Karen J. Prager - The Dilemmas of Intimacy: Conceptualization, Assessment, and Treatment

The Dilemmas of Intimacy applies evidence-based, cognitive-behavioral interventions 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 dilemma is included and addresses the commonly presented problems, couple interaction patterns, and behavioral deficits, as well as many more factors that affect relationships. Strategies for building the therapeutic alliance; interventions with couple behavior, affect, and thinking patterns; and therapist-client dialogues help clinicians with the day-to-day issues that occur in their work.

Unique 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.

Visit the publisher's website at www.routledge.com/9780415816861 for access to additional clinical material, such as the Intimacy Signature basic intake, worksheet packets for each intimacy dilemma, initial formulation worksheets, 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 diplomate 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.

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 identified 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.

All 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.

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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
158.2dc23 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
by Apex CoVantage, LLC

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 finishing touches on the final 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 couple relationship.

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 dilemmasjoy versus protection from hurt, I versus we, and the past lives in the presentcan 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 confront. 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 fulfill their own needs. Still others break up one relationship after another to seek the partner who will fulfill all of their dreams.

My first 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 conceptualize 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 defined 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 difficult 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 benefits of intimate relating in couple relationships using behavioral definitions of intimacy (e.g., Cordova, Gee, & Warren, 2005; Laurenceau, Barrett, & Rovine, 2005; Prager & Buhrmester, 1998; Reis & Shaver, 1988). This book uses a behavioral definition of intimacy to create a treatment framework that is useful for clinicians.

Although my therapeutic home is in the cognitive-behavioral approach, treating intimacy problems has required that I broaden my perspective. As a cognitive-behavioral practitioner would predict, intimacy problems do arise from ineffective attempts to manage intimacy-distance cycles in a relationship, and from nave or problematic assumptions about self and intimate relationships. However, they also stem from schemas that represent insecure attachment relationships earlier in life, and from a lack of self-awareness that compromises one's ability to communicate about feelings, wants, and desires. This book is an effort to integrate these components into a single approach that is not too complicated to be useful for clinicians and not too simple to account for the many variations in intimacy problems.

My purpose is not to supplant existing systems of cognitive-behavioral couple therapy. Rather, this book is part of a growing trend in couple therapy to target specific couple problems, an approach that Snyder (November, 2009) argues should hold an increasingly prominent position in the couple therapy literature. This application of evidence-based couple therapy to intimacy problems takes its place alongside other specifically-targeted therapies for couples, including Spring's (1996) and Snyder, Baucom, and Gordon's (2007) approaches for helping couples recover from extramarital affairs, Wakefield, Williams, Yost, and Patterson's (1996) system for treating alcohol abuse within the context of couple relationships, treatments for sexual dysfunction such as that devised by McCarthy and McCarthy (2003), and treatment for violent couples by Stith, McCollum, and Rosen (2011). Just as comprehensive approaches to treating individual problems have evolved into sets of specific treatments for identified individual disorders, so too are couple therapies now evolving into more specifically targeted treatments for particular sets of couple problems.