The potent cocktail of love, intimacy, sex, and power: an assessment pyramid for couples therapy

An ordered assessment is important in couple therapy where tensions may be high as each partner ensures that the couple therapist understands his or her point of view. Drawing on the literature related to couple therapy, a six-level assessment pyramid is proposed consisting of behavior, emotion, meaning, beliefs, affect, and self. The pyramid has four faces, each of which is linked to the literature on reasons for couple dissatisfaction and divorce. These four faces or themes around which the process is focused are love, intimacy, sex, and power. The pyramid relates to basic common couple complaints but may require additional expert knowledge for complex multiproblem cases. Although the pyramid may be used for an integrative couple therapy approach, therapists do not need to integrate all six levels in their assessment. The pyramid is useful for individual therapists who would like to work with couples, as well as therapists who also have some familiarity with one or more couple therapy approaches who wish to incorporate other models. A case study is presented to illustrate a couple assessment.