4

SESSION 1: HONORING THE PROBLEM

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In the chapters that follow, we expand on the content and process that
occur in each of the subsequent sessions. In this chapter, we discuss the pro-
cedure for the first session, which takes place after the intake screening. The
format of the first session differs depending on whether it is a multicouple
group or a single-couple session.

INTRODUCTIONS AND GROUND RULES

The first multicouple session begins with cotherapists and clients meet-
ing together in the same room. The therapists welcome everyone and intro-
duce themselves to the group. Next, everyone introduces themselves and tells
the group something about themselves (e.g., how long they have lived in the
area, how many children they have, their hobbies). We explain to the group
members that, in our experience, couples treatment works best if therapists
have a chance to work with men and women separately on their own issues
before starting to meet together and address couples issues. We also explain that
the group has two purposes. We want to help couples prevent the recurrence of
physical and psychological aggression in their relationships. However, we also

43

http://dx.doi.org/10.1037/12329-004
Couples Therapy for Domestic Violence: Finding Safe Solutions, by S. M. Stith,
E. E. McCollum, and K. H. Rosen
Copyright © 2011 American Psychological Association. All rights reserved.
 want to help them achieve more satisfaction and enjoyment together. The key
to eliminating aggression and abuse is taking personal responsibility for one’s
actions. The key to decreasing the risk for future aggression is improving the
quality of relationships.
We explain that in the next session the men and women will work
together to establish goals for treatment, and the treatment program will
be designed to meet the client-selected goals. We also let them know that
most of the first six sessions will be conducted in men’s and women’s groups.
The men’s and women’s groups will focus on a broad outline of issues to be
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addressed each week, such as ways to manage anger and conflict, how to relax,
and so on. Clients will often be given a handout that summarizes content of
the session during the first 6 weeks. Clients may have the opportunity to bring
up their own issues during the first 6 weeks, but the focus will be on each per-
son taking responsibility for his or her own behavior, not on discussing the
flaws of the partner. We explain that therapists will switch groups each week
so that each therapist will get to know each client and so that clients feel
comfortable with all therapists.
Next, the group members will be asked to develop group ground rules.
The rules provide a common understanding of how the group will operate.
We begin by asking the clients to brainstorm what they think should be in
the group rules. When asked by a researcher what was helpful about the first
session, one male client said:
Male Client: Stating the rules at the beginning was a good idea.
Interviewer: So, that was helpful.
Male Client: Yes, that was helpful. But it wasn’t, like I said, I’ll rephrase
that, it wasn’t stating the rules, it was allowing people in the
group to make the rules. That gave a lot more freedom of
will. In fact, I think that was incredibly smart. Because it not
only told these people, if we give you the choice to make
the rules, that’s also basically saying, we’ll also give you the
choice to say what you want. If you want to be more inter-
active as the group goes on, then do it at your own pace.
I don’t think anybody was forced to do anything they didn’t
want. . . . I think, for example, [another male client]. He was
real nervous at first, and he started relaxing and getting more
interactive as the session went on. So I think that letting
people make the rules in the beginning. Very smart idea.
Although we believe that it is important for groups to make their own
rules, we make sure that the rules include the following:
䡲 Information that is shared within the group is confidential.
䡲 All participants speak for themselves and not for their partners.

44 COUPLES THERAPY FOR DOMESTIC VIOLENCE

 䡲 The group begins on time.
䡲 No one should be coerced into speaking if he or she is not
comfortable.
䡲 What is discussed in the men’s and women’s groups is not shared
outside those groups except by the person involved. That is, if
a man raises a concern about his marriage in the men’s group,
he is the only one who can share it in the larger couples group.
Furthermore, because safety is primary, partners may not share
with one another what was discussed in the men’s and women’s
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groups after they leave the group.

䡲 No one can participate in the group under the influence of drugs
or alcohol.
Group members may come up with other rules, but we believe it is impor-
tant to include these. After we have discussed the format and procedure of
the treatment, the men’s and women’s groups meet in separate rooms.

GENDER-SPECIFIC PORTION OF SESSION 1

The rest of the session will be gender-specific (i.e., men’s group and
women’s group). Clients are complimented for their willingness to come to
treatment and work on their relationships. The goal of the conversation is to
engender hope and to help clients feel respected. When interviewed by a
project researcher about his experience in the program, one male client talked
specifically about his appreciation that the therapists complimented him on
his courage for coming to therapy:
I like the way they acknowledge right up front, they said, “I know it took
a lot of courage for you to come here.” I appreciate that. I like the way
they acknowledge—because it does. It takes a lot to go in there and start
talking to people that you don’t know about something you’re having a
problem with.
Because the primary goals of the first session are to begin to build rela-
tionships among group members and to develop an alliance between the ther-
apists and the clients, we devote significant time in the rest of the session to
having clients tell their stories. Although the stories are generally full of pain
and not focused on strengths, we believe it is important for them to know that
we respect the pain they have experienced and that we are starting this work
where they are. The therapists at this time use reflective listening and com-
ment on the resilience the participants exhibit to be here to be working on
this difficult challenge.
At this point, if there is time, we often find it helpful to talk about pre-
session change. Questions about presession change are a solution-focused

HONORING THE PROBLEM 45

 technique that serves a number of purposes. The format of the questions is
to ask clients to think back to when they first knew that they would be com-
ing to couples treatment. For some, this may have been a specific decision
they made. Others may have acquiesced to a partner’s demand they come
or felt that the level of conflict in the relationship left them no choice. We
often hear from couples that they see couples treatment as their last resort
before divorce. Regardless of how they decided to come, we compliment
them on deciding to do something to make a difference in their relationship.
We then tell them that people often notice some small changes happening
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once they have made a decision to come to therapy and that if they have
noticed any changes, we would like to hear about them. We make clear that
we are not saying that all the problems have been solved, nor are we think-
ing the changes are enormous, but we emphasize that we want to make room
for discussions of things going better when that is true.
A way to ask this question is:
You know, therapists often forget to ask a very important question at
the beginning of therapy. We have learned that many people already
start to make some positive changes before they even begin therapy,
but we don’t find out about those changes because we forget to ask. It’s
certainly important for us to talk about the problems, but we’d like to
end this evening’s session by asking what positive changes you’ve noticed
in yourself or your relationship since you found out that you would be
coming here.

As de Shazer et al. (2007) pointed out, there are three possible responses
to presession change inquiries. First, the clients may report that nothing
has changed. If so, it is important not to argue but simply to go on and ask
how they hope the group will be helpful. Other clients will, in fact, report
that things have gotten somewhat better. They may report on a positive
experience or interaction, for instance, that seemed out of the ordinary.
The therapists’ response to this should be to “make it bigger” by asking
detailed questions about the experience—what happened, who was involved,
how did it feel when things went better, and so forth. Most important, the
therapists should ask what contributions the clients themselves made to
things going better. It is tempting for clients to report how others are respon-
sible for the change (“My husband didn’t get in my face like he always
does”), but each interaction is, in fact, an interaction, and the therapists
can focus on how the client made a difference in his or her response or in
what led up to it. This begins the process of taking responsibility for one-
self by looking at one’s own contributions to positive interactions. Know-
ing that we want to understand how clients help things go better can help

46 COUPLES THERAPY FOR DOMESTIC VIOLENCE

 clients feel more comfortable when we need to talk about things they need
to change or ways that they contribute to the problems. Presession change
questions are based on the solution-focused model’s assumptions that change
is always happening and that nothing is static (Weiner-Davis, de Shazer,
& Gingerich, 1987). Although we recognize that change is always occur-
ring, if therapists do not ask about change, it is often not noted by clients
or therapists.
This question is not asked simply to create a catalog of changes. As the
discussion continues among the group members, if any participants are able
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to recognize positive changes in their relationship, this can be highlighted.

For example:
You know, as I listen to you talk about all the things you’ve changed even
before you’ve come here to this group, I’m very encouraged. I recognize
that some of you haven’t brought up any positive changes, but the fact
that several of you have noted changes, lets me know that this is going
to be a group in which participants are willing to work, and work hard,
at making things better in their relationship. I’m going to send you all
home with an assignment, between now and the next week, I’d like you
to notice ways that things are getting better in your relationships, and
especially, I’d like you to notice what you are doing to help create this
difference. We’re going to start our [men’s or women’s] group with your
report of differences next week.

At times, no group member is able to report any presession change,

and instead group members are intent on making sure the therapist under-
stands the seriousness of the problem. Pushing them to see what has been
different when they do not yet feel the therapist appreciates the gravity
of their situation will likely leave them feeling misunderstood and skepti-
cal about therapy, especially with an issue as serious as domestic violence.
Rather than push clients to report about presession change, the therapist
should hear some of the story of the problem before pushing for exceptions
to the problem. We find it helpful to suggest that clients may need to “let
off some steam” about their situation, and we wonder with them whether
that would help. Then, rather than suggesting that positive things have hap-
pened, we ask them how they have coped with such a difficult predicament.
This gives them a chance to tell us about strengths without us having
to disqualify their view of the situation as being without positive aspects
right now.
If we run out of time hearing each person’s story and do not have time
to ask participants to report on presession change, we end the session with an
assignment to pay attention to positive aspects of their relationship and to

HONORING THE PROBLEM 47

 early signs of change, and their part in the changes, then we let them know
that we will begin the next session with this report.

SINGLE-COUPLE TREATMENT

Single-couple treatment proceeds in a similar way to the multicouple

group. The cotherapists meet with the couple and explain the program and
its format (as described earlier). The clients are asked about themselves,
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such as, “How long have you lived in the area?” “I noticed on the intake
that you have three children. Why don’t you tell me about them?” “What
kind of work do you do?” We encourage therapists to be friendly and wel-
coming but to block any discussion of problems in the couple’s relationship
until the separate-gender sessions.
After the cotherapists have met with the couple together, the rest of the
session is conducted individually with one therapist and one client. As in the
multicouple group, the therapist compliments each person on his or her will-
ingness to participate in couple’s treatment. At this time, the therapist seeks
to understand the struggles the clients face and what led them to come to
therapy at this time. Finally, as in the multicouple treatment, the therapist
asks about presession change, or if there is not enough time, asks the clients
to pay attention to positive aspects of their relationship and to early signs of
change, and their part in any changes. The clients are asked to be prepared
to talk about these changes the next week.
See Exhibit 4.1 for a checklist summarizing key elements of Session 1.

EXHIBIT 4.1
Checklist of Key Elements in Domestic
Violence–Focused Couples Therapy Session 1
1. Meet with all clients and cotherapists in the same room.
䡲 Welcome participants and introduce cotherapists and clients.
䡲 Provide an overview of the treatment program.
䡲 Develop group rules (multicouple group only).
2. Separate-gender treatment:
䡲 Compliment client(s) for being willing to come to counseling.
䡲 Listen to clients’ stories.
䡲 Support clients’ resiliencies and abilities to cope with difficult situations.
䡲 Ask about presession change.
3. Homework:
䡲 Ask each individual to pay attention to positive aspects of his or her relationship,
to early signs of change, and to his or her role in the change.
䡲 Let clients know that the separate-gender meeting will begin next week with a
discussion of what participants have noticed.

48 COUPLES THERAPY FOR DOMESTIC VIOLENCE

 TROUBLESHOOTING SESSION 1

As we continue to practice and refine our treatment program, we find

that certain obstacles crop up as part of the normal course of interactions.
Here we summarize some of the most common obstacles and offer some tips
for how to work through them.
First, we have found that people minimize violence. Although this pro-
gram works to amplify strengths and avoid shaming clients, it is important for
each partner to recognize verbal and physical abuse and to know that they do
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not have to live with violence in their lives. When clients talk about receiv-
ing physically or psychologically abusive behavior from their partner but min-
imize it, it is often helpful for the therapist to label the behavior as violent or
abusive. If the client’s life was endangered, this should be pointed out. If an
abusive partner minimizes the abuse, it is often helpful to make a comment
such as, “Because I know how much you care about __________, it must have
been very frightening to you to realize how much you hurt him or her” or
“how you could have really hurt him or her.” Helping clients recognize the
violence occurring in their lives is a first step toward helping them end it. This
work is often most effective when done in separate-gender treatment so that
the partner does not feel shamed in front of the other partner.
Second, people often express a need to address pain and anger before
they can deal with solutions. Some couples we work with have expressed con-
cern when the therapist seems to be pushing too hard for signs of progress and
strengths. Clients have reported that it is important that their partner recog-
nizes the pain he or she has caused and takes ownership for it before they feel
safe examining solutions and strengths. We believe that it is always impor-
tant to listen to clients and to meet them where they are. Going at clients’
pace and listening to them is an important aspect of the model.
Finally, clients may find it hard to accept responsibility for their own
actions. It is important that clients have a chance to describe their diffi-
culties in the first session, but it is also important the session not become
simply a condemnation of their partners. Many of our clients feel aggrieved
by their partner’s actions and seem to have little overt ability to see their
part in what has been going wrong. This creates a creative tension for ther-
apists, who must both hear the struggle and gently direct the clients toward
attending to what they have control over—namely, themselves and their
own actions. We find it helpful to empathize and then to redirect the topic
to what the client might do differently in the future. Without empathiz-
ing, we find that we simply encounter renewed attempts to let us know how
difficult things are.

HONORING THE PROBLEM 49