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Facing Our Fears

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PNND11-1Why We Avoid Doing Couples Therapy

By Ellyn Bader and Peter Pearson

As neuroscience increasingly shows how wired we are to our intimate partners, an important question arises for therapists: Why do we primarily continue to see people individually who are grappling with serious problems in their relationships?

We’ve learned how easily one partner’s tone of voice can trigger the other’s amygdala, how the mirror neuron system can instantaneously shape our ability to grasp each other’s inner world, how few of the countless implicit messages passed between people in any interaction are conveyed by language or even become conscious. As Dan Siegel has put it, we’ve moved from a “single skull” model of the brain to the “neurobiology of ‘we.’”

So here’s the question for clinicians: if we now recognize how inescapably relational and interconnected people are, why do most of us continue to work primarily with individuals—most of whom grapple with serious, persistent problems in their intimate relationships?

Part of the reason, of course, is that so many clients themselves avoid couples therapy. Sometimes they resist because they aren’t motivated, or because they fear the unpleasant things their partners might say about them. Often they resist because they want to avoid the unwelcome challenge of self-confrontation that accompanies hearing their partner express dissatisfaction with them and their relationship. Besides, why should partners risk exposing their deepest vulnerabilities with the very person they may see as the cause of their emotional struggles?

By contrast, individual therapy seems like a safe haven. Clients want, and usually get, plenty of empathy from their therapist, and they don’t have to share this special relationship with anyone else. They have the freedom to work on issues that they select, on their own timetable. If they aren’t ready to deal with a problem—a struggle with selfishness, deception in an intimate relationship, addiction—they can simply minimize it, or never bring it up at all.

Another, less-discussed reason that most psychotherapy today is focused on the individual is that many clinicians themselves prefer it. When working with an individual, we get to establish a one-on-one relationship that’s usually pretty rewarding for us. Most of our individual clients feel positive toward us; many express appreciation for our efforts. We get to apply skills that we think we’re already good at: active listening, understanding, and acceptance. If a misunderstanding or power struggle emerges with a client, there’s usually far more calm predictability in the process of addressing it than happens when angry spouses square off against each other in our offices.

Couples therapy, by contrast, can feel like piloting a helicopter into a hurricane. When we started doing couples therapy, more than 25 years ago, full of hope and enthusiasm, we were unprepared for the hostility, bitterness, distrust, and occasional homicidal rage that we’d witness. (One of Ellyn’s clients once sprayed her allergic husband with insecticide, hoping it would close up his airways and kill him.) Brain research suggests that the part of the brain that processes an emotional assault is the same part that processes a physical assault, so when an individual is verbally assaulted by a partner, the brain responds as though he or she is being punched in the stomach, prompting the same toxic mix of fear and rage.

How, then, are we to proceed? How do we construct a bridge of understanding between people who may disagree hotly about what’s wrong, resist self-awareness in the service of blaming each other, have unequal motivations for change, and continue to be terribly unkind to each other? Being an effective couples therapist requires us to develop skills we may not come by naturally and to spend a lot of time feeling unsure of our capabilities.

It may be dangerous for us to continue as we are, closeting ourselves mostly with individual clients. Let’s lay the basic premise of this article on the line here: we believe that individual therapy can be hazardous to a couple’s health. The calm, understanding environment of one-on-one sessions too often leaves a client ill-prepared to take on the gritty, emotion-charged real world of a troubled relationship. In sessions, individual clients aren’t learning how to listen, stay calm when triggered, negotiate actively, or stretch to empathize with an intimate partner who intensely annoys and frustrates them. The client may leave the therapist’s office with valuable insights, but that may not help much when she opens her own front door to find her spouse standing in the hallway, angrily flapping the latest credit-card bill in the air, and accusing her of spending more than they earn. Again!

Before therapists consider inviting more couples into their offices, they need to understand their own resistance to the work. We’ve chosen three cases (we could have chosen many others), each of which gets to the heart of some of the fears and insecurities with which couples therapists regularly wrestle.

Fear of Inflicting Pain: Ellyn’s Experience

When Tom called for an appointment, he told me that he and his wife, Betsy, were just having a few communication problems. As their first session began, Betsy described a 30-year marriage in which she felt shut out by Tom’s tendency to “space out” and spend a lot of time away from the house.

Barely 10 minutes into the session, Tom began to talk about how anxious he’d been feeling during the past week as he anticipated our session. Before long, I got a sinking feeling in my stomach. “I don’t really know what’s bothering me,” he said. “I just seem to stay at work later and later. I don’t feel much desire to rush home.” Years of doing couples therapy screamed out to me: “He’s here to end this marriage, but he won’t say it.” It wasn’t just his words: he barely made eye contact with either Betsy or me; he was emotionally flat, yet perspiring profusely.

“We need to learn how to talk about our issues,” Betsy responded, in a determined but hopeful voice. She put her hand on Tom’s. “I’ve wanted to do this for years,” she said softly. “I’m so glad you finally agreed to come and get some help.”

Looking slightly past her, Tom said, “Yes, we do need to learn to talk better.” He stared down at the rug. “I’m just not good at talking. I’ve never been good about talking.”

As he said this, every fiber of my being was signaling, “This is a man with a secret.” Despite his protestations about his difficulties with communication, he was talking just fine in my office. Could it be that, for some reason, he just didn’t want to speak his truth? My head was spinning. Would he be willing to be direct? Or would I be the one who had to ask? What was the secret that was going to be revealed?

“Tom,” I began, “what do you think your anxiety is telling you?”

He replied, “I’ve been anxious for years, especially when I get into bed at night. Now, since we decided to get therapy, I barely sleep at all. She thinks I have an intimacy issue.”

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