Discover the secrets to teaching supervisees how to conduct successful couple therapy with Dr. Kate Walker, as she unveils her distinct approach to couple intakes. If you're a therapist seeking to enhance your sessions, you're in for a treat! This episode is packed with techniques to ensure both partners feel heard, from the pivotal initial interview to the establishment of individual goals. Plus, Dr. Walker's three-point wrap-up offers invaluable feedback and actionable steps, improving your ability to navigate complex issues like addiction or domestic violence during intakes.
Join us and gain insight into the intricate process of relationship assessment, especially when untangling the web of infidelity. Dr. Walker provides a compassionate roadmap for supporting the betrayed partner and emphasizes the 'how' of couple interactions over the 'what.' This episode is more than a lesson in therapy mechanics; it's a masterclass in adopting a systems perspective to be the calming influence that couples need. With Dr. Walker's guidance, learn how to create a timeline of significant events, use the Holmes and Rahe scale to understand stress, and actively involve couples in their therapeutic journey for a profound and lasting impact.
Get your step by step guide to private practice. Because you are too important to lose to not knowing the rules, going broke, burning out, and giving up. #counselorsdontquit.
Discover the secrets to teaching supervisees how to conduct successful couple therapy with Dr. Kate Walker, as she unveils her distinct approach to couple intakes. If you're a therapist seeking to enhance your sessions, you're in for a treat! This episode is packed with techniques to ensure both partners feel heard, from the pivotal initial interview to the establishment of individual goals. Plus, Dr. Walker's three-point wrap-up offers invaluable feedback and actionable steps, improving your ability to navigate complex issues like addiction or domestic violence during intakes.
Join us and gain insight into the intricate process of relationship assessment, especially when untangling the web of infidelity. Dr. Walker provides a compassionate roadmap for supporting the betrayed partner and emphasizes the 'how' of couple interactions over the 'what.' This episode is more than a lesson in therapy mechanics; it's a masterclass in adopting a systems perspective to be the calming influence that couples need. With Dr. Walker's guidance, learn how to create a timeline of significant events, use the Holmes and Rahe scale to understand stress, and actively involve couples in their therapeutic journey for a profound and lasting impact.
Get your step by step guide to private practice. Because you are too important to lose to not knowing the rules, going broke, burning out, and giving up. #counselorsdontquit.
All right, welcome to your Tuesday training. I'm Dr Kate Walker and this is the training, the live training for members of our Step it Up group. So it's kind of exclusive, it's kind of special, but if you're listening to this on a replay, you're special and you're amazing because you're taking time, add your day to watch some training. Also, if you're listening to this on the podcast, you're awesome too, because you're listening to this on the way to baseball practice or hockey practice or to the gym, whatever it is that you're doing, you're taking a little extra time for you and your clinical skills. So today I'm going to talk you through how I do a couple intake. Now, if you're watching the video, you will get to see me share my screen. If you're listening to me, don't worry, because I will talk you through everything I'm doing, and with a couple intake, what I tell you is almost as important as what I'm going to show you. Why am I doing this? Well, there was a comment last week at TCA about you know it's a shame that we don't really get to watch each other do the things you know. It would be great if we had these examples, and I know in grad school we got to watch some cool videos of the masters you know doing their thing, and it was and it is wonderful when you're able to have a video just to see how somebody else does it. Now, this isn't that video. I'm not going to be demonstrating on an actual couple. Believe me, I thought about it and the reason I don't is because this interview is so good, not because it's mine, but because what it does is it fosters the beginning stages of intimacy. Now I will tell you, I conduct a couple assessment, really over four sessions. So the first session feels like an interview. I go through what I'm about to go through with you. Then the second and third sessions are individual. They were there one and done individual sessions. They are the only time I will ever meet with the folks in this couple individually and it's to assess for a lot of things. If there were any red flags from the interview. If there are or I will, you know I'll assess for addiction and domestic violence. I'll also make sure at that second and third session each person understands I am inviting them to set a personal goal for themselves. I'm not going to reveal what that is, because those individual sessions are confidential unless they reveal an active affair or an active addiction. Those are secrets I make it very clear from the beginning. I will not keep so. The fourth session is a communication exercise. So by the end of that fourth session, my couples can expect feedback on how they communicate, as well as some specific steps they can take. I almost said measurable, that's so in my head right Specific, measurable, trackable. But these are really just specific steps they can take Think of it as homework or you know whatever and they can then decide where they want to take the couple counseling from there. Because I am very solution focused, I'm always inviting the couple to decide if they are wanting to come back, if they would like more sessions, if they feel better. Now. I'm always trying to co-create with them this reality where better happens.
Speaker 1:So I'm taking you through five things today. If I oh, I think I can get through all of this. Actually I need one and one a. So I think there are no, maybe six things, okay. So here's what you, my badasses, are going to leave with. You're going to learn the things I do say, the things I skip. You're going to understand the importance of keeping things equal, the importance of making sure everybody just tells their story one time and taking a systems perspective. And finally, you'll understand the importance of a three point wrap up and, probably most importantly, you'll understand that this is just how I do it.
Speaker 1:All right, I'm trained as a marriage and family therapist. I'm trained as a marriage and family therapist supervisor. I've gotten specific trainings over the years. This is really how I do it. It's not the way, it is a way, but I wanted to do this for you guys because of what I said earlier. You know, you just don't get to see how another person does a thing, and so sometimes it's kind of nice to be like, oh, thank goodness I'm doing it, like Kate does, or ooh, kate's not doing this. I better email her and say, hey, you need to do this. This is the latest research. Remember, when I show you my stuff, you got a promise to help me out If you see something that's outdated or just plain wrong. All right, so let's get started. I'm going to hit the old share screen button, and for that I need my glasses, so you will see lots of glare, but that's okay. So what you are now looking at is my intake. Now, it is long, and it's long because it's designed to get a lot of information, so I will show you things I skip and things I add, but I'm actually going to shove number two to number one.
Speaker 1:So I mentioned the importance of keeping things equal, and in the research we even refer to this as utterances, so the things that each couple, each part of the couple, says out loud. It's so important in that space that you become the least anxious presence in the room. This is a, you know, referring to Bohenian triangulation, therapeutic triangulation. So when there are two people who are at odds right, there's some conflict you, my therapist friend, become that least anxious presence and it affects the entire system. And so making a commitment to keep things equal is how you are going to show your couple people that this is a safe space. This is an ethical imperative, of course, but it is also a clinical imperative, as you are aware of this as a functioning system right here. It may not be pretty, it may not be what they wish it was, but it is functioning as it will and you are now part of that. So keeping things equal is you being that non-anxious presence in the room. So there are times you're going to feel like a basketball referee and, you know, a traffic cop. That's okay, right.
Speaker 1:The important thing is you start off at the very beginning, keeping things equal. So you'll notice what I have here are it looks like a lot of demographic information, and so you know this is stuff I don't dive into a lot, it's usually things now I can glean from their intake paperwork. So what I want to draw your attention to is this box, and so, if you're listening to me, all we're doing we're looking at this box, and this box is empty. Because I'm not a keep it in the lines kind of person. I have a box so I can draw and I can take notes how I want to take notes. But here's the rule Everybody gets to tell their story one time, and so I am loaded with responses like oh, you know, diane, it sounds like you want to respond to Don's comment about that, and I hear you and I want to let you know.
Speaker 1:We'll talk about that in a minute, but for now I'm, this is Don's turn, and so Don's going to tell his story. So, and y'all don't hold me to these names, I'm going to switch them 50 times during this presentation, I imagine. So everybody tells the story one time and I invite them. I might look at Diane and say so. Actually, I would look at both of them and I would say so.
Speaker 1:Who wants to tell me, first, why counseling and why now? Because, as a therapist, we're all aware that the problem has been building right. Coming to therapy isn't like the day after they found out the problem, unless, of course, it was a discovery of an affair. So if that's the case, you'll hear. Well, I found out that you know Don was having an affair, or I found text messages from Diane's boyfriend on her phone. That then it is an incident, of course, but it still behooves you to say why counseling and why now, and to have both partners tell the story. So Diane may say, yep, we're here because I intercepted a phone call from Don's girlfriend and we're in counseling.
Speaker 1:Okay, don, what are your comments on Diane's comments? Well, yeah, I mean, it's what she said, but you know, for years I've been feeling neglected, I've been feeling this, I've been feeling that, and Diane may want to say bup, bup, bup, but you stop right, channel your inner traffic, hop and say Diane, hang on just a minute. I'm going to let Don finish and I commit to both of you that I will make sure to keep this equal throughout our time together today. So keeping things equal. And everyone gets to tell the story one time. Now there's another reason for this, and you'll see as we get to the rest of this interview.
Speaker 1:Now I'm going to scroll to page two. Now, page two has to be my favorite, favorite part of this interview. I love this. In fact, I memorized it and I don't even look at the page anymore. So, if you're listening to me, here are the things I asked each of them, and here's how I preface it.
Speaker 1:Okay, guys, the next questions I'm going to ask you are going to feel like an interview, but whatever I ask one, I'm going to ask the other. So let's start. Who would? I'll ask who would like to go first, or if they seem highly conflicted again, I'm the nonanxious presence in the room I may say you know what, don? Tell me what are the qualities that initially attracted you to Diane. Now, I will tell you, over the years that I've done this. I have a little stopwatch in my head where, when I feel like Don has told his story, I will stop and say okay, diane, your turn. Tell me what are the qualities that initially attracted you to Don. Now, it's really common for each to try to get back into the problem story and I will say something like we will get to that, I promise so. Or I might say something like in fact, that's our next question. So I do it sort of like I don't know what kind of game checkers I guess. So if Don answered this question first and Diane was second, the next question I will start with Diane and then Don will go second.
Speaker 1:So back when I was face to face and everybody was on the couch in front of me generally, I just started with the person on my right and I figured out over the years with couples it's so funny, especially with men and women, I would be like, why are the women always on my right? And then I realized, oh my gosh, this is great information. He did ladies first. So what does that tell me about the system? And I would start to analyze that. I'm telling you you get so much great information just by where people are sitting in that office across from you. But I digress Now.
Speaker 1:So other questions on page two after what initially attracted you, what are some negative concerns that you initially had in the relationship? What are some present positive attributes of your partner. What are some negatives about your partner, what are some things you do or could do to make the marriage more fulfilling for your partner, what are some things that your partner does or could do to make it more fulfilling for you, and what are some expectations you had about relationships. Now I'm going to give you a big old caveat here. If you are seeing this couple for infidelity, it is imperative that you look at the partner who did not do the thing, the betrayed partner and you look them square in the eye and you say I am not trying to establish causality here it doesn't matter what you were doing. If you were swinging by the chandelier naked with the plumber, that did not cause your partner to have an affair. Now, that example probably didn't make any sense, but you get the idea we cannot cause another person to cheat. And so, as you're gathering this background information, it is I'm gonna use the word again imperative that you let the partner who was betrayed understand and know and really hear you say it that they did not cause their partner to cheat. So when you're saying, or she is saying, what is a negative attribute? Well, you know what. They lead their shoes out every night. You know what they walk past the dishes for days. You know what they never take out the trash. Well, you know what. That's not a reason for you to have an affair and you may have to say this multiple times with infidelity. As you're gathering this information, because you've already told them this is gonna feel like an interview. You've already told them you will keep it fair and equal and I hope you've told them at the end you will give them this three point wrap up that I will talk about in just a second, I promise.
Speaker 1:So, getting on to page three, I love this part Now those of you who are listening. Basically, what it's going through are things like affection, child rearing rules, commitments, emotional closeness, financial security, housework sharing. Now, I'm a Gottman fan and I understand what it means to share household duties and what that does to a relationship. So I'm going to ask each partner, on a scale of one to five, how they feel about the present state of the relationship, and I may have to explain this, and I've learned over the years. I skip a lot of this because I know the research about the things that impact relationships the most. Again, I'm not trying to establish causality of why a partner did a thing. This is helping me to understand the state of the relationship and I keep it moving.
Speaker 1:So, on a scale of one to five, don, let me know how do you feel about affection in the marriage? It's a one Diane. On a scale of one to five, where five is wonderful, one isn't so great. How do you feel the state of affection is in the marriage? It's a five. I think we're great. Ah, ooh, okay, that's something to take note, that kind of disparity. One person thinks it's eh, the other one thinks it's amazing. We got some stuff to dig into, but not today, right Today, if you start following those rabbits down those trails, you are going to get in the weeds with your couple.
Speaker 1:So this is when I get to talk about the importance and this is a systemic view of the how versus the what, and a lot of our new associates and even seasoned counselors. They want to grab onto the what. Look what they said. But we need to talk about that or we need to make sure that we follow that. No, instead, notice the how. How are they sitting? How are they conversing? How are they looking at each other? Are they hesitating before they speak? Are they checking their partners before they answer? Are they giving you direct eye contact? Are they able to answer the questions? Or are they just simply saying I don't know, I don't know. So, following the what they say, down those rabbit holes, you will never get through this intake. It won't happen, and I hate to say this and I will own this, as this is something I have been trained to do and to think and how I train others.
Speaker 1:If you get into the weeds with your couple client, whether they're and I know, I used the term married before it doesn't matter if they're married or not married or whatever you have now raised your anxiety, right, because you're kind of like that bloodhound on the scent of a rabbit and you're thinking, ah, I've got to follow this. No, you don't not yet. Breathe remain that non-anxious presence in the room. Very important, all right, I am not gonna lie, I skipped this part about which partner spends more time conducting the following activities. Not that they're not important, but I'm going to ask them in their individual as well, because this is perspective a lot of times, right, sometimes I call it two corners in one car wreck, right, if I'm the cop and I'm investigating the car wreck and you're a witness and then I've got another witness on that corner over there I'm gonna have maybe you're gonna say, oh, look, you know the car's fine. And the other witness over here I walked across the street. They're gonna say, oh my gosh, the car's totaled. You're both right because you're both looking at it from your corner. So I do focus on things like auto repairs, child discipline, employment, grocery shopping, making the bed, recreational activities, but I save that for the individual session when I'm getting that perspective from each one of your corners.
Speaker 1:All right, the next page I don't do this anymore, I used to. This is for those of you who are listening. It says circle the appropriate response, who does X behavior most of the time, some of the time or all of the time. Again, you can probably guess this is something I save for their individual session. So things like who apologizes, who gets quiet, who criticizes, who leaves the house, who makes peace, and you can probably guess the reason I don't do this anymore in that initial couple session. Right, if you're assessing for domestic violence, you're not gonna number one either. You won't get honest answers here, right? Someone will be kind of turning the volume down on the severity or they'll be turning the volume up on it. It's just, it's hard to tell because you're just getting to know these folks. Right, you'll get to this part of the assessment maybe 45 minutes in 30 minutes in. You've known these people 30 minutes, so I save it for the individual session. When I'm assessing this I never skip. So this is psychiatric history. I find this to be so important Because, again, food for thought for that individual session.
Speaker 1:I'm taking notes about what kind of medications they've had in the past. Here's a real common one. I'll have adults in the room who will be taking Xanax or they'll be taking Adderall and I will say, oh, so you're diagnosed with anxiety, or oh, you're diagnosed with ADHD. And they'll be like, no, I'll be like, well, yeah, you are, I mean if you have the medication. So sometimes it's a moment of psychoeducation. Or we'll dive a little deeper, or I'll find out about a past trauma and they'll start to put two and two together that, oh, when they had their second child, they went to the doctor, they were put on an antidepressant Maybe that was postpartum depression and and and we start kind of teasing these things out and they didn't understand or they didn't realize what they were experiencing and what it meant and we can start to put two and two together, but again, not in this session, right? This is food for thought for the next session, that individual second and third session.
Speaker 1:Again, this is, if you're watching it, this is a quickie depression assessment, as well as an assessment for alcohol consumption consumption and violence and things like that. You can already guess this is something I skip and bring into this, the individual session, unless there are some real markers for maybe some suicidal ideation or severe depression, and everybody out here should have that in their hip pocket. Right, you should have some kind of a quickie assessment for these things so you can dive a little further. I'm not going to talk about it during this episode, but definitely maybe that's something we can talk about in the future. And finally, I never skip the medical. This is so important. My internship was with chronic pain patients, so these are folks who'd been injured or they were suffering from some kind of a terminal or even not terminal, just a chronic illness and the effect of medication on mood, the effect of medication on sexual function, the effect of mood on, etc. Etc. So sometimes it's so nice and that was Andy asking to be let out. I'm sorry, bud you're gonna have to wait a minute the effect of so-called medical conditions and medical interventions on mood and intimacy and relationship, that you may be the person who gets to tell this couple for the very first time the impact this is having on them individually and as a couple.
Speaker 1:Now let's get to the things that I add. So, not going to screen share anymore, I'm going to stop the share. One of the things I add at the end is okay, what am I not asking? Now, here's a little secret I didn't tell you before. One of the things I learned to do early on is to create a timeline and I literally on a blank piece of paper, either in addition to this or just another sheet of paper, I'll start putting things down. So when they mention, for instance, the birth of their first child, I'll just casually ask, okay, what year was that? Or I'll try to do the math in my head, which isn't always successful. So I'm taking this timeline of job changes, moves, new babies, marriages, injuries, death of a parent, significant whether they're good or they're bad.
Speaker 1:I'm taking notes and putting together a timeline. So at the end I say, okay, guys, what question am I not asking here? And I invite them to fill in the gap, and I usually give them a parameter of about five years. But sometimes we have to whine that and I'll say, okay, and I'll find out. They've moved 12 times in five years. Or someone was shipped overseas and they were part of a governmental coup, as when they were on a work site. Yeah, I'll find some things out that they don't think to bring to my attention, right? Because for the couple, sometimes they think, no, no, this is what we're bringing. Pay attention to this, but I'm supposed to be trained to look way over here and way over here, which brings me to the three-point wrap-up. I always let couples know at the end of this session I'm going to give you some directions that we can take and if you decide to go forward, I will give you some homework, things to look up, things to read, so that when you come back we can discuss it. So this is what they've been waiting for.
Speaker 1:And my three-point wrap-up, in what I generally train my associates to do also, is going to be surrounding stress, and that is literally like the Holmes and Ray scale. I am giving them feedback on the number and severity of good things and bad things. So, oh, you had triplets. Oh, that's wonderful. Oh, you also had to bury your mom that same year, oh, and you lost your job. Oh, and that caused you to have to move it. Oh, now your job is six weeks on and two weeks off, and right. So I help them understand the impact of stress. Anxiety goes up, cognition goes down, takes away your team skills, makes you a surviving individualist, and that can affect the couple. And I invite them, I will say have you discussed this before? Have you thought about this before? And if they say no, I will say OK, then I will put that down as a direction we can take.
Speaker 1:Moving on, and I go to number two, which is usually related to the life stage. Are you in the new parent stage? Have you just launched your last kiddo? And now you are in that phase of, oh, we're approaching retirement, we have to be a couple. Again, psychoeducational time.
Speaker 1:I let them know how these things can impact a couple. I'm not talking about cause. I'm not saying these things can absolutely definitely cause the problem you're dealing with. I simply help them understand they're normal that everybody goes through these things. This is how I help the client buy in to the therapy process. I've kept it equal. I've helped them understand. I'm not chasing after any rabbits, I'm paying attention to the how and not the what. And now is the moment when I help them see these are things that anybody could struggle with.
Speaker 1:And finally, number three is the presenting issue. If it's an affair, if it's intimacy issue, if it's a parenting issue that's affecting their marriage, I help them understand ways that this will affect their marriage, ways that they can recover and do better. And then I will invite them to do some research on their own if they're interested. Right, so that three point wrap up. Again, I talk about the impact of stress because I've been good and I've kept the timeline and I've asked them OK, what am I not asking? I give them information about the life cycle and where they are in that, and then I save the presenting issue for last and give them information and invite them to do their own research. So looking up Gottman's Four Horsemen of the Apocalypse of Marriage, inviting them to do some research, torski's addictive thinking, inviting them to read something about infidelity recovery, and then I invite them to schedule their individual appointments. And that is how I do a couple intake. So I hope I hit all of the things and you were able to understand what I add, what I skip, why I keep it equal, taking that systemic view of the least anxious presence in the triangle being the therapeutic triangle and then, of course, ending with a three point wrap up that invites the couple to be a part of the process and hopefully creates buy-in.
Speaker 1:So I'm going to look to see if we have anybody who joined us today to see if there are any questions. Ok, it looks like we're good Guys. I'm so glad you hung in here today and I hope this is helpful just to hear how another person does a couple intake. And if you have any comments or things that you do that you think could help me, please, please, feel free to tag me, post me, tag me in the Facebook group and or get into Gosh where else could you do it? I guess you can comment on the podcast, but I'm not sure. But let me know. All right, guys, have a wonderful week and I will see you next Tuesday. Bye.