The Couple Assessment Summary:
A Bridge from Assessment to Treatment
Robert L. Beck, M.A.
Allyson Bishop Crawford, M.S.W.
In their study of the Couple Assessment Summary (CAS), R.L. Beck and A. Bishop Crawford discussed the benefits of using the CAS to help couples recognize and understand the problems that exist in their relationship. The CAS not only allows couples to examine the problems of their relationship, but it also allows couples to understand the therapist’s suggested treatment methods clearly. In other psychological assessments, couples are never privy to the analysis of treatment that their therapist offers, but the CAS offers the therapist’s perspective to be reviewed by the couple. The CAS is actually an extended version of another couple’s assessment, the Couple Assessment Outline (CAO).
Treating couples has many challenges and difficulties (Beck & Crawford, 2000), the most prominent being the necessity to “effectively engage the partners” (55). Both the CAO and the CAS aid in beginning this process of understanding and opening the lines of communication between the partners and therapist. The CAO consists of a very structured four-stage (session) process (Beck & Crawford, 2000), which includes: (p.57)
Session 1: The presentation of the problems
Session 3: The premarital relationship or courtship
Session 4: Conceptualization
The CAS however expands on and focus’ on this fourth session by allowing couples to understand not only the dynamics of the relationship and where the problems stem from, but also allows the couple to plan for treatment with the therapist (Beck & Crawford, 2000). It includes “a brief review of the presenting complaints, a summation of individual history and family history, a review of relationship history and its evolution, and abbreviated formulation/conceptualization of the relationship problems, and recommendations for treatment (p. 57).”
A major difference between the CAS and other forms of traditional psychotherapy is that many therapists to not share their therapeutic insights with their patients whereas CAS therapists allow their patients to become involved with the therapeutic process. This allows therapy to become de-mystified. The couples therefore become full participants in not only their own therapy, but in their marriage.
Since the CAS is an expansion of the CAO their structures are very similar, but the structure of the CAS is much more descriptive. An example of a typical CAS structure (Beck & Bishop, 2000) is the following: (p. 59)
Part 1: A restatement of each partner’s complaint(s) about the
Part 2: A summation of family, individual, and relationship history.
Part 3. A review and restatement of the relationship problems as the
therapist(s) understands it. This statement offers the therapist(s) and partners an opportunity to revisit their perspectives on the problems and offers an additional opportunity to move toward a “consensus opinion as to the nature of the conflicts.
Part 4: The conceptualization, the core of the CAS, offers a therapist-
generated overview of the presenting problems and his or her understanding of their nature and maintenance.
Part 5: The treatment plan, the final section, draws treatment effort
conclusions for the couple and therapist. Treatment tasks are made problem specific and potential outcomes are considered.
Beck and Bishop (2000) also included an actual case assessment for a couple, Emma and Don. This assessment included a breakdown of the structure of the CAS with an actual example and explained how the CAS worked for that individual couple.
As can be seen from its structure and purpose, the CAS is a tool that allows therapists to assess a couple’s situation and allows the couple to feel that someone is in control of their situation, while still allowing room for the client to assist in creating their own treatment.
I. The Assessment Literature
A. Grunebaum, Christ and Neiberg
1. Parameter system
a) Commitment to work on the marital problem
b) Locus of symptoms
c) Duration of symptoms
1. Psychodynamic approach
a) Leads to an understanding of the dynamics of the contributing factors to the relationship discord
C. The Scharffs
1. Five-session system
a) Before conceptualizing and recommending treatment
1. Two-step process
a) A genogram for multigenerational information gathering
b) An evaluation of the individual partners and family system
1. Recommends that the therapist and the couple determine the conscious, unconscious, verbal, and unspoken relationship expectations
2. Conceptualize goals and a new marital contract
II. Couple Assessment Outline (CAO)
A. Originally developed for beginning therapists
B. Levels of the evaluation approach
1. Genera development
2. Marital contract
3. Psychodynamic exploration
4. Assessment of the couples commitment to the treatment
5. Encouragement for couple to share responsibility for change
C. Sessions of the CAO
1. Session 1: The presentation of the problem
2. Session 2: Individual development history
3. Session 3: The premarital relationship or courtship
4. Session 4: The consolidating final session where the conceptualization is shared
III. Introduction of the Couple Assessment Summary (CAS)
A. Was introduced because Beck’s paper (4) does not elaborate in the conveying of the conceptualization to the partners
1. A brief review of the presenting complaints
2. A summation of individual history and family history
3. A review of the relationship history and its evolution
4. An abbreviated formulation/ conceptualization of the relationship problem
5. Recommendation for treatment
C. The rationale for utilizing CAS
1. It assists the therapist in stepping back form the chaos and maintaining a “big picture”, meta/ analytical role
2. It provides a structured tool for the therapist to conceptualize underlying dynamics
3. It offers the couple a sense that they are in capable, safe hands while some order is being made out of chaos
4. It provides a sharpening of focus for the therapy in defining major themes that can then be addressed throughout the process
5. It gives the couple and therapist some respite from the chaotic interchanges in the here-and-now as the document is examined
D. Structure of the CAO
1. A restatement of each person’s complaints about the relationship conflict
2. A review of family, individual, and relationship history
3. The review and restatement of the relationship problems as the therapists understands it
4. The conceptualization, the core of the CAS, offers the therapists-generated overview of the presenting problem
5. The treatment plan, the final session, draws treatment effort conclusions for the couple and the therapist
IV. CAS for married couple
A. Emma (Wife)
1. Forty-seven years old, was the only child of a skilled blue-collar worker father and a schoolteacher mother whose marital relationship was cool and distant
B. Don (Husband)
1. Fifty-two years old, an only child, was born to an executive father who dies when Don was an adolescent. His mother was a homemaker and while present, was not significantly involved in his activities and interest
C. Primary complaints
1. Emotional distance
2. Unresolved conflicts about “little thing”
3. Don retreats, Emma pursues
4. Infrequent sexual activity
5. A “formal” relationship with little spontaneity
1. Both individuals are somewhat “developmentally delayed”
2. Have limited experience in communicating feelings or engaging openly on an intimate level with one another
E. Problems with the relationship
1. Both extremely cautious with the other
2. Sexual relationship has dramatically declined
3. Have different perceptions and memories of significant early events
1. Both were late bloomers
2. Each had little experience in expressing emotions or negotiating emotionally
3. Emma- isolated in the early years, experienced first gratifying interpersonal successes in sports
4. Don- was left floating as a child by parents, and then learned to take care of himself and later his business and wife
5. Emma- ultimately entered intensive psychotherapy to deal with family conflict
6. Don- emotional unavailability resulted in his entering individual psychotherapy
G. Recommendations that ongoing therapy focuses on
1. Increasing communication regarding a new “martial contract”
2. Increasing communication regarding earlier contract
3. Increasing comfort with affection
4. Looking at sexual attitudes, needs, and feelings and improving the sexual relationship
1. Three points made by the author that were especially interesting:
As a group we thought that one of the main points of the Couple Assessment Summary was the fact that both the therapist and the couple have a chance to evaluate the summary and work together to formulate a treatment plan and construct new “marital contract” Second, we thought that it was really important to have the four sessions so that in each one a main issue could be addressed before moving on. Factors like past history, family, and relationship with one another is very important to the assessment
Lastly, we thought that it was important that the CAS was developed to support the CAO because it goes a step further in that it underscores the shared couple and therapist responsibility for understanding the relationship dynamics.
2. Arguments made by the author that group found especially weak:
One weakness of the CAS is that both husband and wife must be willing to review their history, family relationships and conceptualization of their marriage in order to help therapist make an accurate assessment. Also, we believe that if the couple is not willing to interject their ideas and beliefs’ regarding the treatment the summary is useless. The CAS must really be a united effort from the couple and therapist.
3. Concepts that the group would have liked the author to have explained further:
After collaborating, the group decided that the author sufficiently illustrated the components of the CAO and CAS. It was beneficial to have an example of the CAS of a real couple with perpetual marital problems. It allowed us to see the components of the summary (primary complaints, history, problems with the relationship, formulation, and recommendations) that help both the therapist and couple review it and come up with treatment. One thing that might have been explained further is what other assessments or tests are usually used in conjunction with the CAO and CAS when a couple with marital problems seeks therapy. Also, are there certain kinds of assessments or tests that work better with different kinds of marital conflicts?