The Dilemmas of Intimacy: Conceptualization, Assessment, and Treatment

305 Pages·2013·4.349 MB·English

by  Karen J. Prager

THE DILEMMAS OF INTIMACY
The Dilemmas of Intimacyyapplies evidence-based, cognitive-behavioral inter-
ventions to therapeutic work with couples and individuals who have problems
with intimacy. Karen Prager introduces a three-dilemma model that outlines
the risks and rewards of intimate relating. A conceptual model for each di-
lemma is included and addresses the commonly presented problems, couple
interaction patterns, and behavioral defificits, as well as many more factors that
affect relationships. Strategies for building the therapeutic alliance; interven-
tions with couple behavior, affect, and thinking patterns; and therapist–client
dialogues help clinicians with the day-to-day issues that occur in their work.
U nique to this book is the author’s Intimacy Signature, an assessment tool
that incorporates general assessments of couple and individual functioning
with additional measures added for assessing intimacy problems. Through
use of the Intimacy Signature the behavioral, cognitive, and affective aspect
of each couple’s approach to handling intimacy and its dilemmas is laid out.
V isit the publisher’s website at www.routledge.com/9780415816861 for
access to additional clinical material, such as the Intimacy Signature basic in-
take, worksheet packets for each intimacy dilemma, initial formulation work-
sheets, therapist worksheets for in-session and at-home experiments, a couple’s
take-home packet, and individual partner and intimacy assessment interviews.
Karen J. Prager,PhD, ABPP, is a professor of psychology and program head
for Gender Studies at the University of Texas at Dallas. She is also a diplo-
mate in couple and family psychology, specializes in the treatment of troubled
relationships, and offers supervision and continuing education for mental
health professionals on couple therapy.
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THE DILEMMAS
OF INTIMACY
Conceptualization, Assessment, and Treatment
Karen J. Prager
First published 2014
by Routledge
711 Third Avenue, New York, NY 10017
Simultaneously published in the UK
by Routledge
27 Church Road, Hove, East Sussex BN3 2FA
Routledge is an imprint of the Taylor & Francis Group,
an informa business
© 2014 Taylor & Francis
The right of Karen Prager to be identifified as author of this work has
been asserted by her in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
A ll rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other
means, now known or hereafter invented, including photocopying and
recording, or in any information storage or retrieval system, without
permission in writing from the publishers.
Trademark noticee : Product or corporate names may be trademarks
or registered trademarks, and are used only for identifification and
explanation without intent to infringe.
Library of Congress Cataloging in Publication Data
Prager, Karen Jean, 1952–
The dilemmas of intimacy : conceptualization, assessment, and
treatment / by Karen J. Prager.
pages cm
(pbk. : alk. paper) 1. Intimacy (Psychology) I. Title.
BF575.I5P727 2013
158.2—dc23 2013003716
ISBN: 978-0-415-81685-4 (hbk)
ISBN: 978-0-415-81686-1 (pbk)
ISBN: 978-0-203-37537-2 (ebk)
Typeset in Garamond
b y Apex CoVantage, LLC
CONTENTS
Acknowledgments vii
Introduction ix
1 Rewards, Risks, and Intimacy Dilemmas 1
2 The Assessment of Intimacy-Related Problems 14
3 Getting Started and Building the Therapeutic Alliance 39
4 Behavioral Interventions 57
5 Affective Interventions 77
6 Cognitive Interventions 98
7 Intimacy Dilemma #1: Joy versus Protection from Hurt 138
8 Intimacy Dilemma #2: How Much I versus How Much We? 173
9 The Urge to Merge, Dilemma #2, and the Challenges of
Differentiation 195
10 Dilemma #3: The Past Lives in the Present 240
11 Epilogue 275
References 277
Index 285
v
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ACKNOWLEDGMENTS
I am deeply grateful to Greg Eaves, who listened to me read the entire book
aloud over a period of weeks and offered many helpful comments. Monica
Basco made detailed comments on an earlier draft of the book for which I
am in her debt. I also appreciate very much working with Marta Moldavi and
Denise File at Apex who were very helpful with the fifi nishing touches on the
fifi nal version of this book.
This book would not have been possible without the dozens of couples
who shared their relationship troubles with me, and who have given me so
much insight into the challenges of maintaining intimacy in a long-term cou-
ple relationship.
vii
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INTRODUCTION
Couples’ problems with attaining and sustaining intimacy are some of the
thorniest that a therapist will tackle. In my work as a couple therapist and in
three decades of research on intimacy, I have noticed that couples’ intimacy
problems arise from one or more of three intimacy dilemmas. Each of these
three dilemmas—joy versus protection from hurt, I versus we, and the past
lives in the present—can be understood as an inevitable outgrowth of the
rewards and risks of intimate relating. In turn, couple partners’ responses to
these intimacy dilemmas are individual and relational coping styles designed
to increase rewards while minimizing the risks that intimate partners con-
front. Some couple partners withdraw and avoid intimacy whereas others
sabotage it. Some individuals minimize their own aims to get along with their
partners, whereas others attempt to mold their partners to fulfifill their own
needs. Still others break up one relationship after another to seek the partner
who will fulfifi ll all of their dreams.
My fifirst intention in writing this book is to share this three-dilemma
model with other therapists as a tool for organizing treatment for couples and
individuals that struggle with intimacy problems. The assessment tools and
interventions described in this book are designed to help clinicians concep-
tualize and treat couple and individual problems that emerge from partners’
efforts to cope with these three intimacy dilemmas.
A second purpose of this book is to show that evidence-based, cognitive-
behavioral interventions can be applied effectively to the treatment of couples
and individuals who have problems with intimacy once intimacy is defifined
in behavioral and cognitive terms. If in years past, intimacy did not receive as
much attention by cognitive-behavioral theorists as it deserves, it is perhaps
because it has been diffifi cult for psychologists to reach a consensus on exactly
what being intimate entails. However, studies conducted in the last couple of
decades or so have supported predictions about the benefifits of intimate relat-
ing in couple relationships using behavioral defifi nitions of intimacy (e.g., Cor-
dova, Gee, & Warren, 2005; Laurenceau, Barrett, & Rovine, 2005; Prager &
Buhrmester, 1998; Reis & Shaver, 1988). This book uses a behavioral defifini-
tion of intimacy to create a treatment framework that is useful for clinicians.
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