Results show that overall, both Jane and John are unhappy in their relationship. Consider the following recommendations for therapy:

• Examine the other questionnaires carefully to identify the source unhappiness for both partners. During your initial assessment, obtain a careful history from each partner to understand how their relationship developed and what has caused them to be unhappy. Look for physical or emotional betrayals, and/or patterns of communication that have proved painful and non-productive.
• If the source of unhappiness have been betrayals of any kind, be sure to process these after your assessment is completed. For extra-marital affairs, refer to Shirley Glass' work, 'Not Just Friends,' which summarizes the cause of affairs and how to heal from them. For other types of betrayal, you might use the Gottman Recovery Kit, or Susan Johnson's Emotion-Focused Therapy to help with the recovery process.
• For other relationship difficulties, refer to the specific questionnaires in this checklist and their respective recommendations for creating change. Be sure to note during initial assessment for the couple that you have tools to change the patterns of interaction that have led to this couple's pain.
• Remember, it is possible that Jane and John are too unhappy to benefit from therapy and despite your best intentions, you may not be able to help them. While this can feel frustrating to you, avoid judging the couple for not being able to make it work. When there is absolutely no love left for either partner, it is difficult for any therapist to rekindle a spark. Instead, help the couple to get support, mediation, or legal services with the goal of helping them to have as amicable a separation as possible.

Jane and John are both seriously considering ending the relationship. They both have consistent thoughts of leaving one another and have taken steps in that direction. Consider doing the following:

• Clarify the couple's goals and expectations for therapy.
• If the couple does not want to separate or divorce, start by validating that both have serious concerns about the relationship. Examine the other questionnaires in the assessment to identify what changes each needs to rebuild trust in each other and to make the relationship viable. If conflict management appears to be dysfunctional, begin by restructuring how the couple manages conflict. If the couple is so emotionally distant that there is virtually no conflict at this point, work on strengthening friendship and creating shared meaning. Relevant Gottman interventions or others you may prefer should be applied.
• If a significant betrayal or series of betrayals has occurred, and the couple is committed to working on the relationship, work on each issue beginning with the most significant one(s). Refer to the book, 'What Makes Love Last?' by John Gottman or 'Not Just Friends' by Shirley Glass. Each book reviews how to rebuild trust after it has been broken. For repairing past betrayals, consider the resource Emotion Focused Therapy by Susan Johnson.

Jane and John both scored poorly on Love Maps, therefore neither partner feels adequately "known" by the other. Recommendations for the therapist are as follows:

• Explain to the couple that having poor Love Maps is a real problem in this couple's relationship, as it has weakened their friendship. Describe that when a Love Map score is low, partners don't feel adequately known by the other partner or they might worry that their partner is not interested in knowing them, nor continuing to know them in the future. This often results from not asking open-ended questions and not being aware of the stresses, hopes and aspirations that each has. This may be due to a host of problems, including poorly managed conflict, leading parallel lives, a lack of knowing how to connect, the development of emotional distance between them, the relationship not fulfilling their needs, etc. Check other questionnaires to identify why this couple is not staying in touch with who their partner is. Look for conflict management problems, past betrayals, flooding, loneliness, emotional distance, a lack of knowing ways to connect (rituals of connection), etc.
• Use the Gottmans' Love Map Card Deck or another appropriate intervention as a fun way for the couple to talk about what they do and don't know about one another, and as a way to update their Love Maps.
• Teach the couple the skill of asking each other open-ended questions using either the Gottmans' Open-Ended Questions Card Deck or other resources.
• Encourage Jane and John to create a weekly time for updating Love Maps by asking and answering open-ended questions with one another.

Neither Jane nor John feels well respected, admired or loved by the other. Recommendations for therapy include:

• Explain to both partners that a poor fondness and admiration system indicates a significant problem in their friendship. They seem to lack a sense of pride in what their partner has accomplished and they each feel taken for granted. They have not created a 'culture of appreciation' in the relationship in which phrases like 'thank you' are said for things the other partner does for the relationship. Describe how the deterioration of fondness and admiration can follow times of poor conflict management, past emotional injuries or betrayals, turning away from each other's bids for connection, or refraining from expressing needs. Assess if these circumstances apply to this relationship. Ask if there have been significant incidents of betrayal, emotional injury or purposeful turning away from or against one another. If so, it is crucial that these regrettable incidents be processed in order to rebuild fondness and admiration. The Gottman 'Aftermath of a Fight or Regrettable Incident' format can be used.
• Review the other friendship, conflict management, and shared meaning questionnaires to see if any have low scores. Focus on rebuilding these using appropriate tools.
• Suggest that each partner focus on what the other is doing right, rather than what is being done wrong. Have each partner thank the other and express appreciation daily and encourage weekly meetings in which each partner shares appreciation for what the other is doing for the relationship, even the small things that are routinely done often. Suggest that they end the meeting with the question 'How can I help you feel more loved and appreciated in the coming week?
• Use the Gottman 'Fondness and Admiration' checklist to share with one another the traits they admire in their partner and for each trait, a recollection of how their partner exemplified that trait.
• Suggest alternative ways partners can express their appreciation and care for one another such as texting each other 'love notes', surprising each other with small gifts or doing household chores before being asked.

Jane feels that John does not notice or respond to her needs, while she does notice and respond to his. Recommendations for therapy are as follows:

• Explain to both partners that they need to work on Turning Towards in their relationship. For example, Jane doesn't think that John notices when she needs to get his attention, or needs to talk about something, or to joke, play, and have fun. Also, John's interest and enthusiasm rarely matches Jane's. Also, John doesn't respond very often to Jane's attempts to be funny, while in contrast, John feels that Jane does respond to his being funny. The asymmetry in turning towards each other is a real issue in their friendship.
  • It may be difficult to create enough safety and trust in the relationship needed to correct the asymmetry in the Turning Towards system until Jane's past failed bids for connection have been fully processed. Therefore, first process Jane's past failed bids for connection, especially those that have felt like emotional injuries or betrayals, using the Gottman 'Aftermath of Fight or Regrettable Incident' booklet or a similar intervention.
  • Using the 'Gottman-Rapoport Intervention' or a similar exercise, have both partners take turns as Speaker and Listener to voice his or her needs in a non-blaming, positive way (meaning, what he or she does need rather than what he or she does not need). Gently place limits on how many needs are voiced at once, as too long a list may prove overwhelming to the Listener. Suggest that the Listener takes notes, delays stating his or her response or needs until it's his or her turn to be the Speaker, and asks questions only to help clarify the Speaker's needs. When the Speaker is finished, the Listener should try to summarize the Speaker's statements and validate them. Next, have the partners exchange roles. Then repeat the process so that the new Speaker can also feel listened and responded to. Note: Hopefully, the partners will want to respond affirmatively to each other's needs, but it is also ok for a partner to say, 'No, I can't do that,' and explain why they cannot meet their partner's specific need.
  • Sometimes partners innocently don't recognize when a bid for connection is being made. In these instances, have each partner describe the various ways they like to make bids for connection, so that their partner can recognize these as bids.
  • Sometimes, partners believe that needs should be able to be recognized and responded to without being expressed (i.e., loving partners should be able to read each other's minds). In these instances, gently point out and explain that this belief is a myth.
  • If appropriate, explore each partners family history regarding getting their needs met and if it was not ok to express needs. In these instances, explain the correlation between this history and that partner's fear about expressing needs.

Unfortunately, both Jane and John feel that passion and romance (independent of sex) are not going very well in the relationship. Recommendations for the therapist are as follows:

• Review other relevant questionnaires for possible correlates to the lack of romance.
• Help the couple to understand that making romance a priority is important, and help them problem solve to make time for it.
• If the couple lacks knowledge of how to connect with their partner, help them discuss their preferences using either the Gottsex Tool Kit exercises or other appropriate interventions.
• If other relationship problems have diminished their desire for romance and passion, explain the connection between these and relationship satisfaction. This can include the need for calm conflict management or a new plan for how to include romance in the relationship, especially after children are born. A lack of passion can indicate busy and or/chaotic lives, problems in other parts of the relationship, or simply not making it a priority.

John is not happy with the quality of sex in this relationship, but Jane is satisfied. Recommendations for therapy include:

• Share with John and Jane that the quality of sex is a problem in their relationship. Explain that John's dissatisfaction may be due to poor communication about what satisfies her sexually, or from other problems in the relationship such as conflict management, feelings of betrayal, lack of friendship or childhood sexual or relationship abuse. To explore the cause, check results from other questionnaires. Inquire about medical origins for this problem and if appropriate, suggest that each partner be checked by their medical provider as a variety of medication side-effects or physiological problems can affect sexual satisfaction.
• Ask if the couple has had comfortable conversations about their sex life in the past, especially recently. If not, help the couple talk more about their specific sexual likes and dislikes, using the Gottsex Tool Kit or other appropriate interventions.
• If the couple has abstained from sex for longer than several months, consider re-introducing the couple to sensuality using a method like sensate focus that removes pressure on either partner to perform, and allows the couple to learn what they each like. For female partners who are very uncomfortable with their sexuality, the book 'For Yourself: Female Sexuality,' by Lonnie Barbach can be very helpful. For men, the book, 'Male Sexuality' by Bernie Zilbergeld can also be helpful.

Jane and John both report that their relationship is currently unpredictable and cannot provide security, order or peace in their home life. Recommendations for therapy include:

• Help Jane and John understand that they are likely overwhelmed by the negative, unpredictable events in their lives, and that the stress from these events is spilling over into the relationship causing increased irritability and conflict. Ask Jane and John to talk about their external stresses (those coming from sources outside the relationship) using the Gottman Stress-Reducing Conversation or a similar Intervention, to help the couple to listen to one another, empathize with one another, and postpone problem-solving until each person feels fully understood.
• Help them examine where they might exert more control in their lives, even in small ways.
• Help Jane and John learn methods of stress management.
• Help them manage any current crises by eliciting suggestions from the partners and offering your own. To reduce symptoms of stress, you can explain the studies of Tiffany Field, and suggest that they incorporate 15 minutes of non-erotic massage with one another into their day to reduce signs of stress and depression.

Jane does not trust this relationship and feels a fundamental lack of trust and safety. Recommendations for therapy are as follows:

• Help Jane and John understand that Jane has felt emotionally injured and betrayed in this relationship, however John does not feel that way and may be unaware of Jane's hurt feelings.
• Examine individual items endorsed by Jane, and elicit from her the story of what happened that led her to endorse those items. Support John to hear these stories and reassure both partners that understanding these events is the first step to rebuilding trust.
• Using the Gottman 'Aftermath of a Fight or Regrettable Incident' tool, support the couple to dyadically process the past emotional injuries or incidents that have damaged Jane's trust. Be sure that both partners are calm and not flooded while processing.
• Add a 'Dan Wile' intervention to help the couple share their subjective realities about what happened. In this intervention, the therapist speaks for each partner as if the therapist is that partner. In so doing, the therapist role models for the partner how to describe his or her reality without using blame or criticism.
• Elicit from Jane what steps she needs in order to rebuild trust in the relationship. Then, support John to commit to whatever steps he is willing to take to help Jane to rebuild her trust in him.

There is a lack of commitment in this relationship for both Jane and John. Recommendations for therapy are as follows:

• Address both partners' lack of commitment to the relationship, and explore what has led to it. Inquire as to whether the lack of commitment is a recent development or has always been in this relationship. See if there are underlying past regrettable incidents or emotional injuries that created each partner's lack of commitment and have not yet been processed. If there are, use the Gottman 'Aftermath of a Fight or Regrettable Incidents' tool to process these incidents.
• If there is such a lack of commitment that the couple is unsure about proceeding with couple's therapy, see if they are at least willing to commit to a certain number of sessions before deciding not to stay in the relationship.
• If they are, see if you can produce at least some positive results in those sessions, especially in conflict management, since often poor conflict skills leaves both partners wishing for something or someone different.
• If the partners' lack of commitment is related to emotional distance and loneliness, work on strengthening Love Maps, Fondness and Admiration, and Turning Toward, plus creating or strengthening Rituals of Connection.

Both Jane and John struggle with Meta-Emotion and are uncomfortable with negative feelings. Recommendations for therapy are as follows:

• Help Jane and John understand their views on Meta-Emotion. They believe that people can control their emotions and should choose to have positive thoughts and emotions instead of negative ones. They are likely both uncomfortable talking about their own and each other's negative feelings. An example of this type of thinking is: 'When bad things happen, people should just minimize negative emotions and get on with life, either by putting bad things behind them or by rolling with the punches.'
• Share with Jane and John that although they see eye-to-eye on their beliefs about emotions, there is an inherent risk for their relationship. If something happens where they need one another for emotional support, they won't have the skills necessary to listen to each other's feelings and be there for one another.
• Teach the couple about meta-emotions, that is, different beliefs about how feelings should be dealt with. Explore how each partner developed his or her belief system about the role of negative emotions in their world. Consider asking about their childhood histories in terms of how emotions were dealt with and how they were comforted within each of their families.
• If either Jane or John needs new ways to figure out what he or she is feeling, offer Eugene Gendlin's book, 'Focusing,' as a good resource for helping partners become more aware of their own emotions and how to name them.
• Help each partner define what he or she needs from the other partner in terms of emotional support. Note that emotional support can be provided in many ways, e.g., through touch, words, taking over tasks, quiet warmth and just listening, etc. You might have each partner make notes about the other partner's needs in order to remember them better.
• Teach the couple that voicing negative feelings may help diminish them since people tend to get more 'stuck' in negative feelings when they suppress them rather than express them.

Feedback from Jane and John's questionnaires shows that most of their conflict discussions begin with Harsh Start-Up rather than Softened Start-Up. Recommendations for therapy are as follows:

• Explain to Jane and John that most of their conflict discussions begin with blaming, criticism,or statements that their partner is flawed in character or personality. Share with them that in our research, we found that the first three minutes of how a couple raised a conflict issue (i.e., 'Start-Up') predicted how the rest of the conversation will go and could even be an indicator of how successful the future of the relationship would be. Therefore, Harsh Start-Up is a serious problem in their relationship that needs to improve. Describe for them that when Softened Start-Up is used to start a conflict discussion, it tends to predict that it go well, whereas when Harsh Start-Up is used, it usually predicts that a negative outcome. Softened start-up needs to replace harsh start-up for both partners. The therapist may want to tell the couple about Gottman's research
• Identify steps to change Harsh Start-Ups to Softened Start-Ups. The Gottman model involves a partner (the speaker) presenting a position on an issue to the other partner (the listener), by using the following three-step process: 'I FEEL...'' (name an emotion); 2) 'ABOUT...' (ABOUT WHAT - describe the situation that is creating the feeling, rather than describing the other person's personality flaws); and 3) 'I NEED...'' (describe how the listener can help the speaker to feel better about the issue.) The Gottman-Rapoport exercise may also be useful here.
• While reviewing a particular disagreement the couple is discussing, provide an example of what a Softened Start-Up looks like.

Jane and John both feel that their disagreements are full of criticism, defensiveness, contempt and stonewalling, all predictors of relationship breakup. Recommendations for therapy include:

• Educate Jane and John about our research on the 'Four Horsemen of the Apocalypse' and let them know that these four behaviors predict significant problems for couples regarding conflict management. If this is new information, share the definitions as follows: 1) Criticism is blaming a relationship problem on personality flaws in your partner; 2) Contempt means combining criticism of your partner with descriptions of your own superiority and disgust with your partner; 3) Defensiveness is defending against your partner's criticism or contempt by either denying any responsibility for the problem, acting like an innocent victim, or counter-attacking your partner by criticizing him or her while ignoring his or her complaints; and 4) Stonewalling involves shutting down completely and refusing to offer any verbal or non-verbal responses to your partner's statements. Stonewalling may be accompanied by flooding (being physiologically in a flight-or-fight state).
Explain that these behaviors are the best predictors of relationship breakup as they make it very difficult to arrive at a solution to issues.
• Next, observe the couple for up to 10 minutes without intervening as they attempt to discuss a problem. For any of the 'Four Horsemen' observed, provide alternatives and give specifics for each one. For example, for criticism, you can give alternatives, 'Instead of saying 'You're so lazy,' try saying, 'I feel stressed out from doing most of the housework. Would you please take out the garbage tonight?' For contempt, you might say, 'Instead of putting down your partner which may hurt his feelings, try telling him what you would appreciate him doing for you that would make you feel supported, and would give him an opportunity to shine for you. Make sure it's what you do want, not what you don't want.' For defensiveness, suggest, 'Try saying to your partner, 'I'm feeling defensive right now. Can you say that in a different way?' or 'OK, fair enough. You've got a good point.' For stonewalling, take a reading of the stonewalling partner's heart rate. Most likely it will read over 95 beats per minute, or 85 beats per minute if the partner is athletic. Then provide the partner with a self-soothing exercise for a few minutes, like progressive muscle relaxation and diaphragmatic breathing, before continuing with the conversation.

• Try using the Gottman-Rapoport exercise or a similar intervention to slow down their conflict conversation and to provide alternative ways for them to express their positions on their issue. Work on postponing a discussion of how the issue can be resolved until they fully understand each other's point of view. They may also need work on listening rather than simply broadcasting to each other.
• For issues that may have a hidden agenda or underlying feelings within each partner's position, use the Gottman 'Dreams-Within-Conflict' intervention that elicits ideal dreams, feelings, beliefs, or core needs that fuel each partner's position, so that their understanding of each other can deepen, even in the midst of conflict.

Both Jane and John tend to get flooded during arguments. Recommendations for therapy include:

• 1. Explain the concept of flooding, which means when they discuss disagreements or hurt feelings, they both tend to feel overwhelmed and to experience 'diffuse physiological arousal, or 'fight-or-flight.' 2. Describe DPA as a very uncomfortable state in the body, often signaled by a heart-rate above 95 beats per minute, or if the person is very athletic and fit, above 80-85 beats per minute, while they are simply sitting and talking. They want to either run away from each other or make their partner stop talking. If they can't do either one, they may lose control and resort to verbal, and in some cases, physical attack, or they may stay in one place but shut down entirely and stop all normal responses to the conversation in order to withdraw, (called 'stonewalling.') Withdrawing is a partner's attempt to shut out stimulation so that he or she can internally calm down. 3. During therapy sessions, use some sort of heart-rate monitor, such as a pulse oximeter, when working with this couple in order to detect unusual heart-rate elevations in either partner. These devices are small and non-intrusive, sometimes requiring only that a small instrument is gently clipped to a finger. An alarm should be set on the devices such that if the heart-rate rises above 95 beats per minute (or 85 if athletic), an alarm will go off, signaling that the partner is flooded. At that point, that partner's device may be removed. When this occurs in session, stop the interaction, ask the partners how each of their bodies are feeling, and take note of the physical signs of flooding for each partner's future reference. Then guide both partners through a relaxation exercise such as progressive muscle relaxation or a short mindfulness exercise so that the partners can lower their heart-rates. After their heart-rates are closer to a normal range (60-80), the couple can continue their conversation.
• 4. Discuss with the couple how to take a break during conversations at home when either partner is getting flooded. 5. Describe the nature of a break as follows: a) If one person asks for a break, the other partner needs to agree without either partner trying to get the last word into the conversation; b) The partners should agree on a time that they will get back together again to resume their conversation. The break should last at least 20 minutes, but no longer than 24 hours; c) The couple should then part and go to separate places where they can no longer see or hear each other, such as separate rooms in the house or one person outside while the other remains inside, etc.; d) During the break, each partner should do something self-soothing that takes their minds off the discussion with their partner, such as reading a book, listening to some music, taking a walk, going for a run, etc. It's important that the partners do not think of how they can next respond, as that will only keep them flooded; e) They should return to talk together at the time they designated earlier. If one is not yet calm, he or she should still return, but then ask for a specified additional amount of time in order to fully calm down; f) After returning to one another in a calmer state, the couple may resume their conversation.
• Help each partner identify what activity would help that individual calm down when flooded, so that if flooded at home, the partners know what to do to self-soothe. Consider recommending the EmWave biofeedback device made by HeartMath, or the Gottman Relaxation Instructions for self-soothing.
• For awhile, ask the couple to limit conflict discussions to their therapy sessions. Teach alternative conflict discussion skills to calm down their conflict management, such as the Gottman Rapaport Method, the Dream Within Conflict Method, and the Two Oval Compromise Method.
• If Jane floods during a session, stop the discussion and gently guide Jane through a brief relaxation training or other technique of self-soothing. John may follow the instructions as well.
• Explore with Jane and John any relevant history that may be related to their flooding. Be sure to look for past traumas, anger dealt with badly in their families of origin, or past relationship betrayals either during childhood or adulthood.
• Help John explain the effect of Jane's flooding on him, and the effect of John's flooding on Jane, concentrating on their emotional reaction to it rather than criticism of each other.
• Help Jane identify what John can do that would be helpful for her when she is flooded and needs to calm down, and vice versa, what Jane can do when John gets flooded.

• Help the couple to agree on the details of how a break can be taken at home.

Most of the time, Jane and John don't compromise during their disagreements, making the conclusion a stalemate, or a standoff. Recommendations for therapy are as follows:

• Explain to Jane and John that their inflexibility creates a lose/lose, or win/lose outcome to disagreements in that one partner gives in to the other but usually with resentment.
• Explore each partner's fear, anger, or early childhood history that may relate to problems with compromise.
• Explore what it means to each partner to compromise. For example, for some men, it may mean that he is not being a strong 'patriarch' for the family. Or for some women, it may make her feel like she is not being a good 'feminist' but instead is being too subservient.
• Be sure to underscore differences in their histories and meaning systems that have created differences in attitudes about compromise. This will help minimize blame or criticism arising from one partner's unwillingness to compromise.
• Make sure both partners understand each other's positions on the issue being discussed before they move towards compromise. The Gottman 'Dream-Within-Conflict Intervention,' the 'Gottman-Rapoport Intervention' or other interventions designed to open up understanding and self-disclosure during conflict may be useful here.
• Using an intervention like the Gottman 'Two Oval Method for Reaching Compromise,' help the couple sort out what aspects of their positions on an issue are inflexible and cannot be compromised, versus what aspects are more flexible and can be compromised. Inflexible aspects often include core needs, dreams, values or life purposes that pertain to this issue. Flexible aspects for an issue usually involve answers to questions like, 'when?' 'how?' 'where?' 'how often?' 'how much?' 'for how long?' etc. Once the partners have shared with each other their inflexible and flexible aspects, have them examine where there is overlap. Then, while trying to honor each other's inflexible core needs and life dreams, guide them to discuss how they can fashion a compromise using the aspects in which they more flexible.

Jane and John are both in Negative Sentiment Override, meaning that they feel negative about each other, are hypervigilant about the other's negativity, and expect criticism or put downs, no matter what they do or say. Recommendations Suggestions for therapy include:

• Describe to Jane and John that Negative Sentiments are overriding their positive feelings about one another so they often hear or see negativity in whatever their partner says or does, even when their partner says something neutral or positive. Neither feels their partner is their ally.
• Explain that Negative Sentiment Override cannot be reversed without improving the quality of friendship and the ways they process conflict.
• Examine the results of the couple's questionnaires on friendship and conflict management to pinpoint where the couple is struggling the most since Negative Sentiment Override cannot be remedied by working on it directly and is instead an indicator that other aspects of the relationship have not been going well.
• Use the recommendations listed for each respective questionnaire as needed. For example, Jane and John may have used criticism routinely as a way to bring up problems, and now expect to be criticized whenever an issue is raised. If this is happening, work on Softened Start-Up, or how to raise an issue gently without using criticism. If they have been turning away from one another for a long time and resentments leak into every interaction, then work on recognizing and positively responding to bids for connection. Remember that Negative Sentiment Override takes a long time to create and so takes time to repair. Be patient.

John does not usually make repair attempts, but Jane does. Recommendations for therapy include:

• Explain to John and Jane that they tend to fall into a negative cycle in their relationship. This means that their conversations slide downhill because one of them either gets flooded or expresses criticism, contempt or defensiveness. When Jane initiates a repair to get the conversation back on track, then John does not usually accept the repair. If the repair is not accepted, then they cannot get back on track in order to re-establish a positive flow in their conversation.
• For example, if Jane feels criticized and is starting to feel defensive, rather than expressing defensiveness, Jane might initiate a repair with words like, 'I'm starting to feel defensive. Can you say that in another way?' John may accept Jane's repair with words like: 'Oh, OK, let me try it again.' But if the roles are reversed and John makes a similar repair attempt, Jane is more likely to say, 'No, I can't rephrase it. You heard me the first time!' Jane's refusal to accept John's repair attempts may leave John feeling hurt, frustrated and powerless to keep conflict discussions on the right track. Our research shows that a couple's ability to make successful repairs is the major difference between couples whose relationships last and those whose relationships don't last. The inability to make successful repairs is a serious problem in this relationship.
• Identify whether or not John is actually making any repair attempts to which Jane can respond. If he isn't, explore with him what is keeping him from doing so. For example, he may harbor underlying resentments that are not being directly addressed, thus motivating him to maintain ongoing conversational negativity. Or he may fear conversations becoming more positive because he fears getting closer to Jane. Issues like these should be surfaced and understood so that John can be helped to move past them.
• Show John and Jane the Gottman Repair Checklist (a categorized list of repair phrases that help get conversations back on track). Ask them again to discuss a conflict issue, but this time, if either partner thinks the conversation is starting to go badly, ask them to use the Repair Checklist as a guide for initiating a repair. For example, an appropriate phrase from the Gottmans' Repair Checklist can be read aloud in the moment when a repair is needed. Encourage the other partner to accept the repair after it has been spoken. Reassure the couple that although it may sound phony to be reading these phrases during their dialogue rather than generating their own words, reading the phrases aloud will help the couple get the idea of what repairs sound like, so that eventually they can use their own words instead.
• Encourage John and Jane to make repairs by pulling out and using the Repair Checklist when a conflict is discussed at home. Reassure the couple that if this is done regularly, soon they won't need the Checklist as their repair skills improve.

Both Jane and John have difficult past family histories. Recommendations for therapy include:

• Explain that having a difficult family history can mean that both partners carry enduring vulnerabilities (emotional baggage) into this relationship which can trigger conflict during regrettable incidents.
• Consider an individual session with each partner to explore family-of-origin histories, previous trauma or negative experiences.
• Inquire if either partner has told the other about these experiences, and whether or not each is aware of the role these experiences may still be playing in their current relationship. Be sure that both partners are OK if you bring up this history during joint sessions. If not permitted, consider making an individual therapy referral for the partner(s) who are refusing permission to raise their individual issues, so that they can safely explore those historical issues. For example, it is fairly common for one partner who has suffered incest to not have told the other partner about it, and to need to explore its effect individually before considering disclosing it to the other partner. If individual therapy is added to the couples' work, be sure to seek permission to waive confidentiality and if granted, to coordinate care with the other therapist. If there is no awareness of how these experiences are affecting the relationship, and permission has been granted to bring up enduring vulnerabilities, gently suggest this history may be playing a role, almost like an additional phantom person in the room.
• During joint sessions, listen for content, affect, or tone in either partner that hints at past family-of-origin issues. If observed, pause the session to point it out and to explore it further, provided that partner has given permission to explore it while together.
• Identify the enduring vulnerabilities 'hovering in the room' as you would a third party in the relationship that is inflaming the relationship. For the partner suffering from the enduring vulnerability, this can lessen the self-blame and shame the partner feels as well as increasing the other partner's compassion for him or her.
• Work with the couple to distinguish the non-vulnerable partner from the family-of-origin member(s) who initially caused the vulnerable partner's distress.
• When past traumas have clearly affected current relationship processes, go slowly, especially with a history of sexual abuse. It may take the suffering partners a long time to recover their own sexuality and ability to be intimate.
• When particular historical traumas have surfaced, refer to readings and trainings that focus on joint treatment for couples having traumas like these. The Marriage Clinic Casebook ed. by J. Gottman is a good reference for such cases.

Jane feels distant emotionally from John, but John does not feel emotionally distant from Jane. Recommendations for therapy include:

• Raise the problem of Jane's feeling emotionally disconnected from John without blaming either partner for it. Jane may feel that John is not particularly interested in her nor appreciated which has led her to feel distant from him. Jane may also not feel safe enough with John to confide in him.
• Explore how long Jane has felt distant from John and what, if any, events precipitated her feelings. If any regrettable incidents played a role in creating her feelings, process these regrettable incidents or betrayals using the Gottmans' 'Aftermath of a Regrettable Incident or Fight,' or a similar instrument that empowers the couple to explain their own points of view about what happened during the incident while the other partner listens. Be sure that each partner takes some responsibility for the incident when appropriate. Sincere apologies will be more easily accepted after processing these incidents rather than at the outset.
• If no regrettable incidents precipitated the distance, but Jane needs a different quality of listening from John in order to be closer to him, help her to identify her needs about listening more specifically. For example, does she need him to listen to her feelings before offering advice? Help Jane to express what she does need from John rather than what she doesn't need or hasn't liked, and support John to respond to her appropriately.
• Help Jane and John to create rituals of connection to initiate change so Jane can increase her connection with John. Rituals of connection are patterns of behavior that help the couple to connect in a safe and predictable way on a frequent basis. A good example is a time set aside each evening to check in with each other about how their day went. Rituals of connection may also include ways to have fun, like a weekly date night, ways to say good-bye at the beginning of the day, or ways to re-unite at the end of the day. Details of how these rituals of connection will be planned, initiated and completed should be fleshed out so each partner knows what to expect. A good source for creating Rituals of Connection is the Gottmans' 'Rituals of Connection' card deck and exercise.
• Explore with Jane whether or not any past history from her life before this relationship has contributed to her difficulty emotionally connecting with John. Support her to share her story in the therapy, so that John can better understand her fears and concerns about connecting with him.
• Couples with emotional distance between them lose track of who the partner really is and how that partner may have changed over time. John may feel close to Jane, but Jane's feeling distant from John implies she doesn't feel well known by John. Use an exercise like the Gottmans' Love Map Card Deck to help Jane and John to learn more about each other.
• Have the partners pick open-ended questions to ask each other and discuss in order to deepen both their knowledge of each other's feelings, goals, needs, and experiences. The Gottmans', 'Open-Ended Questions Card Deck' is a useful exercise for this process.
• Even though only Jane feels distant, help both partners understand the importance of Turning Towards one another when bids are made rather than away or against. Bids for connection include attempts to get the other partner's attention, interest, or support. The Gottmans found in their research that successful couples turn towards each other's bids for connection 85% of the time, while unsuccessful, unhappy couples only Turn Towards each other's bids 35% of the time. Have the partners practice making bids for connection and turning towards those bids using either the 'Gottman-Rapoport Exercise or another intervention for expressing needs.

Jane feels that handling stressors outside the relationship is an issue, but John does not. Recommendations for therapy include:

• Explain that Jane does not feel supported by John when discussing stressful things happening outside the relationship, but John does not see this as an issue with Jane.
• Research by Jacobson has shown that the greatest predictor of couple therapy relapse is the couple's inability to handle external stress so help Jane and John understand that it is important for them to find ways to master this ability. Our research shows that stressed partners feel best when their partners listen, ask questions, and express empathy rather than jumping into solving the problem. This helps the stressed partner to feel less alone.
• Help Jane and John learn how to listen better, to ask Open-Ended questions about their partner's stress, (especially their feelings about what's most upsetting for them), and to express empathy to deal with stresses from outside the relationship.
• Encourage both partners when they are listening to their partner's stress, to not problem-solve or offer advice unless their partner asks for it. The Gottmans' Stress-Reducing Conversation exercise or another similar intervention can be useful in strengthening this skill.

John thinks that there are problems in how he and Jane relate to their in-laws. Jane does not think there are problems with how they relate to their in-laws. Recommendations for the therapist are as follows:

• Explore the history of Jane and John's problems in dealing with their in-laws.
• Help them discuss their feelings, thoughts and beliefs about this using an intervention that focuses on each partner deepening his or her understanding of the other's point of view before trying to negotiate a compromise. The Gottmans' Dream-Within-Conflict exercise works well for this issue, although many other conflict-focused interventions may work, too.
• Note: There may be cultural differences between the partners in how they relate to / respect their in-laws that could contribute to their difficulties. In some cultures, married couples are expected to live with or near their parents, resulting in one partner taking sides if the partner and parents disagree.
• Consider telling couples about studies that have found it crucial for the success of the relationship that couples put their partners first.

Jane and John both report problems with jealousy in the relationship. Recommendations for therapy include:

• Recognize it is likely that both Jane and John feel insecure in this relationship and worry their partner isn't committed to them. Their perceptions of each other's flirtatiousness may range from accurate to being a distorted view of their partner's behavior. It is important they discuss this issue.
• Help them each select a past incident to focus on in which they felt jealous due to the other partner's behavior. Process these incidents, one by one, so that they can more deeply understand one another's feelings in each incident and hear validation of those from their partner.
• Be sure to have each partner talk about any childhood feelings or experiences from before this relationship that may have been triggered during each incident. Include each partner's responsibility for what he or she may have contributed to each incident.
• Conclude this processing exercise with each partner providing a suggestion of could be done differently the next time to avoid incidents like these. Note: The Aftermath of a Regrettable Incident or Fight tool can be useful in this situation.
• Explore with each partner how appreciated and respected they feel in this relationship. Then, if lacking, help Jane and John to increase overt expressions of respect and appreciation in the relationship.
• Help the partners to voice their insecurities and jealousies without criticism or contempt by focusing on that partner's feelings, the situations that evoke those feelings, and their needs in these situations.
• Explore whether or not each partner is content with their sexual relationship. If not, their discontent may contribute to their behavior and perceptions of each other. Help each partner state what they want in their intimate life together.
• Normalize the fact that most people feel insecure from time to time, and what helps the most is reassurance that the other partner still finds the insecure person desirable.

Both partners acknowledge that an affair has occurred in the past and results in problems for the relationship. Both partners are feeling insecure about betrayal. The questions on this survey regarding affairs are general by design, due to the sensitive nature of this issue. If you have not already interviewed both partners about this infidelity, we suggest you do so to get more specific information. Recommendations for therapy include:

• Recognize that both Jane and John likely feel betrayed, insecure, and untrusting of the other partner. Their commitment to the relationship may be questionable if not, shredded.
• Make sure the affair(s) are over before doing couples therapy. If the affairs are not over, consider referring the person still having the affair for individual therapy to help that person decide which relationship he or she wants to sustain. Couple's therapy is not appropriate when an affar is still occurring.
• Realize that the affairs may have destroyed the fabric of the relationship, but it can be rebuilt.
• Inquire about any past therapy for the affairs. Many couples have sought help for affairs but have been told to either not discuss them or to forgive their partners prematurely. Neither approach is likely to have worked. Shirley Glass's book, Not Just Friends, and John Gottman's books, The Science of Trust, and What Makes Love Last, describe how affairs typically generate Post-Traumatic Stress Disorder in the betrayed partners, including hypervigilance, nightmares, intrusive thoughts about the affair, depression, emotional numbing, and occasional emotional explosiveness. Both partners may be suffering from PTSD. It is important that the therapist evaluates each partner for signs of PTSD, and if either partner is suffering from it, the therapist should provide an explanation of PTSD so that they can better understand each other's behavior, feelings, and fears.
• Begin therapy by dealing with each affair in turn. The betrayed partner should be encouraged to ask questions about the affair, including when it began, how it evolved, who it was with, and so on, with the other partner answering the questions non-defensively. The betrayed partner, however, should be dissuaded from asking questions about the actual sexual acts committed, since those questions usually trigger deeper traumatizing imagery for the betrayed partner. Transparency and honest answers are essential here in order for trust to begin to be rebuilt.
• The partner who had the affair should also be supported to listen to the betrayed partner's feelings about the affair without getting defensive. The other partner should be given non-critical and non-contemptuous ways of describing his or her feelings, and encouraged to bring up those feelings as much as possible only during therapy sessions. If the feelings spill over at home, that partner may want to write them down.
• Only after most questions have been answered and feelings have been heard, and after the betraying partner has deeply apologized for having the affair, can the therapist then begin to explore problems in the relationship that may have precipitated the affair. Beginning this process before the initial steps are taken risks blaming the betrayed partner for the affair, which in fact, was a choice made by the betraying partner alone.
• Explore all areas of the relationship needing intervention and change in order to begin re-structuring the relationship, rebuilding trust, and hopefully moving towards re-commitment. From time to time, the work may slide back to more questions being asked and feelings being expressed about the affair. Honor those, then return to the rebuilding process.
• Once, the first partner's affair has been fully processed, move on to working on the other partner's affair in turn.

John doesn't think he and Jane agree on basic values, goals and lifestyle. Jane thinks they do agree. They may be drifting apart or they may not discuss these issues at all. This could be a serious issue for the relationship. Recommendations for therapy include:

• Identify this area as a problem and explain that our research has found that 80% of breakups are because of people drifting apart in this area. Emphasize that more discussion about these issues can be helpful in order to understand each partner's choices and why he or she has made those choices while not taking sides about which values, goals, or lifestyles are best..
• Structure discussions between Jane and John about their differences in values, goals and lifestyle preferences. It helps to have one partner be the speaker, while the other partner is the listener. The speaker should present views without criticizing the views of the other partner. The listener should wait to present his or her views until it's his or her turn to be the speaker. Instead, the listener should be encouraged to ask Open-Ended questions such as, What is most important about that view? Is there some childhood history that has led to this viewpoint? Does the speaker have some ideal dream related to his or her viewpoint?
• Once Jane and John have each taken a turn as speaker and listener, help them negotiate compromises on their differing viewpoints if appropriate. The Gottmans' Compromise exercise is useful for this process, or any other intervention that helps the partners to accept influence from one another and reach a compromise that both can live with.

Jane doesn't think she and John manage household tasks well, but John thinks they do. Recommendations for therapy include:

• Identify this as an issue for the couple without taking sides or specifying how the partners should split up household responsibilities. They may have resentment or anger towards one another and a sense that the division of labor in the relationship is not fair. Underlying reasons for this problem may include disagreements about work/family balance, the role of men versus women (in heterosexual relationships), power struggles between partners, or difficulty expressing needs.
• Help Jane narrow down which issues in particular they agree or disagree in regarding household tasks.
• Take each issue in turn and help Jane voice what she does need rather than doesn't need regarding these issues. For example, if Jane said, 'I don't like how quickly you do dishes,' help her say instead, 'John, I need you to take your time doing the dishes so they get really clean.'
• Encourage each person to accept influence and Turn Towards their partner's needs.
• Often partners don't express appreciation for what each person is already doing. Encourage both partners to express appreciation to each other daily for the good things they are already doing.
• If there are differences in beliefs about what each person should do, for example, what a person should or should not do in order to be a good partner, then help the couple to discuss these underlying beliefs, including how their beliefs relate to their personal histories, their ideals, and other related needs.
• Help Jane and John reach a compromise in how they divide up household responsibilities that feels fair for each of them. You may need to explain that a compromise sometimes means making small changes rather than big ones, but that they can treat their re-balancing of tasks as a temporary experiment which can be modified in the future.

Jane and John believe that financial issues divide them. Recommendations for therapy include:

• Clarify the particular financial issues on which they disagree, such as how much to spend versus save, who should control the family money, how money should be spent, etc. Discuss each one in turn.
• For each conflicted financial issue, help Jane and John explore how that issue was managed in their families growing up or in their earlier adult relationships. Be sure that each partner also explains his or her reactions to those experiences.
• Help each partner explore the meaning of money. For example, some people money may signify freedom, power, or charity, etc. Ask them to describe how they formed their thoughts and feelings about money.
• Once the histories and values for a financial issue have been understood, help them specify what they need regarding that issue, and work on building compromise.

Jane and John lack ways of playing and having fun together. Recommendations for therapy include:

• Explain to Jane and John that play is the waking equivalent of dreaming. It is restorative and couples that laugh together have a greater chance at long-lasting success. The barrier to this is that life for many couples becomes an infinite to-do list and fun is their last priority.
• Be sure that other serious problems in conflict management are dealt with first, especially if they carry resentment that blocks them from wanting to spend time with each other. Work on those first before concentrating on spending fun time together.
• Discuss how important play is for health and balance, in both individuals and relationships.
• Ask Jane and John to reflect on the beginning of their relationship. Did they have fun together then? (Most likely they did.) Can any of those ways of having fun be re-introduced in the relationship? Help them create a weekly or even monthly date in which they can re-experience fun together.
• Give them a list of ways to have fun, such as the Gottmans' 'Fun and Play' card deck. Ask each partner to look through the suggestions and pick one (or more) that he or she would like to integrate into the relationship, then share those choices with each other. For the choices they both like, ask the partners to make a plan for including that way of having fun together in their relationship.

Jane and John lack a sense of spiritual connection with one another. This can be a problem for the relationship as it indicates they do not share some important values. Recommendations for therapy include:

• Explore what this lack of spiritual connection means to them, and what each partner needs in order to feel more spiritually connected to the other. Ask where their values are similar as well as different.
• Have each partner discuss how they each formed their spiritual values, including their family histories, early experiences, etc .
• If appropriate, suggest that they deepen their knowledge of one another and perhaps find more common ground on which to build greater connection.
• If the couple has young children or is planning to have children, they may need to discuss the spiritual values with which they want to raise their children.

Jane and John have issues regarding children. They either disagree about whether or not to have children, or they have children and disagree about how to raise them. Recommendations for therapy include:

• Identify the specific parenting issue(s) with which this couple is struggling.
• Use an intervention such as the Gottmans' Dream-Within-Conflict exercise or another interventions to manage conflict and help them understand each other's position on each specific issue. Facilitate their exploration of each other's underlying childhood history, earlier adult experience, values and needs relative to parenting without judging their partner's point of view.
• Once each partner listens to the other's point of view and understands it more deeply, guide them to move towards resolving their differences by settling on a temporary strategy with a plan to later re-evaluate and if necessary modify it. The Gottmans' Two-Oval Compromise exercise may be useful here.
• You may need to inform the couple about relevant developmental research so that they can more fully understand the implications of their parenting values. You may also want to suggest relevant readings or parenting classes for the couple such as Bringing Baby Home.
• If they disagree about whether or not to have children, and their positions appear non-negotiable, this may be a 'make-it-or-break-it' issue for them. In other words, they may decide to split up rather than forego their own position on the issue if compromise here isn't possible. If this happens, you may need to help them split in as gentle and understanding a way as possible, given this difference between them is unendurable and unbridgeable.

Jane and John think distressing events have occurred in the relationship. Recommendations for therapy include:

• Review the comments for this questionnaire as well as those in Section 5. These will include answers regarding addiction, domestic violence, and can provide more information about what events have troubled this couple. Conduct individual sessions with both Jane and John to explore in detail the identified events.
• If the events described are included in Section 5 questionnaires, refer to the recommendations in that Section for more specific clinical suggestions.
• If the events are not included in the Section 5 questionnaire answers, take note about which partner suggested the items above, and ask for more information, e.g., the circumstances, timing and events leading up to it, including how each partner initially handled it and how each is managing it now. If appropriate, this topic can be addressed both individually and in a joint session.
• If trauma is involved, look for symptoms of PTSD, depression, and any other troubling reactions, given the circumstances. Refer each partner for treatment or medication evaluation accordingly.
• Try to understand how the couple's responses to their hard events may have shifted them into unhealthy patterns within the relationship, such as explosive conflict management, greater emotional distancing, less interpersonal trust, less sexual intimacy, etc.
• Treat the relationship fallout of the events according to what processes have been affected by them.

Jane and John are gridlocked on perpetual problems. Recommendations for therapy include:

• Identify the issue(s) that either one or both partners feel is gridlocked. Explain that every couple has perpetual issues, which are those that never get fully resolved, as they are based in either personality differences or unmatched lifestyle preferences. Note: If one person in the relationship believes that he or she is gridlocked on an issue, then inevitably they are both gridlocked, since it only takes one person’s difficulty with dialogue to render the issue difficult to discuss for both of them.
• Explain that our research shows sixty-nine percent of all problems couples have, including healthy couples, are perpetual problems. The difference between healthy and unhealthy relationships is in how a couple processes these problems. If they are discussed with humor, positive affect, and acceptance, they don’t usually trouble the couple. However, if discussions of these issues lead to explosive fights, tense avoidance of the issues, or escalated quarrels, the issue is said to be “gridlocked.”
• Learn what form their gridlock has taken. For example, has the couple avoided any discussion but harbored resentment, or have they attempted discussion only to end up screaming and flooded? Check other conflict questionnaires to see if criticism, contempt, defensiveness and/or flooding permeate their discussions. If so, begin with presenting alternatives to these conflict dynamics. Alternatives can be found in the clinical feedback for the other conflict management questionnaires.
• Consider using the “Dream-Within-Conflict” Intervention that uncovers underlying values, beliefs, dreams and personal history that may inform each person’s position on their gridlocked issues. Our research has shown that dialogue about gridlocked issues fails because partners’ dialogue hovers on the surface when actually, partners have hidden feelings and beliefs beneath their position that are crucial for understanding.
• Once people understand their partner's position on gridlocked issues, they can respond with more compassion, empathy and clarity and may be more open to creating a compromise that honors at least part of each other’s needs on the issues. The Gottmans’ “Two Oval Method for Compromise” is useful here, or any other exercise that underscores what partners are inflexible about as well as more flexible about regarding their positions.

Jane and John are lacking shared rituals of connection in their relationship. Recommendations for therapy include:

Explain to Jane and John that creating shared rituals of connection will help them to improve the connection in their relationship. Describe shared rituals of connection as intentional times that partners spend together willingly and predictably when they know they can count on the other's presence. These are a source of joy, fun, contemplation, and connection and may include small events, like partings in the morning or reviewing their days' activities together at dinnertime, or big events, like annual birthdays and holiday celebrations. When couples don't predictably and intentionally connect with one another, they grow apart and feel emotionally distant from one another. This state often follows intense times of either raising children, building careers, or grappling with unforeseen events that result in energy expended elsewhere.
• See if this couple once had rituals of connection for the relationship, and if so, what interrupted them. If they had them in the past, understand what the rituals were and which ones, if any, they might want to re-integrate back into the relationship. Talk about how to do so, including details of what, when, where, and how their rituals of connection can be carried out.
• Using a list or an exercise like the Gottmans' Rituals of Connection card deck, provide Jane and John with suggestions for both small and large rituals of connection that they may want to consider adding into their relationship time together. Couples who have suffered from years of emotional distance may need to start small, for example, with 10 minutes a day of taking turns sharing the highlights and lowlights of their day, then building towards a weekly date night, or even quarterly weekends away together.
• Be sure to follow up at the next session on how their ritual of connection proceeded, and whether they would like to fine-tune their ritual after trying it out once or twice.

Neither Jane nor John feels supported by the other in their various life roles. Recommendations for therapy include:

• Look for gridlocked conflicts in this couple, particularly those regarding their roles in life. Most couples with negative ratings on this scale hold very different values about roles which means they do not feel valued, honored or supported in how they live their lives as lover, partner, worker, and/or family member. Not sharing similar role definitions means these partners probably resent one another, feel unappreciated and disrespected and therefore, fight over how they live these roles day to day. Take care to define which roles generate the most conflict between them, and focus on them one by one.
• For each role related conflict, try to intervene with an exercise like the Gottmans' Dream Within Conflict that creates a speaker/listener structure to help each partner understand the other's history, beliefs, and dreams that have shaped their values regarding their roles in life. It's crucial that understanding precedes problem solving. In other words, these partners need to understand how and why their partners view a specific role differently from how they view it themselves before they approach problem solving.
• Once they understand each other's views about roles, help them work on a compromise in which they honor both their partner's core needs and their own if possible by remaining flexible about role needs that aren't as essential to them. The Gottmans' Two Oval Method for Compromise may be helpful here.
• As Jane and John deepen their understanding of each other's role ideals, ask them to answer the following question for the other: What can Jane or John do to honor and support the other in their chosen role? Remind the couple that our roles give our days meaning and purpose.

Jane feels that her life goals are not supported, but John believes his goals are supported. Recommendations for therapy include:

• Talk with Jane and John about Jane's individual life goals and her goals for their lives together as a couple, including why each of these goals is personally important to her. Perhaps Jane has never talked about her individual goals or personal visions for their future. Or perhaps John doesn't agree with her goals and doesn't support them. Jane may think she has to fight John to accomplish her goals, both individual ones and those for their future together. This may mean a series of discussions, taking each goal one by one in order to understand what values, history, and dreams underlie Jane's belief in them versus John's disagreement with them. Why is a particular goal so important to Jane, but unimportant or even wrong from John's viewpoint?
• Help Jane and John to have these discussions with each other. Be careful that the couple doesn't descend into criticism or defensiveness during their conversations. The Gottmans' Dream Within Conflict exercise may be useful to create a listener/speaker structure in which partners share their deeply held beliefs, history, and dreams that often underlie personal goals and future visions, without moving too quickly into problem solving.
• If compromises are needed in a conflict about Jane's goals, help them identify what each of their core needs are regarding her goals so that they can work towards compromise without Jane having to give up dreams. The Gottmans' Two Oval Compromise exercise may be helpful for distinguishing between aspects of their differing outlooks that are personally meaningful versus less important and more easily sacrificed.
• Ask Jane to clarify for John what support she would appreciate from him in reaching her goals. The Gottman-Rapoport Exercise might be helpful to ensure that John clearly understands Jane's needs. Reinforce John for Turning Towards Jane in fulfilling these needs as best he can.

Jane and John disagree in their views on basic relationship symbols.Recommendations for therapy include:

• Explain to Jane and John that there are some universal symbols that are critical in any relationship such as: the meaning of a home, the meaning of money, the meaning of love. The way they view these symbols together influences how connected they feel in their sense of shared life purpose.
• Learn which particular symbols Jane and John disagree about.
• Look through relevant questionnaires, such as the 12-Area Checklist, for conflicts they may have regarding these symbols.
• Help them discuss their symbol-based conflicts by focusing on their differing interpretations of these symbols. Be careful that they don't descend into criticism or defensiveness during their conversations. The Gottmans' Dream Within Conflict exercise may be a useful tool as it creates a listener/speaker structure in which partners share their deeply held beliefs, history, and dreams that often underlie personal interpretations of symbols, without moving too quickly into problem solving.
• If compromises are needed when there are conflicted meanings given to symbols, help them identify what each of their core needs are regarding these symbols so that they can work towards compromise without giving up their dreams. The Gottmans' Two Oval Compromise exercise may be helpful for distinguishing between aspects of relevant symbols that are personally meaningful versus less important and more easily sacrificed.
As the couple comes to better understand the meanings they each give to relevant symbols, ask the partners what support they would appreciate from one another in honoring the meaning they give to the relevant symbol. The Gottman-Rapoport Exercise might be helpful here to ensure that they are clearly hearing each other.

Jane and John both indicate there is an alcohol problem. Further assessment should be made to determine the nature of the alcohol problem and to rule out an alcohol use disorder. Recommendations for therapy include:

• Recognize that the presence of alcohol in the relationship is a serious problem. Alcohol disinhibits aggression and can lead to episodes of severely escalated quarrels, emotional abuse, and/or physical violence. Alcohol abuse may also lead to greater emotional distance between partners, since they are living at least part of their lives together behind masks of intoxication. There may be serious medical consequences for them.
• Ask each person during their individual sessions the following questions:
  1. How much are you currently drinking?
  2. How much is your partner drinking?
  3. Are you or your partner in alcohol treatment?
  4. Have either of you been treated for alcoholism in the past?
  5. Have you attended AA in the past and would you consider either beginning or returning to your meetings?
  6. Would you consider undergoing detox and/or treatment now?
• Ask both Jane and John how alcohol has affected the relationship, including escalated quarrels and/or emotional distance and loneliness.
• In joint sessions, address the alcohol consumption of both partners as a third party in the relationship that is leading to relationship distress. Use results from other relevant questionnaires to supply additional evidence of the consequences of drinking to the relationship.
• Inquire as to whether Jane and/or John would be willing to limit their intake to one drink a day or quit altogether.
• Ask that neither Jane nor John consumes any alcohol at least 8 hrs. before the time of your session.
• If the partners are willing to quit drinking, advise them to attend AA meetings and to continue their work with you.
• Consider referring either partner to an addictionologist or another specialist in the treatment of alcohol / drug abuse to conduct a more detailed evaluation and individual treatment for the problem.
• Alcoholism has also been shown to be successfully treated with joint therapy. Refer to the work of Robert Navarra, Psy.D. and others for details about how to conduct such treatment.

Jane believes that John has a problem with substance abuse. John does not think Jane has a substance abuse problem. Recommendations for therapy include:

• Recognize that the presence of an alcohol or drug problem in the relationship is a serious concern. Alcohol disinhibits aggression and can lead to episodes of severely escalated quarrels, emotional abuse, and/or physical violence. Drug abuse may also lead to greater aggression or emotional distance between partners, since John living at least part of his life behind a mask of intoxication. Depending on the drugs being used, there may also be serious medical consequences for John if he continues usage.
  1. What substance(s) is John currently using and how much per day/week?
  2. Is John currently being treated for substance abuse?
  3. Has John been treated for substance abuse in the past?
  4. Has John attended AA or NA in the past and would he consider either beginning or returning to meetings?
  5. Would John consider undergoing detox and/or treatment now?
• Consider referring John to an addictionologist or other specialist in the treatment of alcoholism or drug abuse to conduct a more detailed evaluation and individual treatment for the problem. It may also be helpful to ask each partner how alcohol or drugs have affected the relationship. Be sure to inquire especially about escalated quarrels and/or emotional distance and loneliness.
• If John acknowledges that he has a substance abuse problem and is willing to quit drinking or using drugs, advise him to also attend AA or NA meetings, and Jane, to attend Al-Anon meetings.
• In conjoint sessions, address John's alcohol and/or drug consumption as a third party in the relationship that is leading to relationship distress and possible serious health concerns. Use results from other relevant questionnaires to supply additional evidence of the cost of substance abuse to the relationship.
• Request that before coming to sessions, neither partner consumes any alcohol or drug for at least 8 hours before the time of your session.

SUICIDE ALERT

At your next meeting(s) with the suicidal client, it may be necessary to create a subsequent contract, changing the dates as appropriate, until the client no longer appears in danger of self-harm. However, if the partner refuses to sign such an agreement, or for any reason, you don't believe in their credibility even if he or she has signed it, inform the person that in order to prevent his or her self-harm, it will also be necessary for you to call in local officials in order to evaluate this individual for possible involuntary psychiatric hospitalization under relevant state laws. Be aware that failure to follow these recommendations may result in tragic consequences for either or both partners and possible legal penalties for you. The goal is to help keep the suicidal individual safe.

Both John and Jane report moderate to severe situational domestic violence in their relationship. Recommendations for therapy include:

• Recognize that situational domestic violence is minor domestic violence that does not constitute battery and usually does not involve clear perpetrator/victim dynamics. The violence usually follows escalated quarrels in which anger and frustration lead to physical acting out, but there are no injuries in situational violence, and weapons are not involved. Situational violence is usually symmetrical, meaning both parties are violent and take full responsibility for their actions, feel remorse, guilt and regret, and want very much to change.
• Consider Donald Dutton's research which has shown that in 70% of the physical altercations, the woman throws the first blow, but the male usually causes more harm.
• It is crucial to first have an individual session with each partner in which a comprehensive evaluation of the relationship violence is conducted. Clarify the details by asking the following questions: How frequently does the violence occur? How does it begin? How does it end?What specifically happens during the violence and do you attempt to process what happened afterwards? If they do talk about the episode later, what is the outcome? Do both Jane and John honestly admit their responsibility for what happened, especially for the actual violence itself? Or does one partner blame the other for it while ignoring his or her own personal accountability? Do both Jane and John wish to eliminate their own outbreaks of violence? Was alcohol, drugs, or both involved during any of the episodes? Is either partner fearful about the other partner learning that he or she has disclosed information about the violence?
• Be sure to check if any of the episodes have resulted in injuries, broken bones, lacerations, medical visits, or serious bruising. >li>Be sure to check the findings from the next series of questionnaires on characterological domestic violence, as the responses on the above questionnaire may only represent minor episodes in a broad spectrum of serious violence in which couple therapy is contraindicated. If responses to the questions here and/or scores on the following questionnaires indicate the possibility of characterological violence, please see recommendations for the presence of this much more serious problem.
• Given that the domestic violence does not appear to be characterological, the Gottmans' research findings suggest that couple's therapy may be appropriate for Jane and John. Inform theme that the first task of therapy should be to eliminate all domestic violence.
• Review your findings on the conflict management scales, especially the 'Flooding' scale. If flooding is a problem, help the couple to work on the problem of diffuse physiological arousal (flooding) during their conflicts, a state in which one or the other partner moves into 'fight-or-flight,' perceives him or herself to be the object of attack, and reacts by becoming physically aggressive.
• Help them recognize when one or the other is getting flooded, so that either partner can initiate taking a break. During the break the partners should move out of visual and hearing range of the other partner for at least 20-30 minutes, but for not more than 24 hrs. Before separating they should indicate what time they will return to resume their discussion. While they are on break, they should not think about what has been said or rehearse what they can say to their partner when they return. Instead, they should engage in self-soothing activities that get their minds off the conflict such as reading a magazine or book, taking a walk, listening to music, practicing some yoga or meditation, or any other activity they individually find soothing. When they return from their break, they can resume their conversation provided they feel much calmer. In this way, they can avoid escalating their conflict and future violence.
• You may want to recommend that they obtain a biofeedback device that monitors their heart-rate and teaches them to slow their pulse to a reasonable level. If they practice daily with such a device, they may find it much easier to stay calm during conflicts. The Emwave which is made by HeartMath may be helpful here.
• Work with Jane and John to improve other conflict management skills, such as editing out criticism, contempt, and defensiveness, raising complaints gently, making repairs in their conversations before escalations begin, and so forth. You may want to refer to the suggestions for other conflict management scales cited earlier in this document.
• It will be important to help the couple process past regrettable incidents and fights, especially those involving violence. The 'Aftermath of a Fight or Regrettable Incident' exercise may be useful here as it teaches couples how to process such incidents with one another in a carefully structured and thorough manner without getting back into the fight.

Both Jane and John report possible or definite characterological domestic violence in their relationship. Recommendations for therapy include:

• Recognize that characterological domestic violence is defined as domestic violence in which there is a clear victim and a clear perpetrator. The violence is used by the perpetrator as a means to control and instill fear in the victim. Regardless of what the victim does, the violence will continue. The perpetrator does not take responsibility for the violence but instead believes that the violence was "justified" by the victim's words or actions. The perpetrator may also deny there was any violence altogether and try to convince others that the victim is "making it up." The perpetrator's violence is often serious enough to cause injury and poses a severe risk to the victim. Thus far, no treatment has been shown to successfully treat characterological domestic violence. However, the Gottmans' scientific study of a treatment program for domestic violence shows the following results: If the domestic violence is more severe than situational domestic violence but does not fit the full criteria for definite characterological domestic violence (and is named here, "possible characterological domestic violence"), it may be treatable. Because both Jane and John report that there may be or definitely is characterological domestic violence in the relationship, this is an extremely serious concern for this couple.
• Review the scores on all three sections of each partner's answers to delineate whether or not either partner is engaging in definite characterological domestic violence.
• Then, interview each partner separately in an individual session to learn more about the violence. Clarify details such as how frequently the violence occurs, how it begins, how it ends, what specifically happens during the violence, and whether the couple attempts to process what happened afterwards. If they talk about the episode later, what is the outcome? Do both the partners honestly admit their responsibility for what happened, especially for the actual violence itself? Or does one partner who has been violent only blame the other for it while ignoring his or her own personal accountability? Do both partners wish to eliminate their own outbreaks of violence? Was either alcohol, drugs, or both involved during any of the episodes? Is either partner fearful about the other partner learning that he or she has disclosed information about the violence? Has either partner felt controlled by the other partner? If so, how has the other partner exacted the control over the person you are interviewing?
• Be sure to check if any of the episodes have resulted in injuries, broken bones, lacerations, medical visits, or serious bruising.
• In these interviews, you are attempting to confirm characterological domestic violent behavior in either one of the partners.
• Based on the scores above and your interviews, if either partner appears to be definitely characterologically violent, it is imperative that you inform the other person that by staying with his or her partner, he or she is at risk for physical and/or emotional injury and possibly even death. Only separation from that partner can help to ensure his or her safety.
• Emphasize the necessity of creating a safety plan in which one partner leaves the other in such a manner as to increase his or her chances of not being stopped, followed, or found.
• If there are children involved, they should also be taken along with their needs included in the safety plan.
• You may want to provide your client with the following resources: The first is the National Domestic Violence Hotline which is staffed 24 hrs. a day and can provide support and resources. Their number is 1-800-799-7233. Most states also have a state Domestic Violence Hotline so provide your client with that number.
• If neither Jane's nor John's scores and interviews suggest DEFINITE characterological violence but instead indicate POSSIBLE characterological violence, joint therapy may be conducted but only with extreme caution. It may still be advisable to recommend that the couple separates until such time as the violence is totally eliminated. If they accept this recommendation, a temporary separation can be structured in which they meet only in your office or at other venues in which their safety can be better ensured rather than at home, e.g., a restaurant, coffeehouse, theatre, etc. The following recommendations are relevant only for possible characterologically violent partners.
• Review the alcohol and drug questionnaires. If either partner appears to have a problem with substance abuse, inform the couple that the alcohol or drugs may be playing a role in their domestic violence. Recommend that treatment be sought for the substance abuse.
• Inform the couple that the first task of therapy should be to eliminate all domestic violence. Review your findings on the conflict management scales, especially the "Flooding" scale. If flooding is a problem, help the couple to work on the problem of diffuse physiological arousal (flooding) during their conflicts, a state in which one or the other partner moves into "fight-or-flight," perceives him- or herself to be the object of attack, and reacts by becoming physically aggressive.
• Help the couple to recognize when one or the other partner is getting flooded, so that either partner can initiate taking a break. During the break the partners should move out of visual and hearing range of the other partner for at least 20-30 minutes but for not more than 24 hrs. (unless, of course, they are already living apart). Before leaving for their break, they should indicate what time they will return to resume their discussion. While they are on break, they should not be thinking about what has been said or rehearsing what they can say to their partner when they return. Instead they should engage in self-soothing activities that get their minds off the conflict such as reading a magazine or book, taking a walk, listening to music, practicing some yoga or meditation, or any other activity they individually find soothing. When they return from their break they can resume their conversation provided they feel much calmer. In this way, they can avoid escalating their conflict and future violence.
• You may also want to recommend that each partner obtains a biofeedback device that monitors their heart-rates and teaches them how to slow their pulse to a reasonable level. If they practice daily with such a device, they may find it much easier to stay calm during conflicts. The Emwave which is made by HeartMath may be helpful here.
• Work with the couple to improve other conflict management skills, such as editing out criticism, contempt, and defensiveness, raising complaints gently, making repairs in their conversations before escalations begin, and so forth. You may want to refer to the suggestions for other conflict management methods cited earlier in this document.
• It will be important to help the couple process past regrettable incidents and fights, especially those involving violence. The Gottmans' "Aftermath of a Fight or Regrettable Incident" exercise may be useful here as it teaches couples how to process such incidents with one another in a carefully structured and thorough manner without getting back into the fight.
• Often an individual's possible characterological domestic violence has been shaped by his or her earlier history. That history may include traumatizing experiences during childhood, military service, and/or events from other times. If these surface, you may want to refer either partner for additional individual treatment and/or explore his or her history during the conjoint work to understand how its lasting effects are contributing to the couple's troubled patterns.

Both Jane and John report that they are being emotionally abused by their partner through moderate or severe social isolation. Recommendations for therapy include:

• Understand that social isolation is a type of emotional abuse in which one partner prevents the other partner from having friends or social supports outside the relationship, so that the emotionally abusive person can have complete control over his or her partner. Often fears that the recipient of the isolation will betray the abusive partner underlie this form of abuse. It is rare for both partners to be engaging in this form of abuse at the same time. Usually social isolation is thrust on one partner by the other, without reciprocity. However, this case, in which both partners are socially isolating each other, reveals extreme distrust on both sides. This may be a toxic psychological situation that is potentially dangerous to Jane or John's mental and/or physical health. It appears that both partners fear betrayal by the other partner, and their fears compel them to try to over-control the social lives of each other. This is a serious concern for this relationship.
• In individual interviews with each partner, learn more about the details of the tactics being used for social isolation. Assess if and how each partner may have felt betrayed in the past by the other partner, and what fears each may have about future betrayal.
• If these interviews occur early in the therapy before a therapeutic alliance and trust have been established, do not attempt to confront either partner with how they are performing the isolation of the other partner. This will only produce defensiveness and the perception that you are taking sides. Instead, in subsequent joint sessions, gently approach the issue of fear of betrayal. Learn if they have worked through and recovered from betrayals of the past. If not, address them first, either using the work of the Gottmans (See the books, The Science of Trust or What Makes Love Last), Sue Johnson, Peggy Vaughan, Shirley Glass, or others' that you think may be helpful.
• It is important that each partner has a chance to describe how the social isolation has impacted his or her life. Have each partner address the emotions and experiences of feeling socially isolated while the other person listens and then responds. Be careful that the partner speaking does not use criticism or blame of the listening partner but instead only describes his or her own feelings when hearing particular words of the partner. If the listening partner reacts defensively, slow things down. You may want to personally re-word the speaker's description using interventions of the psychologist, Dan Wile, which soften and deepen the speaker's words and make them less threatening to hear. The point here is to bring out the yearning each person feels for love, loyalty and safe connection with their partner.
• If either Jane or John has experienced betrayal before their relationship with each other, help either partner to describe this betrayal and the impact on him or her so each partner can understand more compassionately why attempts were made to socially isolate the other partner in the past. Then aid each person to discover new ways to express their needs for loving safety and security with their partner. The Gottmans' Expressing Need card deck may be useful here. Each partner should be encouraged to detail what words or behaviors help them to feel loved and safe.
• Reinforce each partner whenever he or she turns towards their partners' needs rather than ignoring or belittling them for having needs.
• Help the couple to create and integrate into their relationship new rituals of connection with one another that will help to deepen their friendship and enhance their romantic interactions.
• Gradually introduce the notion that with more feelings of safety and security, it is OK for each partner to have other friendships and supportive connections outside this relationship. Then enable the couple to discuss outside relationships they want to have, including what needs those relationships serve for them and the boundaries that protect these relationships from becoming a threat to the couple's relationship.
• Be sure that both partners can ask for and receive reassurance of being loved from the other if either one feels insecure again.

Both Jane and John report being emotionally abused by each other through degradation and humiliation. Recommendations for therapy include:

• Understand that degradation and humiliation are powerful forms of emotional abuse that can endanger the mental and physical health of the recipient. Degradation involves one partner belittling and insulting the other partner when they are either alone together or with other people. It also includes one partner gaslighting the other, a term derived from an old movie in which the abusive partner repeatedly invalidates their partner's reality while presenting a different reality that contradicts it, a process that ends up making the victim feel crazy. This abuse shreds the victim's self-esteem and self-concept, thereby rendering that partner fearful and easier to control. The long-term effects of degradation and humiliation can approach those of physical abuse in creating Depression, Post-Traumatic Stress Disorder, and other anxiety-related problems in the victim. Because both partners report emotional abuse through degradation, this form of abuse is a serious concern for this couple.
• If it is early in the therapy, individually interview each partner in terms of their being the victim of their partner's abuse. Learn what has happened that has led each of them to feel degraded and humiliated by their partner. Carefully assess what lasting effects the emotional abuse has had on them. Also find out whether or not they have processed these events together afterwards and recovered from them. Has the abusive partner held him- or herself accountable for the abuse? Does the abuser express to his or her partner a wish to change his or her behavior? Your findings from these interviews can inform you about whether this abuse appears to be changeable in this relationship or is perhaps intractable.
• In a joint session, educate them about the effects on mental and physical health of this form of abuse. For example, John Gottman has found in his research that contempt in a relationship (which includes humiliating and degrading the partner) is one of the strongest predictors of separation or divorce as well as a compromised immune system in the recipient. It might be helpful to say that couples often resort to degrading and humiliating their partner when they are furious, frustrated, or flooded, and have no other ways for communicating how they feel. Unfortunately this way of communicating sabotages their being listened to. Explore whether Jane and John can at least intellectually acknowledge their parts in their emotionally abusive interactions with each other.
• Process an experience in which each of the partners has experienced being humiliated and degraded by the other. Using an intervention like the Gottmans' The Aftermath of a Regrettable Incident or Figh exercise, help the couple to share their feelings, points of view about what happened, their specific regrets about the incident, and their ideas about how to make such an experience better next time. For each of these incidents, be sure each partner fully grasps the other partner's reality about these incidents so that they each understand the impact of their emotionally abusive behavior on their partner.
• Explore each partner's earlier history to learn from whom they learned the communication style of degradation and humiliation, as most partners who use this pattern have learned it early on in their lives through their caretakers humiliating and degrading them.
• Work with the couple on changing their ways of expressing anger, resentment, and other negative emotions in ways that are not degrading, humiliating or otherwise emotionally abusive for their partner. Focus on the importance of using words like, I feel something or I'm upset about... (about what situation, not about some trait of the partner's). Have them practice expressing their feelings and needs using this alternative.
• Review other questionnaire findings to see if either partner reports getting flooded during their conflicts. If flooding or diffuse physiological arousal is a problem for either partner, work on the couple taking breaks when either person becomes flooded. (See recommendations for work on flooding cited in the Flooding Scale feedback or in the Gottmans' writings.)

Both Jane and John report being moderately or severely emotionally abused through sexual coercion. Recommendations for therapy include:

• Recognize that sexual coercion is a form of emotional and/or physical abuse that includes one partner's sexual insensitivity towards the other, pressuring sex when that partner doesn't want to, intentionally hurting the other partner during sex (either one of the latter actions may constitute rape). By using sexual coercion, the abusive partner may be trying to sexually denigrate his or her partner so that the abuser can psychologically and/or physically control the partner. Sexual coercion can endanger the victim's mental and/or physical health and produce lasting effects such as Depression, Post-Traumatic Stress Disorder, or other anxiety-related disorders. It is extremely rare for both partners in a relationship to report being abused through sexual coercion but Jane and John have.
• Interview each partner individually. Ascertain what experiences each one has had of being sexual coerced by his or her partner. Check for the possibility of poor communication during sex in which either partner may have misunderstood the communications of the other partner. For example, one partner may have interpreted the other's silence to mean consent, or not believed their partner's veracity regarding their needs. If early in the therapy, approach each partner carefully when questioning his or her role in the couple's sexual relationship. Avoid blaming or criticizing either of them for their behavior, but instead, focus on their perception of their sexual life and their likes and dislikes. Above all, ask each partner if they are experiencing warmth and closeness during their lovemaking. (It is likely that they are not.) Evaluate each partner for signs of psychopathology such as PTSD, Depression, problems with addiction, or personality disorder.
• Examine the results of other questionnaires, particularly the ones on substance abuse, psychopathology (SCL-90), and conflict management. If any of these suggest drug or alcohol abuse being part of the picture, or a partner with Antisocial Personality Disorder or other psychopathology, or flooding plus other conflict mismanagement, be aware that referral for individual psychotherapy or addiction treatment and/or psychiatric evaluation may be needed to augment conjoint treatment.
• In joint work, address sexual coercion and how it is sabotaging the couple's safety, closeness and trust with one another. Try to understand how and why it is being used within the broader context of the couple's relationship. Sometimes sex is forced as a desperate attempt to recapture closeness when closeness seems impossible to achieve otherwise. Focus on what dynamics trigger episodes of sexual coercion in order to glean needs beneath the surface that are not being expressed or met. Once these are fully understood, help them find alternative ways of voicing their needs verbally. The Gottman-Rapoport Intervention may be useful here.
• Suggest that the couple foregoes sexual contact for awhile until greater trust and emotional intimacy can be found. Then their sexual expression can be re-created in such a way that it manifests their love for one another rather than sabotaging their closeness.
• Using an intervention like the Gottmans' Aftermath of a Regrettable Incident or Fight help the couple process incidents that have felt most injurious for each of them. Be sure both partners, depending on the incident, understand the impact of their negative behavior and take responsibility for it where appropriate.
• Work on developing new rituals of connection that help the couple build emotional safety and intimacy. In doing so, it may deepen the work to include unearthing each partner's old childhood history regarding how each was ignored, neglected, or perhaps abused that may have led to their current patterns of interaction.
• Re-introduce sexuality as an open door once the couple has strengthened their friendship and conflict management. You might have each partner create a ladder of erotic behavior, moving from least anxiety-provoking to the more difficult steps, and then based on acting upon these, with the smallest steps coming first, suggest that they gradually re-introduce sexual intimacy into their relationship. Be sure that either partner feels free to say, no or stop with absolutely no penalty. Additional tools for this work can be found in the Gottmans' Gottsex kit.

Both Jane and John report emotional abuse through property damage. Recommendations for therapy include:

• Recognize that emotional abuse through property damage is defined as one person either destroying items his or her partner cherishes and/or damaging vehicles, house structures (often walls or doors), furniture, or other items. A partner's damage of property is often a dysfunctional way to express rage, anger, frustration, or other negative emotions because it involves physical,violent action, may frighten and intimidate the other partner, reminding him or her of the possibility of bodily violence and thereby increasing the abuser's control over the partner. Emotional abuse through the damage of property is extremely stressful for the victim, jeopardizing the victim's mental and/or physical well-being.
• Individually interview each partner to learn details of how they have each experienced emotional abuse through their partner's damage of property. Find out what triggered these episodes, how each partner behaved during them, specifics of what damage was done, and the outcomes of each episode. Most likely they occurred during escalated quarrels. Are there particular issues that generate these episodes? Are alcohol or drugs involved? Has either partner been frightened or intimidated by them? Has the couple attempted to process these events with each other afterwards? If the episodes were discussed later, has the abusive partner acknowledged responsibility and guilt for his or her actions? Or does the abusive partner only blame the other partner? Also, assess each partner for possible psychopathology such as Depression, PTSD, or other anxiety-related problems.
• Review findings on other relevant questionnaires for both partners, such as the conflict management, flooding and psychopathology scales. Most likely, one or both partners has reported difficulty with flooding or diffuse physiological arousal plus other conflict management problems.
• Work first on eliminating explosive and emotionally abusive behavior by educating the couple first on its effects. Then process episodes in which each partner has played the abusive role. Be sure that each partner fully understands and takes responsibility for the impact his or her behavior has had on the other partner.
• For each partner, see if early childhood experiences were either related to the abuser's actions or to the other partner's response to them. Often partners who in childhood have witnessed their caretakers being abusive repeat the abuse later either as perpetrator or victim in their own adult relationships.
• Be sure to work on antidotes to flooding or diffuse physiological arousal by teaching the couple how to recognize when they are beginning to get flooded and to take effective breaks before their conflicts become escalated. Refer to the recommendations listed for the flooding scale and elsewhere in this document.
• Review the results of their conflict management scales, and work on giving them tools for calmer and more gentle conflict management.
• Help them voice their needs to one another without using criticism or blame. The Gottman-Rappaport exercise may be useful for this.
• Encourage Jane and John to Turn Towards each other in their responses to needs being expressed.
• Help them build new rituals of connection, or ways of connecting with one another that they can count on in order to deepen their friendship, trust and feelings of safety with one another.

Both John and Jane have elevated scores on the SCL-90 Somatization scale. This is a concern for the relationship and for each of the partners as well. Recommendations for therapy include:

• Individually interview each partner to learn more about their symptoms relative to this issue. What symptoms in particular are troubling them? How long have they suffered these symptoms? Have they ever been treated for them? If so, what treatment did they receive? Are they currently taking any medications for this problem? Would they be willing to permit you to speak with the health practitioner who has been helping each of them with this problem? Do they think this health issue may be affecting their relationship? If so, how? Gathering this information will help you to address the particular relationship dynamics that may be affected by the specific symptoms suffered by each partner. Be sure to review other questionnaire results that may also reflect the specific concerns related to this problem.
• Consider referring each partner to an individual therapist for treatment of this problem, and to a psychiatrist for an evaluation and possible psychopharmacological intervention where appropriate.

Jane has an elevated score on the SCL-90 Obsessive-Compulsive scale. John does not. This is a concern for Jane individually and for the relationship as well. Recommendations for therapy include:

• Individually interview Jane to learn more about her symptoms relative to this issue. What symptoms in particular are troubling her? How long has she suffered these symptoms? Has she ever been treated for them? If so, what treatment did she receive? Is she currently taking any medications for this problem? Would she be willing to permit you to speak with the health practitioner who has been helping her with this problem? Does she think this health issue may be affecting her relationship? If so, how? Gathering this information will help you to address the particular relationship dynamics that may be affected by the specific symptoms Jane is experiencing.
• Also, individually interview John to learn from him how Jane's symptoms have been affecting him individually and his relationship with Jane.
• Be sure to review other questionnaire results that may also reflect the specific concerns related to this problem.
• Consider referring Jane to an individual therapist for treatment of this problem, and to a psychiatrist for an evaluation and possible psychopharmacological intervention where appropriate.

Both Jane and John have elevated scores on the SCL-90 Interpersonal Sensitivity scale. This is a concern for the relationship and for each of the partners as well. Recommendations for therapy include:

• Individually interview each partner to learn more about their symptoms relative to this issue. What symptoms in particular are troubling them? How long have they suffered these symptoms? Have they ever been treated for them? If so, what treatment did they receive? Are they currently taking any medications for this problem? Would they be willing to permit you to speak with the health practitioner who has been helping each of them with this problem? Do they think this health issue may be affecting their relationship? If so, how? Gathering this information will help you to address the particular relationship dynamics that may be affected by the specific symptoms suffered by each partner. Be sure to review other questionnaire results that may also reflect the specific concerns related to this problem.
• Consider referring each partner to an individual therapist for treatment of this problem, and to a psychiatrist for an evaluation and possible psychopharmacological intervention where appropriate.

John has an elevated score on the SCL-90 Depression scale. Jane does not. This is a concern for John individually and for the relationship as well. Recommendations for therapy include:

• Individually interview John to learn more about his symptoms relative to this issue. What symptoms in particular are troubling him? How long has he suffered these symptoms? Has he ever been treated for them? If so, what treatment did he receive? Is he currently taking any medications for this problem? Would he be willing to permit you to speak with the health practitioner who has been helping him with this problem? Does he think this health issue may be affecting his relationship? If so, how? Gathering this information will help you to address the particular relationship dynamics that may be affected by the specific symptoms John is experiencing.
• Also, individually interview Jane to learn from her how John's symptoms have been affecting her individually and her relationship with John.
• Be sure to review other questionnaire results that may also reflect the specific concerns related to this problem.
• Consider referring John to an individual therapist for treatment of this problem, and to a psychiatrist for an evaluation and possible psychopharmacological intervention where appropriate.

Both Jane and John have elevated scores on the SCL-90 Anxiety scale. This is a concern for the relationship and for each of the partners as well. Recommendations for therapy include:

• Individually interview each partner to learn more about their symptoms relative to this issue. What symptoms in particular are troubling them? How long have they suffered these symptoms? Have they ever been treated for them? If so, what treatment did they receive? Are they currently taking any medications for this problem? Would they be willing to permit you to speak with the health practitioner who has been helping each of them with this problem? Do they think this health issue may be affecting their relationship? If so, how? Gathering this information will help you to address the particular relationship dynamics that may be affected by the specific symptoms suffered by each partner. Be sure to review other questionnaire results that may also reflect the specific concerns related to this problem.
• Consider referring each partner to an individual therapist for treatment of this problem, and to a psychiatrist for an evaluation and possible psychopharmacological intervention where appropriate.

Both Jane and John have elevated scores on the SCL-90 Anger-Hostility scale. This is a concern for the relationship and for each of the partners as well. Recommendations for therapy include:

• Individually interview each partner to learn more about their symptoms relative to this issue. What symptoms in particular are troubling them? How long have they suffered these symptoms? Have they ever been treated for them? If so, what treatment did they receive? Are they currently taking any medications for this problem? Would they be willing to permit you to speak with the health practitioner who has been helping each of them with this problem? Do they think this health issue may be affecting their relationship? If so, how? Gathering this information will help you to address the particular relationship dynamics that may be affected by the specific symptoms suffered by each partner. Be sure to review other questionnaire results that may also reflect the specific concerns related to this problem.
• Consider referring each partner to an individual therapist for treatment of this problem, and to a psychiatrist for an evaluation and possible psychopharmacological intervention where appropriate.

Both Jane and John have elevated scores on the SCL-90 Phobic Anxiety scale. This is a concern for the relationship and for each of the partners as well. Recommendations for therapy include:

• Individually interview each partner to learn more about their symptoms relative to this issue. What symptoms in particular are troubling them? How long have they suffered these symptoms? Have they ever been treated for them? If so, what treatment did they receive? Are they currently taking any medications for this problem? Would they be willing to permit you to speak with the health practitioner who has been helping each of them with this problem? Do they think this health issue may be affecting their relationship? If so, how? Gathering this information will help you to address the particular relationship dynamics that may be affected by the specific symptoms suffered by each partner. Be sure to review other questionnaire results that may also reflect the specific concerns related to this problem.
• Consider referring each partner to an individual therapist for treatment of this problem, and to a psychiatrist for an evaluation and possible psychopharmacological intervention where appropriate.

Both Jane and John have elevated scores on the SCL-90 Paranoid Ideation scale. This is a concern for the relationship and for each of the partners as well. Recommendations for therapy include:

• Individually interview each partner to learn more about their symptoms relative to this issue. What symptoms in particular are troubling? How long have they suffered these symptoms? Have they ever been treated for them? If so, what treatment did they receive? Are they currently taking any medications for this problem? Would they be willing to permit you to speak with the health practitioner who has been helping each of them with this problem? Do they think this health issue may be affecting their relationship? If so, how? Gathering this information will help you to address the particular relationship dynamics that may be affected by the specific symptoms suffered by each partner. Be sure to review other questionnaire results that may also reflect the specific concerns related to this problem.
• Consider referring each partner to an individual therapist for treatment of this problem, and to a psychiatrist for an evaluation and possible psychopharmacological intervention where appropriate.

Both Jane and John have elevated scores on the SCL-90 Psychoticism scale. This is a concern for the relationship and for each of the partners as well. Recommendations for therapy include:

• Individually interview each partner to learn more about their symptoms relative to this issue. Ask the following questions: What symptoms in particular are troubling? How long have you suffered these symptoms? Have you ever been treated for your symptoms? If so, what treatment did you receive? Are you currently taking any medications for this problem? Would you be willing to let me speak with your health practitioner who has been helping with this problem? Do you think this health issue may be affecting your relationship? If so, how?
• Gathering this information will help you address the particular relationship dynamics that may be affected by the specific symptoms suffered by each partner. Be sure to review other questionnaire results that may also reflect the specific concerns related to this problem.
• Consider referring each partner to an individual therapist for treatment of this problem, and to a psychiatrist for an evaluation and possible psychopharmacological intervention where appropriate.

Poor appetite is an area of concern for Jane but is not an area of concern for John

Trouble falling asleep is an area of concern for Jane but is not an area of concern for John

Awakening early morning is an area of concern for Jane but is not an area of concern for John

Restless or disturbed sleep is an area of concern for Jane but is not an area of concern for John

Feelings of guilt is an area of concern for Jane but is not an area of concern for John