Couples Therapy Plan |

James Fitzgerald Therapy, PLLC

James Fitzgerald, MS, NCC, AAP, Psychotherapist

A Detailed Overview of the Therapy Process for Couples

Please read this important disclaimer first

This area of the website is for James Fitzgerald’s therapy clients only. You must be registered, with a subscription, and logged into your account to view this page. If you have reached this website in error, please notify the website owner, and choose another page to exit.

This page (therapy action plan) on the website (jamesfitzgeraldtherapy.com) is a dynamic and ever evolving online document. Some of the links to websites, videos, audio, and documents may not work or the page it links to may not be set up yet. You are welcome though to start using this page for a reference and guide to therapy sessions. Stay in constant communication with your therapist as you work through this plan. I encourage you to take your time and be patient with yourself. I humbly ask for your patience with the process of setting up this invaluable resource. This plan is directed toward my individual clients. In the near future (December of 2022) I will also have a similar plan for couples. Please keep checking on the progress. In the time between, please review the plan listed here, as some information is relevant to couples therapy, it is all connected.

There is no charge for the information on this website, and the information or website is not dependent on the money received from therapy sessions. There does not seem to be any conflict of interest. Many of the resources linked to from this site are subject to copyright laws and permission has been granted for use with my clients only. James Fitzgerald is not responsible for the content on the content creator’s website or media channels, and makes no claims as to their authenticity, veracity, integrity, validity, accuracy, and/or reliability of any claims they make in their content. I have provided links to the content in order to offer many different options for characterization of the concepts and topics. Every content creator has their own personality, demeanor, presence, and knowledge.

The material and content on this page is educational and informational only, to be used as a reference point, and not intended to be construed as your specific treatment plan. I will develop and implement a treatment plan for you, which is required by insurance and outlined in ethical standards of practice. We will review this outline together, and I will provide guidance and direction for you, on how to navigate through this process. This action plan outlines and details many but not all of the techniques, interventions, and approaches that might be in your treatment plan. An electronic copy of your treatment plan is stored in the electronic health records software’s servers, and is available upon written request.

Why do I recommend following a therapy action plan and assign “homework” in between sessions?

More and more therapists are assigning homework to their clients. Not only have short‐term therapy models endorsed this practice, but the benefits are being recognized by many traditional therapists as well.

Why homework? Assigning homework is beneficial for several reasons. With the evolution of health insurance company’s plans and practices, therapists assign between‐session homework to help maximize the effectiveness of treatment. Homework is an extension of the treatment process, provides continuity, and allows you to work between sessions on issues that are the focus of therapy. Homework is also a tool for more fully engaging you in the process of change. Assignments place more responsibility with you to resolve presenting problems, counteracting the expectations that some may experience— that it is the therapist alone who can cure the client. For some, an action plan with homework can even bring a sense of self‐empowerment.

Another added benefit of homework is that these assignments give you the opportunity to implement and evaluate insights or coping behaviors that have been discussed in therapy sessions. Practice often heightens awareness of various issues. Furthermore, homework increases the expectation for you to follow through with making changes rather than just talking about change.

Homework requires participation, which creates a sense that you are taking active steps toward change. Homework allows you to try new behaviors, bringing these experiences back to the next session for processing. Tracking your progress with assessments, diary cards, and journals makes the process tangible and objective. Modifications can then be made to your thoughts, feelings, or behaviors as the homework is processed in the therapy session. Occasionally treatment processes can become vague and abstract. By adding focus and structure, homework assignments can reenergize therapy.

Moreover, homework can improve discipline and increase your motivation to change as it provides something specific to work on. Additionally, homework may increase the involvement of your family members and significant others in your process by using assignments that call for their participation. It promotes more efficient care by encouraging you to actively develop insights, positive self‐talk, and coping skills between therapy sessions.

Consequently, many clients express increased satisfaction with the therapy process when homework is given. They are empowered by doing something active that facilitates the change process, and it reinforces their sense of control over the problem. All of these advantages have made the assignment of therapeutic homework increasingly prevalent.

Jongsma, Arthur E.; Bruce, Timothy J.. Adult Psychotherapy Homework Planner (Practice Planners) Wiley. Kindle Edition.

Table of Contents

A short summary outline of this plan and the natural progression of therapy

Intake and screening process completed, documents are signed and reviewed.
Education and brief overviews are provided for the types of therapy (individual and couples)
Issues commonly addressed by therapy, counseling, and coaching (individual and couples)
SMART long-term goals for therapy, short-term objectives, and interventions planning
Orientation to therapy and what to expect, frequently asked questions reviewed
Beginning assessments toward a diagnosis for insurance purposes and ethical practice guidelines
Review of the learning objectives for the modules
Therapy sessions progress on a regular basis
Interventions (Guided Meditations)
The Couples Therapy Treatment Planner by Jongsma is integrated into this plan.

Psychoeducation homework will be assigned in sessions; most of the materials and content will be on this website
Homework assignments and daily practice; these will be essential
Review of barriers and blocks to completing homework, reassess therapy plan if needed
Therapeutic interventions processed with therapist
Lessons/Exercises and Handout/Worksheet pdfs will be located on the client engagement website
Assess for further interest in adjunct services for guidance on developing a health and wellness plan.
Participate in sessions informed by the primary therapy approaches in the individual therapy plan.
Adhere to the Gottman “Sound Relationship House” and “Love Maps” Method
Review of “The Four Agreements: A Practical Guide to Personal Freedom” by Don Miguel Ruiz
Review of “How to be an Adult in Relationships”
Review of “The Seven Principles for Making Marriage Work” by John Gottman
Review of “Internal Family Systems Therapy with Couples” Toni Herbine-Blank & Martha Sweezy
Review of “DBT Skills Training Manual Interpersonal Relationships Module” Marsha Linehan
Review of other relationship self-help and/or self-improvement podcasts, seminars, books and workbooks as needed.
- Brene Brown “Atlas of the Heart”
- John Howard “More than Words”
- Melanie Beatty “Language of Letting Go”
- Harriet Lerner “The Dance of Anger” & “The Dance of Intimacy”
- Gary Chapman “The Five Love Languages”
- Sue Johnson “Hold me Tight”
- Deb Dana “Anchored”
- Bell Hooks “All about Love”
- Marshall Rosenberg “Non-Violent Communication”
- Amir Levine & Rachel Heller “Attached”
Continuing assessment of goals, the approach to therapy, and the program evaluation
Relapse prevention planning and implementation

There is some overlap of the objectives, interventions, skills, techniques, and knowledge from the approaches listed. Other approaches have an influence on the work but are not described here

1. Intake and Screening

You should have received an encrypted email (HIPAA compliant for privacy) with the intake forms to sign electronically for the official electronic medical records. The following forms will serve as a reference only. If you have any questions, comments, or concerns, please contact me. Thank you. In May, 2023, these forms will all change and you will be asked to complete the new forms.

Vermont Professional Public Disclosure Statement

Therapy Agreement and Informed Consent to Treatment

Information About and Consent for Telehealth Service

Information About and Consent for Electronic Communication

HIPAA Notice of Privacy Practices

2. Types of Therapy

The therapy action plan is informed by and will integrate the following therapeutic approaches, science, and best practices.

This page may include approaches intended for individual therapy. The following links will lead you to brief descriptions and landing pages for that module/section. Some of the links are to free resources:

3. Relationship Issues Addressed in Therapy

RELATIONSHIP ISSUES ADDRESSED

This link leads to a page with a thorough list of common issues people experience that motivate them to seek out therapy. This list may include problems experienced by both individuals and couples.

Short Term Goals in Therapy Sessions

Provide a confidential dialogue, which normalizes feelings.

Enable each person to be heard and to hear themselves.

Establish boundaries so each person feels safe and empowered to express their point of view in a way the other can hear and understand, even though they may not agree.
Teach active listening, using I statements “a part of me feels…” “when….” “because another part needs…” and objective terms from the beginning

Reflect the relationship’s difficulties and the potential for change

Inform couples that it is not a matter of one person being right or wrong, since both partners make sense from their perspective. They will be learning how to better understand each other and improve communication to restore harmony and intimacy
Identify times in the past that have been good and what was different.

Help each partner begin to understand how he or she is contributing to the conflicts and can contribute to solutions.

Move from the “blame game” to looking at what happens to them as a process.
Look for exceptions
Help both partners see the relationship in a more objective manner
Identify repetitive, negative interaction cycles as a pattern
- Sex/Intimacy
- Resentments > Explosions
Change the view of the relationship via functional perspective taking
- How is this behavior helpful to him/her/you?
Understand the source of reactive emotions that drive the pattern
- How does this situation trigger past hurts?
- How does this situation trigger feelings of failure, rejection, loss of control or isolation?
Empower the partners to take control and make vital decisions
- What are workable solutions to this problem?
Facilitate a shift in partners’ interaction
- Which solution will you choose?
- What is each person’s responsibility?

Create new and positively bonding emotional events and establish intimacy

Meet the couple where they are— What can they currently comfortably do?
What do they hope they will eventually be able to do?
Teach the 5 love languages (touch, gifts, words, acts, quality time)
- Have each partner make a list of what those things are for them

Long Term Goals of Therapy

1. Verbalize a basic understanding of the following approaches to therapy and the underlying science

Gottman Method and the Seven Principles
Non-Violent Communication
Neuroscience of Human Connection
Internal Family Systems
Dialectical Behavior Therapy
Cognitive Behavior Therapy
Attachment Theory
Somatic Approaches
Sensorimotor Approaches
Polyvagal Theory
Restorative Yoga
Mindfulness Based Cognitive Therapy
Mindfulness Based Stress Reduction
Interpersonal Psychotherapy

2. Reduce symptoms (frequency, duration, severity) of the following:

Adjustment (Life Changes)
Anger (Resentments and Contempt)
Anxiety (Fear and Worry)
Attention Deficit (Inattention and Poor Concentration)
Autism Spectrum (Awkwardness, Introversion, Isolation)
Bipolar 1 & 2 (Depression, Hypomania, Mania, Psychosis)
Chronic Pain (Autoimmune, Diabetes, Fibromyalgia)
Depression (Anhedonia, Suicidality)
Eating Problems
Self Harm
Personality
PTSD
Grief/Loss
Shame/Guilt
Substance Abuse

This is not a complete list of the problems, just the most common I see.

3. Prevent relapse of behaviors and/or symptoms

4. Achieve and maintain a baseline level of satisfaction, functioning, and daily activities of living

5. Increase satisfaction in primary relationship, and improve communication and non-violent conflict resolution skills.

6. Learn mindfulness practices, emotional regulation skills, anger management techniques, and grounding and coping skills that result in a reduction of symptom frequency, severity, and duration.

7. Develop and maintain self awareness, insight, and wisdom as measured by self-report

8. Develop and maintain a structured daily routine of self-care, relapse prevention, and health and wellness

9. Address individual needs for the couple as they arise (Refer to the Wiley Treatment Planner Series)

The treatment plan, therapy outline, goals, objectives, and interventions are subject to change as your therapist develops new skills, attains new certifications, and integrates new material into this website. You may or may not be given notice of any changes in advance of updates to this page.

5. Orientation to Therapy

We will review the intake documentation, public disclosure statement, informed consent to treatment, limits of confidentiality, privacy policy, consent to telehealth, consent to electronic communication, and treatment plan.
We will review the optional health and wellness program, ‘strengthening your conscious self’ to determine the appropriateness and level of commitment to participate in the adjunct program.
We will establish rapport toward building trust and a therapeutic alliance, in a safe and supportive, validating environment. We will strive to achieve attunement, and conscious presence of the moment.
You will be invited to describe in as much detail as you are comfortable with; the nature and history of the symptoms of the presenting problem, including sensations, emotions, thoughts, and behaviors that are unwanted, maladaptive, unhelpful, or harmful.
You will be asked to verbalize any symptoms of depression, anxiety, anger, dissociation, hallucinations, recent episodes of hypomania or mania, history of psychosis, self harming thoughts, suicidal thoughts, and homicidal thoughts.
Your therapist may, if appropriate to circumstances, assess the depth of depression and any suicide potential.
Your therapist will address such concerns appropriately, taking the necessary safety precautions as indicated, including referrals to higher levels of care (i.e. hospitalization, inpatient setting, residential programs, rehabilitation and treatment facilities, etc.)

6. Assessments

Please do not complete any assessment listed on this page unless I have asked you to complete an assessment. Many of them have been adapted directly from the official testing/assessment instrument. They may require assistance in scoring and interpreting results. Thank you for your cooperation.

We will determine behavioral, emotional, and attitudinal information toward an assessment of specifiers relevant to a DSM diagnosis, the efficacy of treatment, and the nature of the therapy relationship.
Your therapist will help you identifying your current stage of change. We will assess your level of insight (syntonic versus dystonic) toward the “presenting problems”
- Do you demonstrate good insight into the problematic nature of the “described behavior,” agrees with others’ concern, and are you motivated to work on change?
- Do you demonstrate ambivalence regarding the “problem described” and are you reluctant to address the issue as a concern?
- Do you demonstrate resistance regarding acknowledgment of the “problem described,” you are not concerned, and you have no motivation to change?
We will determine if you meet the criteria for co-occurring mental health disorders using the necessary evidence-based assessments (oppositional defiant behavior with ADHD, depression secondary to an anxiety disorder) including vulnerability to suicide, if appropriate (increased suicide risk when comorbid depression is evident).
We will determine if there are any issues of age, gender, or culture that could help explain the currently defined “problem behavior” and factors that could offer a better understanding of the behavior.
We will assess the severity of the level of impairment to functioning to determine appropriate level of care (if the behavior noted creates mild, moderate, severe, or very severe impairment in social, relational, educational, or occupational endeavors)
We will continuously assess this severity of impairment as well as the efficacy of treatment (no longer experiencing severe impairment but the presenting problem now is causing mild or moderate impairment).

Client Intake Satisfaction with Life Domains Survey

The online version is available, a PDF version of the assessment will be available for download soon

Client Intake Questionnaire/Biopsychosocial History

The online version is available, a PDF version of the assessment will be available for download soon

Client Intake: Patient Health Questionnaire (PHQ 9)

The online version is available, a PDF version of the assessment will be available for download soon

Intake: Client Readiness to Change Questionnaire (RCQ)