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Accommodation and Exposure Therapy for Couples Report (Assessment)


This paper looks at the possible methods of solving problems that couples go through in their marriages. It uses Robert and Sophia’s situation to contextualize issues that couples face and their possible solutions. In addition to the case study, the paper uses eight sources to back the arguments. The study shows that most problems that couples face are a result of OCD, and goes further to advocate the Accommodation Therapy and the Exposure Therapy as the best solutions to problems among couples.


The Family System proposes the division of the mind into three sub-categories. The founders of this theory called these parts, the managers, exiles, and firefighters. Each of these parts plays a role in the formation of the self. The most problematic part is the exile, which entails traumas, pains, and humiliations from an individuals’ childhood. The firefighters and managers prevent exile problems from disturbing an individual (Yahav, 2002).

In the case of Robert and Sophia, they both have burdens from their childhood. Robert is antisocial because of the alienation he underwent while growing up while Sophia experiences a trauma because her uncle raped her.

During my first interaction with the couple, I will ask them to talk about their past lives. I will create an environment that will make them talk freely. Talking about themselves will enable me to detect their tones and moods when they mention certain events about their past lives. These elements of their will expose their burdens. I will then talk to them and convince them to stop keeping their painful experiences within themselves. An intensive talk will serve to make their protectors release the exiles they hold and take up new and better responsibilities.

Using the DSM-5 diagnostic system

In handling Robert and Sophia’s case, I will apply the Relationship Distress with Spouse or Intimate Partner approach. The two have poor conflict resolution skills and exhibit dysfunction in behavior, cognitive, and emotional faculties. They frequently quarrel and even fight. In addition, Robert’s behavior has changed drastically. He has an extra-marital affair and does not talk openly to his wife. Sophia, on the other hand, experiences stress due to her husband’s infidelity. The DSM-5 proposes the use of the Relationship Distress with Spouse or Intimate Partner approach in dealing with such symptoms (APA, 2013).

Assessment, Diagnosis, and Treatment of a Couple or Family

Socio-cultural factors

Robert’s unsatisfied childhood needs are responsible for his status. The lack of brothers or sisters and his alienation caused him social problems. He grew up with the fear of socializing with other people. In addition, he experiences fear that is natural and common among most men. According to Harmon et al., men naturally fear failure, criticism, and medication (Harmon, Audra, & Ginsburg, 2006).

He is afraid of talking about his problems because of his socialization. His culture has different expectations for men and women. Men do not talk about their problems with their wives. Robert is afraid that his wife will consider him a failure, and his colleagues will criticize him. Living in different countries has exposed him to different cultures. His new culture requires him to discuss issues with his wife. This acculturation causes him confusion.

His wife, on the other hand, is experiencing trauma because of her childhood experience. The trauma makes her oversensitive and hyperactive to Robert’s infidelity. She reacts violently because of her mental disorder. According to Abramowitz et al. (2013), Sophia’s obsession with her molestation causes anxiety, doubt, and avoidance. Sophia expects Robert to reassure him that he is ready to stay in the marriage. The need for reassurance is due to the compulsion that arises from the obsession with her childhood experience.

My social background, biases, and values might cause me problems in understanding the couple’s situation. The socio-cultural history of America has put women and men in almost the same rank. There is no clear difference between feminine and masculine roles. Therefore, I might find myself forcing Robert to abandon his patriarchal disposition and talk to his wife about his problems. I also do not believe in cheating on one’s partner. This belief may make me subjective during the treatment. Worse still, I may find it difficult to understand why Robert does not share his problems with his wife because I believe in openness in marriage.

Ethical issues in assessing and diagnosing a couple

Counselors need to observe ethical standards while handling their clients. The American Counseling Association, ACA, and the American Association for Marriage and Family Therapy propose some ethical standards for counselors to observe.

According to ACA, counselors should be ready to give back to their communities. Giving back refers to the readiness to serve their people without expecting payment. Sometimes, their clients may lack money to pay for the services. In such cases, the counselors should be ready to offer services to them and not harass them for not paying for the services (ACA, 2014).

Sometimes, due to poor romantic relationships with their partners, clients can show readiness to have sex with their counselors. In the case of Robert and Sophia, both clients have no time for each other. They work for long hours and do not find time to be with each other. In addition, Sophia may want to revenge Robert’s infidelity by having sex with somebody else. The counselor should always avoid the temptation of having a sexual relationship with clients (ACA, 2014).

The AAMFT proposes a two-year avoidance period before engaging in any romantic relationship with former clients. The avoidance prevents either of the parties from taking advantage of their professional relationship (AAMFT, 2012).

AAMFT encourages marriage and family therapists to refer to cases that are beyond them to other experts. They discourage them from struggling with difficult cases or deliberate refusal to refer them. Both ACA and AAMFT propose that marriage and family therapists should seek consent from their clients before referring them to other experts. The therapist should write down the consent or record it to serve as evidence of the client’s involvement. In addition, they advise therapists to come up with ways of helping their clients continue with the treatment before they stop working with them (AAMFT, 2012).

Therapists should also provide services to their clients without discrimination. They should not reject or give unsatisfactory services to clients because of their color, ethnicity, age, or religion. Experts discovered that acculturation is one of the main causes of OCD. Therefore, most of the couples who seek therapy are likely to be of different races, ethnicity, and religions. Therapists should not compromise their services because of these factors (Harmon, Audra & Ginsburg, 2006).

Treatment plan

Focus of therapy

The therapy for the couple should mainly focus on their obsessions. Robert’s obsession is the fear that their relationship may not work, while Sophia’s obsession is Robert’s infidelity. The best therapies for this couple are exposure therapy and accommodation therapy. Exposure therapy helps them realize the lack of logic in their obsessions (Nolen-Hoeksema, 2014). Each of them will ignore the urge for compulsive responses to the obsessions. Accommodation Therapy, on the other hand, helps the affected people to assistance from relatives, spouses, and friends (Abramowitz et al., 2013).

Treatment goals for the couple

The major goals for this couple are faithfulness, finding time to talk about their problems, and for intimacy and openness to each other. When Robert starts to talk about his problems with his wife freely, the therapy will have worked. He is not satisfied with the relationship but does not talk about the cause of his dissatisfaction. Accommodation therapy will be very effective in handling this situation. He should make deliberate efforts to involve his wife in his problems. The exposure therapy may also help him realize that it is not helpful to cheat on his wife because of not having time for him (Yahav, 2002).

Sophia is very observant due to her lack of trust for men. Her uncle molested her when she was growing up, and this incident caused anxiety in her. Exposure Therapy is the best for handling her problem. The therapist should help her confront her obsession by avoiding situations that may trigger compulsions. The attainment of this goal is when she stops spying on what Robert does with other people.

Intervention methods

Susie Scot argues that therapists must help suppress or eliminate irrational characteristics in their clients. This philosophy is very important in coming up with methods of intervening in a situation similar to Robert and Sophia’s. Scott argues that the responsibility of therapists is regulating rationality (Scot, 2006). Therefore, in the case of Robert and Sophia, the therapist will have to prevent their clients’ emotions from going beyond their normal working conditions.

As Scot (2006) proposes, the therapist should help Robert realize that getting another woman was an overreaction. He should go through the CBT and be in an environment that allows him to recover on his own. The therapist should also allow Robert and Sophia to interact with anxiety triggers repeatedly. They will realize that the triggers are not important, and will eventually stop worrying about them.


Abramowitz J. S., Baucom D. H., Wheaton M. G., Boeding S., Fabricant L. E., Paprocki C., Fischer M. S. (2013). Enhancing Exposure and Response Prevention for OCD a Couple-Based Approach. Behavior modification, 37(2), 189-210.

American Association for Marriage and Family Therapy. (2012). Code of Ethics. Alexandria, VA: Author.

American Counselling Association. (2014).Code of Ethics. Alexandria, VA: Author.

American Psychological Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM 5. Arlington, VA: American Psychiatric Publishers.

Harmon, H., & Audra, L. (2006). The Role of Gender and Culture in Treating Youth with Anxiety Disorders. Journal of Cognitive Psychotherapy, 20(3), 301-310.

Nolen-Hoeksema, S. (2014). Abnormal Psychology. (6th ed.). Boston: McGraw-Hill.

Scott, S. (2006). The Medicalization of Shyness: From Social Misfits to Social Fitness. Sociology of Health & Illness, 28(2), 133-153.

Yahav, R. (2002). External and Internal Symptoms in Children and Characteristics of the Family System: A Comparison of the Linear and Circumflex Models. American Journal of Family Therapy, 30(1), 39-56.

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