:45JUDITH Yes.
00:02:45SUSAN HEITLER …for these problems?
00:02:45RICHARD Hmm… hmm…
00:02:50JUDITH Yes.
00:02:50SUSAN HEITLER Ah… You want to tell me what your experience was there.
00:02:50JUDITH Well, we're there, ah, we had four sessions with another therapist…
00:02:55SUSAN HEITLER Hmm… hmm…
00:02:55JUDITH …and every time we would go to this therapist, my husband and the therapist would talk about my problem and, they, it was, it was like he didn't even have anything to do with this, it was all about me.
00:03:05SUSAN HEITLER Hmm… hmm…
00:03:10JUDITH And I felt they were talking about me…
00:03:10SUSAN HEITLER Asking about previous treatment can alert the therapist to potential problems.
00:03:15SUSAN HEITLER What are you feeling right now?
00:03:15JUDITH I am, I am angry.
00:03:15SUSAN HEITLER Yeah.
00:03:15JUDITH I am angry because nobody is listening to me. I mean, I, I, I go to a therapist try and get something done, and ah, it's not working.
00:03:25SUSAN HEITLER Okay. So it's very important for this therapy to work that if you begin to feel that angry feeling in here, will you be sure to tell me right away?
00:03:35JUDITH Okay.
00:03:35SUSAN HEITLER Good.
00:03:35RICHARD We should also let you know, what I think…
00:03:40JUDITH What do you mean?
00:03:40SUSAN HEITLER Ah… hold on to, hold…
00:03:40RICHARD …in gangbusters, I mean, you could have…
00:03:40SUSAN HEITLER …hold Richard, hold on just a sec.
00:03:40RICHARD I'm so
y.
00:03:40SUSAN HEITLER Let me just finish with Judith. I just want to be sure, we are absolutely clear.
00:03:45SUSAN HEITLER Angry spouses will often talk for or about one another. These crossovers are almost always inflammatory. I intervene immediately to prevent them. Quick intervention shows Judith and Richard that here they will be safe and will be heard.
00:04:05JUDITH Yeah, I feel, I feel like he is accusing me of getting angry, when I have every right to be angry.
00:04:05SUSAN HEITLER Okay, things are going fast. Let's slow down just a sec. I can see that you are cooking(ph).
00:04:15SUSAN HEITLER Judith repels from topic to topic. Then could continue picking up speed and anger would be counterproductive.
00:04:20SUSAN HEITLER What's going on…
00:04:20JUDITH Okay.
00:04:20SUSAN HEITLER …with your anger. I want to catch up though(ph) and find out from you Richard, what was your experience in the prior therapy.
00:04:30SUSAN HEITLER Symmetry is essential, needs to be established right from the beginning of treatment with special attention to symmetry of air(ph) time.
00:04:35SUSAN HEITLER Hmm… hmm… What was the problem for you?
00:04:40RICHARD The fact that she was ah, there is… there is this anger, that, that comes and comes and comes and…
00:04:45JUDITH Where do you think it comes from Richard?
00:04:45RICHARD It comes in, in waves…
00:04:50SUSAN HEITLER Hold, I need to, hold on, hold on, hold on. So you felt that the last therapy was unfulfilling, you didn't accomplish what you want…
00:04:55RICHARD I my mind that's the reason we are here. Because we want to fix this problem.
00:05:00SUSAN HEITLER Okay good, let's look at how to do that. Let's look first at exactly what the problem is and then we'll look at how to fix it. Before we get into it, I would like to make a recommendation.
00:05:10RICHARD Hmm… hmm…
00:05:10SUSAN HEITLER Which is that usually in therapy sessions here. We tape the sessions.
00:05:15SUSAN HEITLER Recitation of the therapy sessions by listening to audio tapes during the week can significantly accelerate treatment.
00:05:20SUSAN HEITLER Okay, we are on. Let's clarify what it is that you want to get out of treatment here. And I would like you to turn to each other and share with each other, why you are here…
00:05:40SUSAN HEITLER Suggesting that the couple face each other and dialog about their treatment goals there is multiple purposes. I look initially for a quick assessment of basic dialogue skills and deficits. I also evaluate ability to
ing different viewpoints to consensus.
00:05:55SUSAN HEITLER Could you do that?
00:05:55RICHARD Well, ah, one thing that, that, that the Judi has…
00:06:00SUSAN HEITLER Try and talking with Judi and telling her what you want to get out of therapy here.
00:06:10RICHARD We've gotta get your anger under control. This is getting ridiculous.
00:06:15JUDITH Oh, with(ph) my anger under control. That's why we are here. That's why you think, we are here. No…
00:06:20RICHARD To come to grips with the fact that even the smallest discussion escalates into a, an argument, based on the fact that you can't seem to handle your anger.
00:06:30JUDITH Oh, why don't, no, no, no see…
00:06:35SUSAN HEITLER Hold on, hold on just a second. Hold on.
00:06:35JUDITH It's because of his…
00:06:35SUSAN HEITLER Hmm… hmm…
00:06:35JUDITH …failure to commit to something that's very important to me.
00:06:40SUSAN HEITLER Hmm… hmm… So you are saying that for you there is something that you're wanting him to commit to.
00:06:50JUDITH Yes.
00:06:50SUSAN HEITLER Hmm… hmm… What is that you want?
00:06:50JUDITH To have, have a family.
00:06:50SUSAN HEITLER Hmm… hmm…
00:06:50JUDITH He can't commit to that, at all.
00:06:55SUSAN HEITLER Tell me about your feelings about having a family?
00:06:55SUSAN HEITLER Rather than allow Judith to speak for Richard, I invite him to express his viewpoint.
00:07:00RICHARD …I love having a big family. I just don't think that, that this is the time to have a child yet.
00:07:10JUDITH Why isn't this a time to have a child, when is it, when I am 45 years old, Richard.
00:07:10RICHARD Because, please.
00:07:10SUSAN HEITLER Hold on. How frequently do you get this upset at home?
00:07:15JUDITH A lot.
00:07:15RICHARD I would say, I would say frequently.
00:07:15SUSAN HEITLER Even when I am trying to understand the diagnostic picture, I don't allow fights to escalate.
00:07:20SUSAN HEITLER …what would have been the next step?
00:07:25JUDITH Well, he probably would have left the room, because he doesn't want to talk about it.
00:07:30SUSAN HEITLER And you would have.
00:07:30JUDITH Well, I would have kept talking about it. I don't just run away, I talk about things.
00:07:35RICHARD Yes.
00:07:35SUSAN HEITLER Hmm… hmm… So you would have try to keep talking about things.
00:07:35JUDITH Yes.
00:07:35SUSAN HEITLER And is her hunch (inaudible ) would you try leave the room or what would you at that point.
00:07:42RICHARD Not because I don't want to talk about it, but because, it's… it's the, it's the tone, it's, it's the, this, she comes at me with gangbusters.
00:07:50SUSAN HEITLER …hold on just a sec.
00:07:50JUDITH How… how can you…
00:07:50SUSAN HEITLER Hold on. When I say hold on here, I really like that you stop just now. Because, one element in making this therapy a positive experience for both of you is when you are not gonna repeat in this room, what goes on out there.
00:08:10RICHARD Okay.
00:08:10SUSAN HEITLER Now, when I say cut, that's it, you quite down, and I was very impressed Judith that, you did stop when I asked you to. Is that an agreement you are willing to make with me.
00:08:20JUDITH Yes.
00:08:20RICHARD Ah… and, and may.
00:08:25SUSAN HEITLER Hold on.
00:08:25RICHARD I'm so
y.
00:08:25SUSAN HEITLER I just want to ask the exact same question with you. If you get agitated or I arguing something, and I say cut, are you willing to stop.
00:08:35RICHARD Of course, I'm willing to stop.
00:08:35JUDITH But I still want to say what I have to say, and I don't feel like I'm going to say it.
00:08:40SUSAN HEITLER Hmm… hmm… Go for it.
00:08:40JUDITH Why he can't commit to, ah, to a family.
00:08:45SUSAN HEITLER So what is that, that you are saying about what you want, why are you here.
00:08:50JUDITH I don't want Richard to be able to commit to a family and to be able to listen to me. We've talked about this…
00:08:55SUSAN HEITLER Okay, stop just a minute, I'm getting a little ah, struck by the fact that both of you invest a whole lot of energy in talking about the other person. And in doing that you miss the opportunity to convey what you want. And I'm gonna ask the question one more time, and let's pretend there is a wall here, so that you can't see Richard that he is hiding here.
00:09:20JUDITH Okay.
00:09:20SUSAN HEITLER And instead, all you can see is you and what you want. Now, what is that you would like to get what you want by the end of this treatment, for you? I want.
00:09:35JUDITH I want a family. I want to be listened to.
00:09:40SUSAN HEITLER Ah… hold on a sec. I wanna write those two down, listen to and you want a family. Okay, do you feel like I heard the critical piece about what you want?
00:09:55JUDITH You know, I have so much anger I mean…
00:09:55SUSAN HEITLER I see that.
00:09:55JUDITH …I have so much I need to get out, and I feel like, I have to, I get there and then you say stop…
00:10:00SUSAN HEITLER Right.
00:10:00JUDITH …and I get there and you say stop and I need to get it out, because…
00:10:00SUSAN HEITLER Right.
00:10:00JUDITH …he certainly doesn't listen, you're supposed to listen to me.
00:10:05SUSAN HEITLER Right. This is a dilemma. Let me think for a minute. On the one hand, you want to get all of that fire out.
00:10:10JUDITH Yeah, I want to get it out. I want to…
00:10:15SUSAN HEITLER At the same time, at home when you get it out does it seem to result in some change, something good happening.
00:10:20JUDITH No because he doesn't listen.
00:10:20SUSAN HEITLER Right, right.
00:10:20JUDITH He walks away, he leaves.
00:10:25SUSAN HEITLER And that's a common thing, that most people don't like to see, you know, ah… the fire it's like you're dragon
eathing fire, if you are angry, but some people like not.
00:10:30JUDITH Well, how I (inaudible ) what I feel out, I can't.
00:10:37SUSAN HEITLER Ah, that's exactly what we are here today. How else can you get out what you want, because that being after that…
00:10:45JUDITH But that's not why I'm here, I am here because I want a family, and I want Richard to commit to me.
00:10:45SUSAN HEITLER Right.
00:10:45JUDITH And I want to find out why he can't commit to me.
00:10:50SUSAN HEITLER Umm… things get going real fast here. We are gonna slow down a bit. Umm… not because I don't want to hear you, but because I do want to fully understand this problem that is a very real one, a wanting to be heard.
00:11:05JUDITH Hmm…
00:11:10SUSAN HEITLER And a wanting to have a family. I don't think more explosions of anger, because they haven't worked at home, they are not gonna work here and besides we know that's outrage change it.
00:11:20JUDITH But I am angry, I, I am angry.
00:11:20SUSAN HEITLER Hmm… hmm…
00:11:20JUDITH I'm not somebody who just coming in and I just want a family and I just.
00:11:25SUSAN HEITLER I really do understand. I see that you are very angry. Tell me, when you get angry, what helps you to calm down.
00:11:35JUDITH I don't know. Ah… I am…
00:11:35SUSAN HEITLER Do you have trouble calming down, once you are angry like that.
00:11:40JUDITH Oh, is that look like I'm trying to calming down.
00:11:45SUSAN HEITLER Oh, hold on, ah, hold on. I want to know from you, because you are the only one that knows what goes on inside of you, inside of you.
00:11:50JUDITH I don't think about it, I just do it. It's like a madness…
00:11:50SUSAN HEITLER Right.
00:11:50JUDITH …so, I am, I am blooding it out. I don't think about it.
00:11:55SUSAN HEITLER I see and then after you let it out, what do you experience.
00:12:00SUSAN HEITLER I address the common misconception