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Object Relations Couple Therapy, Case Study Example

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Rachel Green, age 30, her boyfriend, Ross Gellar, age 33 decided to visit the office to resolve their relationship problems. The two had dated on and off for several years and after a one night amorous relationship, Rachel had become pregnant. Although the two decided to keep the child, they are worried that their previous conflicts will draw them apart, which would be detrimental to the child. Ross had admitted to Rachel that he had been with another woman a day after the two went on a break, which contributed to Rachel’s want to end the relationship even though they still had feelings for one another. During this period of time, Ross recognized that he was jealous of Rachel’s ex-boyfriends and wanted to continue the relationship. Both partners have noteworthy dating histories. Rachel had been engaged, but broke off the wedding when she learned that her fiancé had been cheating on her with her best friend. Ross has been married thrice before, once to Rachel, and already has a child with his first wife, who left him for another woman. Both partners come from affluent families and Ross’ family follows the Jewish faith, while Rachel’s family is unreligious. The couple currently does not live in the same household and they are planning on moving in together in the months prior to the birth of their child. Since both partners have had relationship difficulty in the past, they are not planning on getting married. They feel that even if they break up again, they will continue living together and care for the child despite other relationships that may occur. The couple has a good support network, and live within close proximity to Ross’ sister, Monica, in addition to her husband Chandler, and their friends Phoebe and Joey.

Therapy Model Selection

Object relations therapy will be used to diagnose Rachel and Ross’ relationship. Previous sessions have revealed that the two felt a lot of pressure from their parents while growing up, which may contribute to their behaviors as adults. Once the clients are able to identify how their past experiences influence their current behaviors and emotions, they will be able to modify these behaviors in a manner that benefits their personal and romantic relationship (Scharff et al., 1997). This session will focus on determining how their past experiences dictate their current behaviors and how they can break free from this pattern.

A major ethical issue that may arise during the course of therapy would be the determination of whether or not Rachel should abort the child. Since Rachel does not belong to any religious affiliation and Ross and his family are of the Jewish faith, it is likely that there would be disagreements about this decision if it were to arise. As a therapist, it is essential to remain neutral on the topic and to determine how both Rachel and Ross would feel if this were to occur. Furthermore, it is important to make them understand that their feelings about this decision stem from their treatment as children. By drawing the connection between their current behaviors and actions with their past experiences, Ross and Rachel will be able to find a reasonable resolution to this issue on their own, with the function of the therapist serving primarily as a prompter for conversation.

Transcription

Transcription of Therapist’s Half of the Interview	Identify Microskill	Question/Skill Rationale
Hello Rachel, hello Ross. Begin by describing what is currently on your mind.	Probing	It is important for the therapist to greet the clients and to prompt the beginning of the conversation.
I understand your worry. How does Rachel’s pregnancy impact your relationship?	Packaging	After listening to the couples’ concerns, it is helpful to determine how they feel about their situation.
Stress is a normal part of your situation. How does this impact your ability to communicate?	Packaging	The clients should be made to feel that they are understood so the therapist can establish a connection with them.
So when was the last time that you two fought about this?	Probing	The conversation slowed down, so an additional probe was needed.
I see, so you two are still concerned about Ross’ short relationship with the woman at the Xerox store.	Reflecting feelings	Feelings were reflected in order to allow the conversation to continue organically.
So this upsets you, Rachel?	Probing	Rachel did not respond, so she was addressed.
How have you two dealt with this conflict in the past?	Probing	Ross did not respond either, so they were addressed to ask this painful topic.
Did this resolve the issue?	Probing	Although their reactions to this problem were discussed, it was important to determine the impact that it currently has on their relationship.
Ah, so this reminds you of conflicts you’ve had with your sister, Monica. What were those arguments like?	Packaging	This question was asked to determine the link between Ross’ childhood and his current behavior.
It seems that you are currently engaging in a similar behavior with Rachel as you did you sister as a child. How did your parents react towards these arguments?	Packaging	This question was asked to determine the link between Rachel’s childhood and her current behavior.
I can see why you react this way. Because you needed to always be right as a child due to parental expectations, you continue this in your current relationships. Is this right?	Packaging	This question was intended to address how Rachel deals with her adult relationships, in an attempt to allow her to see a connection between past and current experiences.
I see. Rachel, do you have any siblings?	Packaging	The aforementioned concern was not addressed, so probing was continued.
How did you three typically interact with one another?	Probing	The aforementioned concern was not addressed, so probing was continued.
It is difficult to make your voice heard in a family of three. Were you the first to leave the house?	Packaging	The aforementioned concern was only partially addressed, so probing was continued.
It appears that you have a need to make your opinions clear. Is this the same case in your relationship with Ross?	Packaging	The concern was addressed, so an attempt was made to determine the link between childhood experience and adult behavior for Ross.
So it seems that both of your personalities in these situations derive from your personalities as children.	Reflecting feelings	Feelings were reflected to encourage Ross and Rachel to continue talking.
Tell me about an additional conflict you’ve had.	Probing	Probing was used to continue the same discussion.
So it appears that the past relationships you’ve had with others have bothered one another quite a bit.	Reflecting feelings	Feelings were reflected to keep the discussion going.
It seems that you two have been interested in one another for quite some time.	Reflecting feelings	Feelings were reflected to keep the discussion going.
And what bothers you about Rachel’s past relationship with Joey?	Probing	Since another sensitive topic in their relationship was reached, probing was required to encourage speaking.
So he wanted to marry Rachel after learning that she was pregnant.	Reflecting feelings	Feelings were reflected because Ross seemed bothered by this experience and it would be beneficial to continue this conversation in this direction.
Since you all three of you are still friends. How does this make you feel? Tell me more about the obligation that Joey felt to propose to Rachel.	Packaging	Packaging was used to keep the conversation going.
It seems that this proposal encourage you two to work things out.	Reflecting feelings	Reflecting feelings was used to encourage Rachel and Ross to continue talking.
It seems that you two are committed to one another but are afraid of what will come in the future.	Interpreting	Interpreting was used to determine how Rachel and Ross really feel about their situation.
Does your family have any opinions regarding your decision to stay unmarried?	Probing	Probing was used to determine how Rachel and Ross’ parents and therefore childhoods influence their decision making.
How do you each feel about their reactions?	Probing	Probing was used to continue this discussion.
Ross, I understand that your mother is encouraging you to marry Rachel due to the pregnancy. How does this make you feel?	Packaging	Packaging was used to determine how childhood tendencies are reflected in this current situation.
I think it is important for you both to do what makes you happy.	Information giving	Information giving was used to make Ross and Rachel understand that they can break free from their old patterns.
Has your mother influenced your choices in the past?	Probing	Probing was used to determine whether Ross typically follows his mother’s advice.
How long did you date Carol before you two were married?	Probing	Probing was used to determine to what extent Ross follows his mother’s advice.
So she was your first girlfriend?	Probing	Probing was used to determine more information about Ross’ first wife.
It appears that you rush into your decisions. It is better to think things through thoroughly.	Interpreting	Interpreting was used to link Ross’ past tendencies with his current actions.
It is clear that your mother’s opinions have a heavy impact on your actions.	Interpreting	Interpreting was used to link Ross’ current actions with the thoughts and opinions of his mother.
So your dad voices strong opinions as well?	Probing	Probing was used to determine whether Ross’ father exerts influence on his actions as well.
You almost took Rachel to her high school prom because of your dad’s opinions?	Probing	Probing was used to learn more about a situation in which Ross’ father exerted influence on his actions.
So you were attracted to her even then?	Probing	Probing was used to determine the link between Ross’ tendencies to follow his father’s advice using a balance with his own opinions.
I see, so you two have known each other for quite some time. Rachel, how did you feel towards Ross as a child?	Packaging	Packaging was used to determine Rachel’s feelings about Ross’ influenced actions.
It appears that your failure to notice Ross as a child has motivated his current want to maintain a relationship with you in the present.	Interpreting	Interpreting was used to determine how Ross and Rachel’s past interactions dictated the problems that exist in their current relationship.
When was the last time you saw Ross before moving to New York City?	Probing	Probing was used to uncover more information about Ross and Rachel’s childhood together.
So Barry asked you to marry him a few years later?	Probing	Probing was used to determine more information about Rachel’s previous serious relationship.
How was your relationship with Barry prior to the wedding?	Probing	Since this is a sensitive topic, additional probing was needed to uncover information about the relationship.
So it seems you promised to marry him due to his family’s relationship with yours?	Probing	Probing was used to determine the relationship between Rachel’s decisions and the influence of her parents.
You seem to be happier after deciding to leave him.	Interpreting	Interpreting was used to confirm that Rachel feels that she made the correct decision in calling off marriage.
Have you spoken with him since?	Probing	Probing was used to confirm Rachel’s decision.
It appears that his behaviors have not changed. How do you feel about this?	Packaging	Packaging was used to determine how Rachel feels about her decision in the context of her relationship with Ross today.
It is healthy that you were able to cope with this so quickly. Do your parents feel the same?	Packaging	Packaging was used to determine whether Rachel’s parents agree with her sentiments.
It appears that your parents made a lot of decisions for you as a child.	Reflecting feelings	Reflecting feelings was used to confirm whether Rachel’s parents led her actions as a child.
I see, that’s why you left Long Island.	Reflecting feelings	Feelings were reflected to encourage Rachel to continue discussing her childhood.
It seems like it is a big deal to leave your family like that. Did finding a job in New York City worry you?	Packaging	Packaging was used to allow Rachel to determine the relationship between her past and current experiences.
It’s excellent that you have such as good support system here.	Attending	Attending was used to demonstrate that Rachel’s certainty about her decisions is positive.
It seems that since many of your decisions were made for you while you lived with your parents, it’s difficult for you to be sure that you’re making the right choices now.	Interpreting	Interpreting was used to confirm Rachel’s current state of mind.
It’s impossible to know with certainty which decision is right, but it is important to think about all the options and determine which seems best.	Information giving	Information giving was used to encourage Ross and Rachel that problems are a natural part of life.
So you’re currently happy in your relationship with Ross?	Probing	Probing was used to determine the positive aspects of Ross and Rachel’s current relationship and why they are together despite their problems.
Ross, how do you feel?	Probing	Probing was used to determine how Ross feels about the relationship as well.

Reflection

Ultimately, object relations therapy appeared to be a useful approach to treat Ross and Rachel because it appeared that their relationship issues were rooted in their relationships with their parents. It was important to make the couple to understand the reasons behind their previous decisions that made them unhappy. Both Ross and Rachel rely too much on the demands of their parents. Rachel almost married a man that she did not love because he was wealthy and her family liked him. On the other hand, Ross felt pressured to marry his first wife Carol quickly after his first sexual encounter with her because his parents felt that it was not proper to engage in a sexual relationship prior to marriage.

Using this model was difficult in this situation because it was difficult to make Ross and Rachel recognize how their past experiences are related to their current actions and behaviors. As a consequence, it was challenging at first to convince them to discuss their childhood relationships with each other in addition to with their parents. However, after a series of prompting, they took strides towards recognizing how all of these events were connected. Despite this initial difficulty, the model was effective overall because it allowed Ross and Rachel recognize the reasons they were making bad decisions, which contributed to their unhappiness. They had a hard time making their own decisions for the first time and failing, which scared them. However, this exercise in addition to future therapy sessions will allow them to realize that it is necessary to make their own choices because this is what will make them happiest, even if the future seems uncertain.

The microskills that I incorporated into the therapy session were effective, primarily because there were points in time that the couple was slow in continuing the discussion. Therefore, it was useful to use probing to direct their thoughts. Furthermore, when discussions were slowing down but it appeared that the couple still had more to say, reflecting feelings and interpreting were useful methods to keep the conversation going. Since the couple needed a lot of encouragement to talk, it was difficult to incorporate a broad range of microskills into the therapy session (Neber et al., 1992). However, it is expected that as the couple becomes more familiar with me as a therapist, there is potential for expanding this in the future.

Fortunately, no ethical issues were present in the therapy session. Before beginning the session, I was worried that the couple would be considering aborting their child to resolve their relationship issues. While this is a potential solution to the problem, it is essential for the therapist to remain completely impartial. However, it is difficult to accomplish this with this type of issue. If this situation would have occurred, it would be essential to continue probing the couple and impartially repeating their feelings in order to prompt conversation, but to avoid providing input. Through this process, the couple may be able to work out their debate. If I was asked about this question directly, I would ask how each client would feel if they were to abort the child and how this would impact their relationship. Ultimately, they would be able to guide one another and come to a decision.

References

Neber, J.O., Gordon, K.C., Meyer, B., and Stevens, N. (1992). A five-step “Microskills” Model of Clinical Teaching. Journal of the American Board of Family Practice, 5:419-424.

Scharff JS, Scharff DE. (1997). Object relations couple therapy. Am J Psychother., 51(2):141-73.