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As a private-practice family psychologist, I have found video therapy (Arauzo, Watson, & Hulgus, 1994) is both a tremendous
clinical and business aid. I have also used training aids such as bottles of Gatorade to help families understand and practice
good boundaries. While some literature supports the use of video in family intervention (e.g., Cunningham & Ward, 2003),
very little research is available documenting the effective use of visual aids to facilitate couple or family work. In this
article, I describe my clinical experience with both techniques. It is hoped that this description will encourage other scholar-practitioners
to begin providing evidence regarding the overall benefits of strategies such as these in therapy.
Video Therapy
To be both clinically and financially successful (the dual requirements for a successful private practice) a private-practice
family psychologist must work quickly, efficiently, and use research-based therapy techniques. This means that the private
practice clinician must constantly juggle and balance clinical and business requirements. Business demands include managing
(1) the marketing of the practice, (2) third party payers, (3) accounting and taxes, (4) office space, and (5) a competent
office staff. In private practice, there is a direct correlation between clinical abilities and increased business demands
and overhead. By reducing the number of therapy sessions, video therapy provides both a cost effective and clinically efficacious
treatment tool.
After obtaining all the necessary releases, family therapy sessions are videoed. The patients own the video and take the
recording with them out of each session for review and "homework." In this way they then have an unbiased record
of the session that allows each to look at the impact of his/her behavior on the other(s). Thus, video therapy allows the
family to see interaction-change and progress over time. For example, if during a family therapy session the parents begin
to fight, children typically become agitated and try various techniques to distract the parents and interrupt the fight.
While the parents may, for a while, try to ignore the child's attempt to distract, eventually one or both parents get sidetracked
and focus on correcting the child. Then, often with a glazed look on their faces, they will turn and ask, "Where was
I?" When this interaction is watched after the session, the impact of the behavior of the children is apparent to everyone
who watches the video.
With couples, video therapy is an excellent way to develop mutual empathy. Typically, in the heat of an argument, couples
do not listen to each other. Instead, they are focused on thinking about what they are going to say. After the session,
when the heat of emotion has subsided, the experience of watching the session often triggers an empathic response. I believe
this occurs for several reasons. They can listen, since they have already said what they wanted to say, and because anger
has been either expressed or processed, they are in a better place to experience empathy. I have often witnessed compassionate
responses from couples when watching video therapy. Therapeutic healing occurs from the insights, discussion, and understanding
that a family achieves outside of the therapy session using this powerful therapeutic tool. Watching the video therapy appears
to allow processing in a perceptually different way. A great deal of healing can occur outside the therapy session, allowing
the patient to maximize the time spent in therapy while minimizing the cost by using the session repeatedly.
Many times in family-of-origin therapy sessions, patients achieve resolution and healing, especially in repairing relationships.
However, the patient is often unable to recall the resolution later, or distorts the positive results of the therapy session.
When reviewing the videotape, the patient corrects any distortions and reinforces the positive outcome of the session. For
example, I worked with a twenty-four-year-old woman who feared that her twenty-two-year-old drug abusing brother would commit
suicide. I suggested family therapy so the members could talk about their fears and the impact the suicide would have on each
family member. During the session, her brother was clear-headed, convincing, and reassuring about the recovery steps he was
taking. Four months later he overdosed and died. The family was devastated and blamed themselves. I also wondered about my
therapeutic effectiveness. I asked the family to review with me the video tape session so I could help them process their
guilt. The videotape reassured them that they had done everything they could have done and had been deceived. It was validating
for me as not many therapists have the luxury of post-death reassurance. I, like the family, had imagined that I had done
something wrong, but when reviewing the videotape we could all correct our distortions.
Patients with trauma histories or dissociative disorders will often describe horrific events as if they are reading the
newspaper. In such cases the patient may be unaware of how disconnected he/she is from emotion and the disconnect between
content and affect. The patient is unaware that this ability to "look as if everything is ok" contributes to the
inability to get wants and needs met. When seen on playback, the person can see the incongruence between what is expressed
and what is felt. This aids in the beginning of self-empathy and the beginning of affect congruence. To illustrate, a client
recently videotaped her session during which she was processing her recent rape. She spoke without emotion, talked about a
horrific event as if she were reading a grocery list. I asked, "Do you know you're not showing any emotion?" She
could not comprehend the question. I stopped taping and played the tape for her. As she watched herself talking about the
trauma without outward emotion, she began stroking and comforting her image on the video monitor. With tears streaming down
her face she said, "Poor baby, poor baby, I am so sorry."
Training Aids in Therapy
I use Gatorade bottles to demonstrate boundaries. I have found that the use of Gatorade bottles to demonstrate boundaries
is an efficient, useful, and easily understood way to demonstrate the difference in perceptions, opinions, and feelings.
I use a bottle with red Gatorade and a bottle of green Gatorade. I give one bottle to the husband and say,"Imagine that
this is you and inside of this bottle are all of your thoughts and feelings." I do the same with the wife. Then I take
the bottles back and hold them together allowing the sides of the bottles to touch. I then say, "It does not matter
how close you get to each other, you cannot get in each other's bottles. The only way to know what is in the other's bottle
is to tell each other with words." Males especially, because they are visual, usually understand this concept immediately.
I ask the couple to attempt to learn what is in their partner's bottle, their innermost thoughts and feelings. The bottle
concept demonstrates the phenomenon of two people looking at the same event yet seeing and describing it differently. I use
the bottles to demonstrate visually the difficulty of controlling, manipulating, or making someone do anything they do not
want to do. I have two bottles "Velcroed" together to demonstrate enmeshment. I pull these bottles apart to demonstrate
stuck together vs. distance and the distortion that some couples have - that the only way to have a boundary is to get divorced.
I use both video therapy and Gatorade bottles as vehicles to illustrate difficult, emotionally-laden concepts and to speed
up the therapeutic process. After watching a videotaped session, most clients begin developing empathic responses. At that
point I no longer have to deliver hard-to-hear corrective feedback because most clients can recognize projections, distortions,
rude comments, attacks, lack of compassion, and denial. Typically, after one demonstration with the bottles, most couples
are able to understand, integrate, and use boundary concepts. Specifically, they obtain a healthy understanding of the issues
related to (1) mind reading, (2) intent vs. impact, and (3) distance-closeness. Often they correct future boundary violations
by observing, "You are trying to get into my bottle."
Both video therapy and training aids use something concrete to demonstrate something abstract, consistently producing
powerful therapeutic results.
References
Arauzo, A. C., Watson, M., & Hulgus, J. (1994). The clinical uses of video therapy in the treatment of
childhood sexual trauma survivors. Journal of Child Sexual Abuse, 3 (4), 37-57.
Cunningham, R., Ward, C. D. (2003). Evaluation of a training programme to facilitate conversation
between people with aphasia and their partners. Aphasiology 17 (8), 687-707.
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