Thinking under fire: Mentalization-based couple therapy for high conflict and domestically abusive couples'

The question of working psychotherapeutically with high conflict and domestically abusive couples is one that continues to raise anxieties within the field.

Embracing a relational approach offers an alternative perspective to the more familiar individual-based treatment interventions.

Drawing on my therapy with a married couple who presented in a crisis following an abusive incident, I will outline how I approached the assessment, my understanding of their presenting problem and the basis on which the therapy was conducted.

During the eight months of treatment, the couple had frequent breakdowns in communication, and I found myself drawing on a range of mentalization-based techniques that supported and maintained the working alliance.

Helping the couple break the damaging effects of the abuse, which was seriously affecting them and impacting their children, provides a particular focus for this submission.

The rationale for undertaking couple therapy in situations of domestic violence and abuse was examined. The dynamic elements of theory underpinning practice, together with mentalization-based techniques designed to tackle disregulated states of mind that may lead to violent and abusive exchanges, were considered through the presentation of a case example.