Their case manager referred Joe and Beth to me for marital therapy. The case manager reports Joe (veteran) has been diagnosed with PTSD. Beth has a childhood trauma history and has been diagnosed with Bipolar disorder. The case manager reports they are a high conflict couple, neither is currently taking medication or participating in individual therapy. Joe a 28 years old Army Veteran has been married to Beth, who is 30 years old, for 7 years. They have a 5 y.o. son and 18 month old daughter. During their marriage Joe was deployed to a combat zone twice, once to Iraq and once to Afghanistan. Joe was a combat infantryman involved in multiple firefights and exposed to multiple Improvised Explosive Device (IED) blasts. As a result of physical injuries and PTSD Joe was discharged from active duty two years ago. Joe has had two extra-marital affairs. Joe and Beth report they participated in marital therapy after the first affair, but not after the 2nd one. Both initially report the affairs are no longer a problem. “We have gotten past that..”
Beth reveals, through tears and yelling, she was 8 months pregnant with their daughter when Joe came home and told her he was leaving her for another woman. Beth reports “I told him how much I loved him and begged him not to leave me.” This is what Sue Johnson (2008) refers to as primal panic. Beth reports they decided to get pregnant after completing marital counseling following the first affair and feels stupid for believing their marriage was in a good place and choosing to get pregnant. She reports “I thought we were fine. I had no idea Joe was having an affair.” She reports, as a result of her previous naiveté, she is unsure how she will know if or when Joe can be trusted. Beth vacillates between extreme anger, rage (about the betrayal of trust) and fear of Joe leaving. Joe reports Beth “needs to know where I am constantly. If I’m not in her presence, she wants to know where I am and what I’m doing.”
Joe was discharged from the Army (medical retirement) about two years ago, due to physical and mental health (Post Traumatic Stress Disorder) issues. Joe and Beth report the first affair occurred shortly after Joe returned from his first deployment. The second affair occurred as Joe was being discharged from the Army.
Identify Negative Cycle
The following demand-withdraw pattern was enacted during session three: Beth is angry and frustrated. She often yells and screams at Joe during session. “You act like you never want to be with us. I have to beg you to spend time with me…with us.” When Beth yells and screams Joe goes silent. He stops responding, crosses his arms, and turns slightly away from Beth. Joe gets angry, at least his version of angry, and states “If I’m not right by her side, if she can’t see me, she freaks out and wants to know where I am, who I’m with and what I’m doing.” He reports being frustrated by Beth’s lack of trust. He states “I’ve done...